>> good morning this meeting will come to order. welcome to september 29, 2022 special meeting of the government audit oversight committee of thboard of supervisors. our board presidenttia monwalton temporary in for supervisor mandelman. the clerk is alisa samara and thank sfgtv for staffing the meeting. madam clerk, do we have announcements? >> the board is convening hybrid meetings that allow in person attenance and

public comment. providing remote access and public comment via telephone. we'll take public comment as follows: public comment will be taken on each item. those in person will be allowed to speak first and are then take those waiting on the telephone line. those watching channel 26, 28, 78 or 99 and sfgovtv.org the public comment call in number is streaming across the screen. the number is 415-655-0001. again, 415-655-0001. when prompted enter the meeting id-24844890060. then press pound then pound again. when connected you will hear the meeting discussion but will be muted and in listening mode only. when your item of interest domestics up and public comment is caused those joining in person should line up to speak and those

on the phone dial star 3. if you are on your phone please turn down your tv and listening dwigess you may be using. we will take public comment from those in person first and then go to public comment telephone line. you may submit public comment in writing in either of the following ways, e-mail to stephanie.cabrer@sfgov. org. if you e-mail (inaudible) you may send written comments via u.s. postal service to the office in city hall at 1 dr. carton b goodlett place, room 244, san francisco california, 94102. item acted upon today are expected to appear on

bord of supervisors agenda october 18 unless otherwise stated. >> thank you madam clerk, and i will amend my statement earlier. you just heard from our clerk stephanie cabrera and i mentioned before alisa somera also here so the only thing better then one clerk at the meeting is two. and with that, before we go to the agenda items i like to make a motion to excuse supervisor mandelman who is unable to join us today. please call the roll. [roll call] >> three ayes. >> that -thank you. motion passes. please call item 1 is 2 together. >> item 1 is hearing released june 1, 2022

by the civil grand jury titled, “buried problems and a buried process - the hunters point naval shipyard in a time of climate change,” for departments to review and report back to the board of supervisors on what each agency's response to the recommendations are; and requesting san francisco public utilities commission, department of public health, environmental protection agency, navy, and other related agencies to report. item 2, resolution responding to the presiding judge of the superior court on the findings and recommendations contained in the 2021-2022 civil grand jury report, entitled “buried problems and a buried process: the hunters point naval shipyard in a time of climate change;” and urging the mayor to cause the implementation of accepted findings and recommendations through her department heads and through the development of the annual budget. >> thank you madam clerk. colleagues, this committee heard the two items during the last gao meeting and continued to today to insure that we could draft a full and complete responses to

the grand jury report, and president walton is sponsoring this hearinger temporarily joining the committee as mentioned today, and i know has done enormous amount of work leading up to our prior hearing and leading up to today and incorporating all the feedback and testimony from the last hearing on this. welcome president walton, thank frz all your work on this and i'll turn it over to you for remarks and call on speakers. >> thank you chair president and supervisor chan and thank you for the public attending this afternoon. as you know, we did have the first hearing on this item on september 15, and we are in the report discuss the dangers and concerns with sea level rise and ground water on the shipyard. the board of supervisors was asked to respond to findings 4, 5 and 6, and recommendations

2, 3 and 7 on pages 37 and 38 of the civil grand jury report. as stated at the last hearing, the issues raised in the grand jury report are extremely troubling and very real and that is alarming. our office has most certainly taken all the risks into account and have provided a response to findings and recommendations reflective of our shared concerns. i do want to repeat our goal here is about solutions to address the concerns raised and solutions that we actually have the power to implement. we have a response to the findings and recommendations we will provide but i want to take the opportunity to hear from two parties who were not at the hearing september 15. today we have (inaudible) herrera with the environmental protection agency and (inaudible) toxic substance control. i first like to call up

the parties representing the environmental protection agency. >> good morning supervisor walton, chan and preston. i'm (inaudible) herrera, assistant directing at the u.s. environmental protection agency region 9 in san francisco. i work for the super fund and emergency management division at epa. epa and federal agencies partners the signature is of the federal facilities agreement, the california department of toxic substance control and the san francisco bay regional water quality control board oversee the navy's cleanup of the hunters point naval shipyard super fund site. i want to

thank you for inviting us on another hearing oen the very important issue. both my division director, michael montgomery and i were out of the country for the first hearing, so thank you supervisor walton for reading allowed our jount regulatory agency statement. i watched the hearing and listened to the many concerns raised. this issue is very important to our agency and to our administration. epa and the regular torry agencies remain committed insuring the navy addresses contamination at the shipyard. climate change is very important to us. we take responsibility for cleaning up including future impacts from sea level and ground water rise and the history of environmental injustice experienced by community members

very seriously. a recent statement emphasized how the super fund process, especially the 5 year review is very dynamic and the sign adopted to evolving conditions and science and climate change is no exception. as stated, the agencies will work with the navy to insure climate change considerations, especially conducting a vulnerability assessment related to sea and ground water level rise are factored into the protectiveness of the remedies of the shipyard, especially throughout the upcoming 5 year review. epa is committed to working with the navy or state partners, the city and all community stakeholders to promote open communication and transparency. including around this issue to insure the remedies are protected for the city reuse plan for the shipyard. i'm happy to have the opportunity to speak toed and i look forward to answering

any questions you have. >> thank you so much. appreciate you being here most definitely. it is important to have the environmental protection agency at the hearing to questions and concerns not only of the body but of course questions and concerns we have in community. the first i do want to note is, will the epa provide the staffing and further oversight and of course the studies that address the specific concerns that were provided in the civil grand jury report? >> hunters point is one of the biggest priority sites in region 9. we have the involvement of our leadership from the very top of the administration. many of the community members and stakeholders have met with dr. carlton

waterhouse and regional administrator martha guzman and made it very clear the site is one of the biggest priorities. we have a team of experts and also contractor support that help us review and make the decisions related to the cleanup as hunters point. we also work very closely with our partner regulatory agencies with etsc and with the water board. they also have their teams, their contractors and their expert ice the water board has done studies around climate change and (inaudible) write a letter that will include several recent reports that we are evaluating and taking into consideration while we address climate change issues

at hunters point. >> the epa will be making sure that all those parties you mentioned take into account the civil grand jury report and put strategies into place? >> we appreciate the grand jury bringing up to the issue to have the dialogue, so yes, we will make sure we incorporate climate change into the decisions we are making . we will ask the navy to access vulnerabilities of the remedies in place and also to develop an adaptive plan. >> and then, what is the environmental protection agency prepared to do if the navy ignores the civil grand jury report and does not include strategies to clean up the shipyard immediately, and also if they don't take into account the risk determined by the report? >> we will set the expectations for the

navy to make sure that they incorporate climate change impacts into the remedies at the site, and we do have a process in place, we have federal facilities agreements, we have again, the attention of our leadership on the issues related to the site, so we have ways to elevate it to navy leadership and we also have ways to deal with this agreements through dispute processes and so forth. we are going to be-we are going to continue to work with the navy to make sure that the remedies at the shipyard are protected, including from the impacts of climate change. >> just out of curiosity, what is the epa prepared to do if the navy doesn't act accordingly? >> we will elevate and

we will have discussions at the top. if we have to go do the pent gone we'll bring up the issues to make sure what is done at the site is protective of human health and the environment. >> i ask the questions because there is a lot of dist trust between the community and the navy and the one department we need to be supportive and we need to make sure the navy does what it is supposed to do and make sure the shipyard is hundred percent clean is the environmental protection agency, and it is very important that we have clear responses and the navy understands that the epa will do everything in their power to make sure they clean the shipyard and do what the community is requesting. >> the regulatory agencies, epa is committed to make sure that we will not sign or approve anything

that does not meet federal and state standards and we do not feel is protective of human health and the environment and includes adaptive measurements for climate change impacts. >> the one thing i do want to say, which is not hundred percent on you, but the importance is the shipyard will be cleaned up immediately. not signing off on documents, not signing off on plans and strategies the navy plans to include doesn't necessarily get the shipyard clean any quicker and any faster so definitely appreciate your support and pushing the navy to do the right thing and do it in a timely manner, because at the end of the day, any back and forth slows down the cleanup process and most certainly continues to increase the opportunity of negative effects for the surrounding

community. >> i understand housing is a big priority for the city, but, we are making sure that-we are prioritizing public health and the cleanups are protective for residential use before we move forward. >> just real quick, my statement has nothing to do with the housing, my statement is about the shipyard being clean as soon as possible for public health and public safety. you not approving something the navy wants to do does not help us get the shipyard cleaned faster so hopefully you are pushing them to do the right thing as quick as possible because any back and forth games the navy plays with the epa still pushes back the cleanup and does not help us (inaudible) this has nothing to do with the housing. i just want to be clear on that. i don't know

colleagues if you have questions or anything for epa. thank you so much mrs. herrera. i appreciate you being here today and for coming in to speak to this body in person and respond to the report. i'm looking forward to what the epa will include in the 5 year plan to make sure that we hold the navy accountable as we move for ward so thank you for being here. >> thank you all. >> now we'll hear from (inaudible) with the department of toxic substance control. >> good morning. glad to be here supervisors, walton, chan and cabrera. thank you for inviting to address this committee. my name is (inaudible) the chief of the northern california division of site mitigation and remediation program. i oversee our work in northern california.

the hunters point naval shipyard is a priority for the department. the mission is protect california people communities and are environment from toxic substances, enhance economic vitality by restoring land and compel manufactures to make safer consumer products. we recognize our critical control in achieving environmental justice and we prioritize our work in communities that are long over-burdened by multiple sources of contamination and pollution like hunters point. we work to insure the investigation and site mitigation activities are thorough and the actions protect public health and the environment now and into the future. we recognize climate change as a urgent crisis and we prioritize attention to assess impact of climate change on sites including impacts of sea level rise and ground water

rise. our decisions are based on best available science as california law requires and we rely on exprlts in sea level rise such as the california ocean protection council and bay conservation commission for up to date science. we agree that ground water rise and sea level rise is a important issue at hunters point and we work with our sister agencies of epa and water board to insure that these issues are addressed on a ongoing basis, and the 5 year review is a opportunity where we will be looking at that specifically. we are committed to protect people and the environment and the community around hunters point and i'm glad to be here and answer any questions and also glad now to read the letter from the water board. is that appropriate? >> yes, please. >> okay. thank you.

this is deer supervisor preston chan, mandelman and walton, thank you for the opportunity to discuss the civil grand jury report problems and process hunters point naval shipyard in a time of climate change discussed september 15 and again on september 29. unfortunately lead staff from the san francisco bay walter quality control board are not available to participate. we are committed to previously scheduled racial equity environmental justice training. in lieu of attendsing the hearing we are sharing the following information about our mission authority and attention to clean up actions climate change and environmental justice. the san francisco bay water bored has responsibility and authority to protect water quality for people and the environment throughout san francisco bay including hunters point. this responsibility includes many sources

of pollution and hab tit impact including the contam nakez from operations at the hunter point naval shipyard. we are a regional agency with regions defined by water sheds of the state water resources control board which is part of the california environmental protection agency. our mission is to preserve enhance and restore the quality of california water resources and drinking water for the protection of the environment public health and all beneficial uses and insure water recess allocation and efficient use for the benefit ofprint and future generations. hunters point naval shipyard is one of the ihooest priorities for the cleanup due to extent and type of contamination, potential for exacerbating water quality impact from climate change and the community long history and ongoing experience of environmental injustices. the san francisco bay water board oversees and directs pollution cleanup under the comprehensive environmental response compensation and

liability act known as super fund in conjunction with the u.s. environmental protection agency region 9 and california department of substance toxic control. we are the primary regular tore agencies overseeing the cleanup of the shipyard superfund site. the san francisco bay water board direct pollution prevention and control related to all other pollution releases to surfaces or waterways that threaten or impact streams, the san francisco bay or ground water underlying the area including from industrial commercial residential and municipal facilities and land. we agree that superfund site cleanup should account for climate change. the existing remedy selection implementation and long-term evaluation review process provides multiple water quality protection opportunities and activities that can and must consider

potential climate issues to increase resilience for the future. the san francisco bay water board is committed to addressing environmental justice in our region. our staff engaged historically and recently with leaders and representatives of community based organizations and environmental justice advocates regarding the environmental and human impact from the shipyard and cleanup. the san francisco bay water board is planning regulating and addressing climate impacts for several years, specifically with response to drought wild fire, sea level rise and flooding. the last few years in response to emerging climate science and community efficacy the san francisco bay water board evaluated and expanded scientific research from ground water rise. we prioritize communities most vuliable. site changes and vulnerabilities are informed by science and information on incremental climate related chaimpgs such as sea and ground

water level, seasonal chaipg in par tisitation or temperature and changes in the intensity frequency or duration of extreme weather events. please note our san francisco region water quality control plan and board meeting agenda for october 12, 2022 item 7 and links are provided in the pdf document to click to get to these documents. the san francisco bay water board has and continues to take the following actions implemented by geologist engineering, and scientist. addressing disadvantage communities with the highest pollution and health burdens historically red line neighborhoods, highest (inaudible) is the high est priority. assigning oversight to the ground water protection or toxic cleanup division. hiring new staff with environmental justice and community engagement experience. requiring waste management or sites

cleaning of released contamination to conduct assessment for vulnerability for contaminant mobilization from sea level rise or ground water rise and propose adaptation plans. revising cleanup goals and or remediation methods based on updated environmental justice priorities and/or studies indicated sea level or ground water rise that elevate the risk of water quality or human health impact from a site or to it a community. approving remediation methods that protect against future contamination mobilization or flooding from sea level rise or ground water rise. we are basing the actions on the following body and state of science available and growing to inform and direct protective cleanup divisions for shoreline sites around san francisco bay. we will continue to apply the relevant information to sites around san francisco bay including the hunters point naval shipyard. these are the studies published,

recently (inaudible) mod-flow modeling of water table response to sea level rise along the california coast 10 meter model resolution available for a range of hydraulic conductivety value include projection for ground water under a range of sea level rise scenarios. available for downloud on the letter and (inaudible) explain impact of sea level rise on liquefaction in the san francisco bay area. the toxic tide map exposure of hazardous facility it sea level rise and storm surge does not include rising ground water. (inaudible) rapid assessment of depth to ground water for the san francisco bay shoreline based on interpretation of empirical data and once again there is a link to the data in the letter.

(inaudible) a report for the city of alameda refined depth to ground water mapping sea level rise scenarios and investigation of impact on sea level rise. contaminants above human health benchmarks. this is a study published soon refined accessment of depth to ground water, alameda marin (inaudible) includes projections of future depth to ground water under a raimpg of sea level rise scenarios. data available fall 2022. this is a future study to expand science coverage in san francisco bay and fund specifically by the san francisco bay water board. refined assessment of depth to ground water for contra costa county continuing work from pathways and

(inaudible) 2022. these are proposed studies not yet funded but under consideration to be funded in part or whole with public grant funds. prop 68 proposal, work in the islay creek water shed to investigate changes in the water table due to sea level rise and increases in extreme (inaudible) potential for contaminant mobilization. prop 68 proposal lead by coastal quest, one task of the project would be refined assessment of depth to ground water for santa clara county using the same method of pathways (inaudible) port of oakland sea level rise impact and integration of ground water rise in the bay converivation (inaudible) to help a

broad range of stakeholders identify the points of intersection between sea level rise and ground water rise under different time based scenarios. the san francisco bay water board reiterates that hunters point naval shipyard is one of the highest priorities of cleanup. the community long history ongoing experience of environmental injustice. the san francisco bay water board continues to rely on our authorities under circluand california water code and best available science to oversee and direct the navy's environmental cleanup of the hunters point naval ship yard super fund site. (inaudible) account for climate change including sea and ground water level rise. if you have any questions or wish to speak further with the san francisco bay water board staff please contact executive officer lisa

(inaudible) sincerely eileen white, executive officer. >> thank you. i do have couple questions. just for the record, why was the department of toxic substance not able to attend the hearing on the 15? >> we were not available and i apologize and we are very glad to be here today. >> then, do you know why the water board is not in attendance today since this is such a priority? >> i do know why, they mention it in the letter. they had a previous commitment to a racial equity environmental justice training for their executives across the state. >> how big is their staff? >> pardon me? >> how big is their staff? >> i don't know the answer to that question. >> probably pretty big, right? never mind. one question i

do have is, will the department of toxic substance control provide the additional staffing further oversight to address the specific concerns of the study for the grand jury report? >> dtsc has made hunters point a priority and we continue to. we have a team of two project managers toxicology engineers that help and guide the efforts at hunters point so we will insure we have the staff committed to address the concerns and issues around sea level and ground water rise as mentioned in the civil grand jury report, yes. >> thank you. supervisor chan. >> thank you president walton and thank you chair preston. my

question is, this is probably better if the staff is here from the regional water board. the question it says in the letter you mentioned or they mention that they do see there is a climate crisis, there is a climate change and impact with ground water level rise and therefore they are going to make amendments and it is actually going to be made for the board meeting on aublth 12 and they listed to say item 7 in the letter and then to look at the agenda is to say -for long-term for flood protection consideration and close municipal solid waste bay front landfills. the question is, because on the agenda it does not include a package, so do we know or if

you know and can answer, what is the amendment? what is the amendment that they are going to make so we know that we have-we are going to meet the requirement or that we are actually going to have a new level of requirement, better requirement to help us better understand ground water rise level change and impact for toxic waste. >> i will have to take your question back to the water bord and get a answer. >> that is the problem. just sending a letter is not suffice for precisely this reason. it is okay, we understand you recognize the need, but you are not really telling us exactly what the actions are being taken to meet the needs and so what we will love for you to relay back the message since you are here reading this letter on their behalf, is then that we would like to

see what is exactly the amendment as soon as they have that material available, because right now it is just posted on the agenda and it needs to be in a (inaudible) fashion back to the body so it is clear to us what exactly the amendment is being made and responding to the needs of san francisco. thank you. >> thank you vice chair chan. i have one quick question. if you could clarify. it is reference to some additional studies that you listed. i'm wondering in terms of timeline whether those are anticipated to be completed and are part of the 5 year review or later? >> i am not as familiar with the studies the water board mentions but i can once again ask them to get a answer back to you. >> thank you. >> thank you chair preston. i don't have anymore questions. i

think it is time to go to public comment. >> thank you, i just wanted to-before we go to public comment just give a opportunity to the mayor's office. when we ended the last hearing we had i think-or i had urged reconsideration of some of the mayor's office comments so i wanted to hear from-i see mr. polino here. will the mayor be updating any responses previously provided to the committee? >> thank you for the question chair preston. we did take into consideration and discuss pretty thoroughly between ocii, dph and our office. we won't amend the response specifically to finding 2 from the civil grand jury report. i differ to director (inaudible) to more of the specifics as to why, but really as i noted last two weeks ago in committee, the word neglected specifically was the one word within that we were

hung up on, but again i differ to the director as to kind of why again we would not be amending it, but i appreciate the opportunity to go back is and look at it so we can have the thorough discussion. >> thank you. before we hear from mr. (inaudible) on that, with respect to i believe recommendations 1 and 2, which were the ones calling for a independent study and are the second one being the mayor and board collaboratively fund that independent study, it remains the position of the mayor's office that those will not be implemented? >> no, if that was the road the board wanted to-the committee wanted to take we would absolutely have our departments work with-i'm sorry, looking at your face, myer answer may not react to the question. if there is a recommendation by the board to either form a task force, independent study we would work with our

departments to be supportive of that effort. >> the reason you see a perplexed face from me-the assertion and responses which it sounds those are not being amended are those two recommendation won't be implemented so we have responses formally saying something will not be implemented, will not be funded for recommendation 1 and 2, but i am hearing something a little different, maybe less clear from you. that was my suggestion last time was in addition to the one you highlighted about the term neglected was that the mayor's office reconsider the response on those. i guess i just want to ask again-you can say-i don't know what to do if the response says we will not implement something and you are saying you will implement something. i don't know what to do with that. you should amend the response,

right? >> i understand the question now. as far as the response goes we didn't feel it was necessary to form a additional element of oversight because there is existing structure there, but again, if it is the prerogative of the board to move forward with that we would absolutely collaborate and have our departments work together in a way that is productive. >> thank you. i'll leave it to president walton to sort out how these overlapping responses can be reconciled. i don't know-director if you wanted to address the point on-just raised. >> thank you supervisor preston. i did not have anything else to add. we discused at the last meeting and don't want to take up the board time with no new information. we would work cooperatively if a committee was formed on additional studies. thank you.

>> supervisor chan. >> thank you chair preston. because we have this open-ended question last time when we met about specifically subpoena the navy for their presence to answer questions before this body, just would love to follow up with our deputy city attorney just get a answer and on the record. >> deputy city attorney ann pierson. as i are think i mentioned during the last meeting the board rules do late out a pathway by which the committee may direct the clerk to issue a subpoena. there are also federal regulations that describe the pathway for sending such request to the navy. it is a pathway for testimony or for information. i am doubtful however that would be able to secure testimony or information within the timeframe that is required for response to a civil grand jury report. >> thank you. i think

that's my response back to if you can relate back to the navy, maybe perhaps through director (inaudible) to help us since you read their letter or response on behalf of the navy last time when we met during this public hearing. i think while this body does have the power of subpoena request their presence before us, that i do believe for the sake of the city and county of san francisco and for the sake of you know, san franciscans that we do have a collegial and collaborative partnership and that means that when we having a public forum, having a discussion, that perhaps they should consider answering the call so to speak in public as well so this is transparent and that we actually have the public's trust about the process. that it actually does have integrity, that we are responsive to the needs and we are

meeting the demands for safety and cleanup. >> thank you for visor chan. i will be relaying that request to our navy partners as we did the first time when the committee referenced the subpoena. thank you. >> thank you vice chair chan. let's go ahead unless you have additional comments or question president walton before we open for public comment and seeing none, let's open to the public comment. >> any members who would like to make comment for item 2? please line up to your right, my left. remote public callers press star 3 to be added to the queue. for those already on hold, please continue to wait until the system indicates you have been unmuted. >> are we ready? my name is (inaudible) the founder of marie

harris community foundation. i'm here today because it is personal. i stand in the center of truth. there is no cryptnite for the truth. the truth is that all these departments dropped the ball. you said a important word, the word is protection and i believe it is meant to be preservation of human life. the department of toxic and chemical waste, you guys have dropped the ball. people are getting exposed. toxic exposure. why? because i have two separate tests that said so from two different labs that are testing positive for pci24, plutoneium and uranium. there is silica and lead by isotopes at above range. you cannot do

your job efficiently from zoom. you have to come down do the opportunity and show you give a dame. epa we want you to go to the pentigone. it is time to stop wasting time. this is going on decades. this has to be the generation, the generation that this stops with. i'm asking you guys to rise to the occasion. i am asking you to preserve human life. proposition-the proposition that has a list of all of the toxic chemicals you guys have on the list, how do you know (inaudible) we have been carrying as much as evidences you need in our bodies. the problem is, if you are really invested in the truth of the matter, you would think about the preservation of human life. you get out of your seats, come down to the community and start

walking and (inaudible) >> i apologize for interrupting the speaker but your time has lapsed. all speakers are provided two minutes. [speaking in the background] [applause] >> dr. (inaudible) hunters point community (inaudible) i want to thank the supervisors for your astute attention to this life and death matter want. in 1994 when the epa and department of defense entered into the rab implementation guideline agreement, it formulated a body that brought together the navy remediation team, the members of

the federal facilities agreement sig torry, the community stakeholders city department of public health and monthly forum that the federal government pays for interest and it is in your interest of the community for you to simply support the reinstatement of the hunters point shipyard restoration advisory boards, the ep a also announced the formulation of environmental justice national department. vice president harris is leading that and i sent you a copy of a letter that i sent to her with regard to the life and death exposures to radiation occurring at the shipyard right now as we speak. in november of 19-2000, 86.4 percent of san francisco voters voted to adopt proposition p. in 2001 supervisor maxwell codified it into the a resolution.

supervisor walton the most powerful thing you can do is implement prop p as an ordinance. that is the next step. i want to leave with you documents for your independent assessment. first is one that is very important you have never seen before. this is a navy document from 2004 that shows a military (inaudible) is located at the coastline here. this is metal flat. that is a military burn pit. this is the most recent mapping. >> i apologize speaker for interrupting but everyone is limited to 2 minutes today. >> thank you for your comments and we will-if you give those to us we will take a look. i want to remind we have a buzzer that goes off at 2 minutes. it is very important we apply that equally to

everyone regardless of testimony. the clerk will cut you off at 2 minutes. welcome. >> i good morning president walton, chairman preston and vice chair chan. i am (inaudible) policy advocate of green action. moreover, i'm a 65 year old native resident of san franciscans. in 2000 all most 22 years ago four supervisors put prop p on the ballot. that was susan bierman who we adore, michael yaqui who is a commission on the united states commission on civil rights, tom (inaudible) good comedian who became a state assemblyman after he left his supervisor seat and supervisor mark leno a former california state senator. this tells me that because they cared and listened to the

residents of san francisco regarding the cleanup of the naval shipyard, we supported them as they pursued other political endeavors. the passage of proposition p was a voice of the people saying to the city and county of san francisco to demand the navy totally cleanup the shipyard before any transfer. therefore, it is the duty of the supervisors to enact an ordinance to carry out this declaration of policy, which was non binding. in closing, i wanted to say that-lastly, i hope we all agree humans have a fundalment right to live in a toxic and are contaminated free environment, so thank you for taking a stance on the issue and we look forward working with you. [applause] >> i'm going to try to

stay within my two minutes. thank you guys for having this hearing. i particularly appreciate this particular subcommittee for holding this hearing. my concern is this, everybody i talk to on this issue including your fellow board members tends to do the minimal possible and kick the ball down the road and everybody wants to get something done on this particular issue. i don't have any doubts, it is very frustrating, it is very complex, there are a lot of people volved and a lot of departments involved and we said inbut we as community have been carrying that burden with zero compensation while every single level of people who have some power in

this who are getting paid to do this job keep blaming the other guy. including this board. so, my question is not what is the navy going to do, because i have met with deputy-or assistant secretary james polici of the navy who rose to the rank of vice admiral. i met with assistant secretary, callten waterhouse. they are both on board. you guys as the board of supervisors have a overriding responsibility. none of this property can be forwarded or transferred without you. i need you guys to do your piece and stop allowing this stuff to continue to go through and everybody else will show up at the table

when you do that. please trust and believe that and if you want their cell phone numbers, i will give you-- [applause] >> my name is (inaudible) talked about the hearing today so i have two points i would like to raise. one is, i do believe that you were saying something about the regulations, the rules. does that mean that this city cannot do anything until the epa or whatever the letter was, the organization from until they agree to what can be done in the bayview? because this young woman just said that she has spoken with people from the navy and are they agreed something has got to be done so that is one thing. the other thing is this, i (inaudible) from the green party. it is online with the bayview times that

says there is poisoning of the bayview started after the-during the cold war, not during world war ii and started to attest for the atomic bomb. i dont know why so many african americans died after world war ii, i don't know why the government at all levels (inaudible) because if you keep (inaudible) letting the real estate agencies bring in-build more housing, it is going to mean (inaudible) what is happening in the mission it will mean gentrification. (inaudible) especially the peoplet thawent to war that cleaned the shipyard and descendants so think it is incumbent of all the board of

supervisors to make sure (inaudible) we keep informed and we be informed about it. >> hello, my name is tonia randel from the marie harris community foundation. i live in the bayview on the top of hunters point. beautiful views. cost $200 thousand and 15 year s of my life. that is how much it has taken away by living up there. 15 years. i have three times the amount of arsenic in my body that is acceptable. i have three times amount of manganese in my body and i'm scared. i would like to invite all the departments including department of public works, and the health department to come down, come on down to

our area of the shipyard and we'll give you a toxic tour. there you can take a nice deep breath of what we have been breathing. i will hand you a glass of water. if you want water we can give that to you too. i look at my granddaughter, he is 16 years old. 15 years of my life is gone. 15 years i'll never get that back. so come on down. come on down and see us at the shipyard. look at the beautiful-the beautiful old buildings and take a deep breath and inhale and tell me how safe you feel. thank you. [applause] >> i'm a outsider and

insider a member of the san francisco bay resident. i live in orinda, i don't live in bayview hunters point. i went to a press conference at the bayview two years ago, and i heard these stories. and i just want to communicate my outrage that this is happening. this has been going on for decades. if it was in my neighborhood in orinda or oakland where i recently lived or in your neighborhood, would it have gone on decades? no. i hear today a lot of words intention, address, revise, approve. i agree with vice chair chan. we need action, specific steps with deadlines. we all know that is how things actually happen because then there is accountability. what steps are the various organizations and i

know it is complicated. it is a bire ocacy and i don't understand it all but i do know that if you are committed to preserving and protecting the life of real people, this is not a generic description, this is real lives, real people who are suffering and have suffered and it is enough. i hope you will take those actions and demand those kinds of deadlines that we need to change this. thank you. [applause] >> seeing no more in person public comment let's move to remote call in line. please send in the first caller. >> good morning board of supervisors. i really appreciate our bord board of supervisors holding these government agencies accountability 6789 my

name is (inaudible) a bayview resident community leader and community organizer for green action for health and environmental justice. i appreciate the epa 5 year plan but i like to ask them, would they like to live in a toxic bowl of soup for the next 5 years? with rising sea levels we may not have 5 years to wait. rising ground water and sea levels can flood and spread the radio active and toxic contaminated areas that the government plans on capping and not removing it leaving it in my backyard, the backyard of bayview hunters point. again, it is not a decision of whether it is cleanup full cleanup or capping, they are making a decision on who lives and who dies. thank you. >> thank you for your comments. next caller, please.

>> hi. my name is ahsha jane with greed for justice network. i wanted to comment about the response from the mayor's office. to me it looks like it was written from a regulatory perspective talking about procedures. things like this process has failed badly. it seems the process and framework needs to be repaired so i wonder what our next steps for doing that. for example, the framework, how can we be more responsive to that? is it a issue of funding? how do we remove the blockers and actually make the cleanup happen in practice? thank you. i'll release the rest of my time. j

>> thank you for your comments. next caller, please. >> thank you president walton and supervisors for holding this meeting. my name is (inaudible) a resident of bayview hunters point. i have been trying to do comedy recently but i must say the water board not being present here for a hearing on the most egregious and long unresolved issue of environmental racism in san francisco because they are getting trained on racism has to be the funniest thing i heard. thanks to (inaudible) and epa for being present here today to make your statement. we heard from (inaudible) last week, so we are looking some creativity in wordsmithing.

(inaudible) no one is able to answer a question about the cleanup. i sit on the very usefully named mayor's hunter point shipyard cac where the navy does all the talking and (inaudible) who have never visited bayview hunters point. why should we listen to the navy? epa is ultimately responsible here. i hope the supervisors-do not let epa hide behind navy, because they are ultimately responsible for this. dph (inaudible) the water board and ocis, do you have a opinion on the-let's come back to the grand jury report why we are here. do you have a opinion that is not the mayor's? if you dont, once again don't come here and waste our time. why is the mayor not here? did the mayor resign? why is the mayor sending a random person who will not answer a single

question? who is the director and why is he not here? where is the mayor? thank you. >> thank you caller. next caller, please. >> good morning supervisors. eric brooks with local grass roots organization our city san francisco. we worked for the last couple decades to help deal with the contaminated sites in the bayview and treasure island. i want to start off by pointing something out. supervisor walton, you have been stellar in running these hearings, but it needs to be made clear and if you look at the vadeio video you will see it when you asked the epa if they follow the guidelines of the civil grand jury report they very carefully avoided saying the word yes, they just said vague things how they follow

science and climate change and refused to answer your question. that means the responsibility we have is deal with this locally because the feds are not going to help us, and so what that means primarily is doing actual work as was raised before. i was going to say last week and got cut off, supervisor haney when he was supervisor specifically contacted at our request, contacted, sfdph and said we need you to help community physicians do community health studies of the people that actually live on treasure island on this site. the health department refused and used we are too busy with covid as their excuse. dph-it is the way to the top at dph going along with the interest of real estate developers and

the navy so what we need you to do is to direct the health department to support the efforts that are going on by dr. (inaudible) and others in the bayview hunters point to do the health studies because those are being done. we need to also do health studies on treasure island and most importantly, the studies are not incorporated by department of public health so we need the studies incorporated. the other thing important with the recommendations- >> all public comments are limited to two minutes today. thank you for your comments. next caller, please. >> hello supervisors. my name is elainea ingle with 350 san francisco and san francisco climate emergency coalition. i want to thank you supervisors for trying to hold accountable the epa, navy, the

state agencies and the mayor's office. if hunters point contamination is a priority for the ernest statements of the speakers from the various agencies, i would really hate to see a site that is not a priority. also the nice fuzzy talk about racial and environmental justice, just stop talking and are start doing something agencies and the mayor's office. we seek a complete real and thorough cleanup and removal of radio active and toxic contamination from the hunters point site. the community deserves no less. thank you. >> thank you for your comments. next caller, please. >> this is steve (inaudible) committee for labor party. i think you have what is pretty obvious is that

corporate capture these agencies. the developers control the mayor's office, they control the state of california agencies and they control the u.s. government agencies, which are supposed to be upholding interest of the people of san francisco and the country to health and safe environments. i think there are people also you should subpoena including newsom's california department of toxic substance control. where is the state agencies who are supposed to be doing oversight on what is going on at hunters point, treasure island? they are mia. the other thing is, the san francisco bay water board needs to be involved. state, local and federal agencies have responsible for oversight are not doing it. you still have amy brown who is an environmental engineer for the city and county of san francisco selling condos at hunter

point. why hasn't the district attorney investigated and prosecuted? i think what we are talking is corruption mpts there was a hearingyard where you had to talk about subpoena people to come who are not showing up. government officials who are being paid by the taxpayers of san francisco to do a job and they are not doing it. the department of public health, you had another hearing on treasure island and department of public health said they are not investigating the people who live at treasure island hunters point for health conditions. why not? residents of san francisco, black and brown and all residents in hunters point and treasure island have not-their health situations have not been investigated by malfeseance of these departments so i suggest you subpoena these department heads and ask them who is running their department? is it the corporation, the developers in hunter point and treasure island running their agencies? it appears that is actually the circumstance. they continue to build condos at treasure islands-

>> all public comment is limited to 2 minutes. next caller, please. >> hello. my name is dr. robert gold president of san francisco bay physician frz social responsibility and representing hundreds of physicians and other health professionals throughout the san francisco bay area. i want to express our organization's outrage at mayor breed's dismissal of the grand jury report. we already have a situation where we have inadequate categorization of the legyish radioactive toxic waste at the site is document bide the reports of committee to bridge the gap and dr. dan hursh whereby the navy directed so called cleanup has been faulty in terms of categorizing the extent of waste,ing the radioactive elements that are there and as well even

had faulty science at the heart of it. for example, trying to categorize background levels right in the middle of the contaminated site. as well, the navy has resisted using the most modern remediation goal, trying to use 1970's epa levels opposed to more modern levels. this was and remains a problem even if the toxic and radio active contamination in bayview hunters point was a static situation, but to think about the impacts for example of the atmospheric wave that came from the storms last winter that just flooded the areas and would have stirred all this waste up, as well as to anticipate what the clear impacts of global warming are going to be, it is really imperative that the agencies and the city take seriously the conclusions of the

grand jury report and act in support of the community needs here. thank you. >> thank you for your comments. next caller, please. >> my name is dan hursh, president of committee to bridge the gap retired director of the program on environmental and nuclear policy uc santa cruz and (inaudible) series of reports on hunters point. i want to identify what i think is the issue here. a issue not addressed at all in the statements which have been frankly rather filled with platitudes rather then substance. the central issue is the issue president walton raised two weeks ago, which is there has to be a 100 percent complete cleanup of the site and president walton's commitment

the site will not transfer to san francisco unless that occurs. so, the elephant in the room is that the navy with dtsc and epa approval and with the acessence of the city and county agencies has decided to break the promise on a full cleanup and instead leave the great majority of the contamination at hunters point not cleaned up. covered up with a thin layer of soil and asphalt and walk away. transfer to the city. that cover will be torn up by the development and as the grand jury shows rising ground water will bring contamination up to the surface in any case. the essential issue is the only way to protect large numbers of people's health is the board of supervisor insists on carrying out the pledge president walton has made, which is hundred percent complete cleanup of the site and if it doesn't occur the city

not take the land. if you dont use your leverage these agencies are doing nothing to protect people. if you dont use your leverage people will continue to be hurt. i urge you to focus on the central issue which is refusal of the navy on the promise- >> thank you. next caller please. jrkss >> hi. my name is elliot hellman, a member of the san francisco chapter of 350.org which is a international organization fighting climate change. i live in the mission bay neighborhood and first of all, i like to thank supervisor walton for demanding hundred percent full cleanup, but it needs to be a real total hundred percent

cleanup. it does not include cap. i think the history of this whole project really shows that it needs to have citizen oversight. the people on the front line in the bayview hunters point need to be involved and overseeing and enforcing the cleanup of their neighborhood. as i said, i dont live in that neighborhood, but really this effects all of us in san francisco with imminent sea level rise, there is a really good chance of contamination of the entire city drinking water and all of the homes and residents and stores along the bay shore, so i just want to urge you all to vote for a full cleanup with full participation by the community. thank you. >> thank you for your comments. next caller, please.

>> hi, renee jenkins a former bayview resident now livling in oakland. i want to say thank you for having the hearing. but also mention that treasure island and other ports of oakland have been contaminated, richmond--due to the united states navy or united states government and it is their responsibility but also ours to leave a clean environment for our children and our community so wanted to bring to the issue that it is important and vital that we realize it is one ocean, one shoreline. what happens and what we start here in the shipyard will establish everything from further on. but thank you again for listening. >> thank you for your comments. next caller please.

>> thank you. this is michael lion. this whole process has really incredible example of racist genocide. it is really no other way you can talk about it, and it's-perhaps you read the san francisco standard article showing how willy brown is being given hundred thousand dollar a month to lobby for lenard to continue this project. this is just capitalism going crazy, and i really don't see how it will be possible to have a cleanup. it is buried too deeply, and the

city broke it and the city is going to have to fix it. thank you. >> thank you for your comments. next caller, please. >> hello. hi. i'm (inaudible) sutton and i'm with san francisco bay physicians for social responsibility. i'm a public health professional and calling toland my support for all of the concerns by the community members who have been for decades and decades and decades experiencing the health harms of the bayview hunters opponent contamination. appreciate the attention to the matter that the board of supervisors has been playing but i wanted to really put in a very strong urge that the intergenerational passing of this poison needs to be halted and the board of supervisors is clear

can actually stop the race to the bottom by using its power to essentially demand the action that has been needed. there is a lot of information out there about what needs to be done, the things missing is the political will to do this and so i just really urge the board of supervisors to use its authority to refuse to transfer the land absent hundred percent cleanup actually promised to this community for decades now. i thank you for your attention and just really hope that you'll use your authority to help the community that is suffering so long from this disaster. thank you. >> thank you for your comments. there are no other callers in the queue. >> are thank you madam clerk. public comment on these two items is closed. president walton, i don't know if you have additional

comments or questions or want to move forward and discuss the proposed bord responses to the findings and recommendations of the civil grand jury. >> thank you chair preston. what i in10ed to do is read the resolve clauses. i know i need to motion to amend resolution. i also have amendments that you or supervisor chan or city attorney does not have that i wanted to introduce here on the floor. i wonder can i juts state those amendments? >> deputy city attorney pierson, any procedural clarifications for us as we work on these amendments? >> deputy city attorney ann pierson. i presume you will be making amendments to fill in the content of the board's responses. to the extentia have additional amendments you like to ask the committee to offer you can read those into

the record and i'll let you know if they raise any concerns. >> thank you. i would love to read those amendments into the record now. on page 4, line 21, cross out not so it will read--r2, will be implemented. and then on line 24, cross out would be very difficult, which is the last 5 words and replace it with is necessary and. then on line 25, cross out the complete line 25 on page 4 to read, we will work to secure the resources for the independent commission and third party study. and on page 5, line 1, cross out however

to read, in addition. those are what i will also read as part of the resolve clauses into the record. chair preston, if it is alright with you i'll go ahead and read just the resolve clauses into the record. just reminder that this board of supervisors was asked to respond to findings, 4, 5 and 6 and recommendations 2, 3 and 7 on pages 37 and 38. i do want to read those findings before i go into reading the resolve clauses. finding 4, despite the enormous stakes of process governing the shipyard cleanup there is little understanding of the process throughout the city or even that the city can influence this process. finding 5, the city and county of san francisco is poorly prepared to

discover new information pertinent to the shipyard clean up to proactively look for risk and problem overlooked or under-prioritized by the federal facility agreement sig tores or development responses to new information or problems. and finding 6, no proactive mechanism exists for the city and county of san francisco to articulate interest and concerns about the cleanup for the federal facility agreement signatory nor (inaudible) to such interest and concerns from the signatory. recommendation 2, the mayor and the board of supervisors should collaborate to provide funding for the study recommended in recommendation 1 and the fiscal year 2022-23 budget or by september 1, 2022. recommendation 3, by

september 1, 2022 the board of supervisors shouldt pass a ordinance to prepare a oversight committee that includes a controller or designee relevant technical experts from public utility commission and department of public works and other relevant city departments to perform due diligence on behalf of the city and county of san francisco into the federal facility agreement signatory decision making and to prepare agenda of questions and request to be communicated to the signatory by the department of public health in advance of major cleanup document releases. recommendation 7, by march 1, 2023, the hunters point shipyard cleanup oversight committee should prepare a report on the recommended request for the federal facility agreement signatory based on the ground water study

recommended in recommendation 1 and deliver that report to the board of supervisors, the mayor and department of public health. and i am going to read the resolve clauses, which really respond to the meat of the findings and recommendations ask i do just encourage that you let me fully read the responses because there are howevers in my responses so just want to get the latitude to read before we get responses. it reads as--resolve that the board of supervisors reports thoopresiding judge of the superior court that they agree with finding number 4 for the following reasons: the report clearly indicated confusion around the navy cleanup process and timeline on the shipyard and the needs for more transparency from the navy. in addition, we find the city and county of san francisco has very

little opportunity to influence the process set forth by the navy for the shipyard clean up as the navy is a federal agency. the city however can determine whether or not a transfer of land from the federal government to the city would take place. and be further resolved the board of supervisors report to the judge of superior court that they agree with finding 5 for reason as follows: the city and county of san francisco can most certainly work to increase staffing to adequately address issues and problems that arose on the shipyard missed by the federal facility agreement signatory. seamingly, a deeper commitment from city and county of san francisco to identify additional issues in order to provide responses to new information or new problems is needed. and be further resolved, the board of supervisors reports to the judge of superior

court that they partially agree with finding for 6 for reasons follow s. the board believes the establishment of bayview hunter point shipyard citizen advisory committee along with consistent meetings with the navy and environmental protection agency demonstrate a proactive mechanism does exist for the city and county of san francisco to articulate its interest and concerns about the cleanup for the federal facility agreement signatory. furthermore, the existence also demonstrate the city and county of san francisco understand said the importance of community representation, feedback and participation and insuring the shipyard is clean and safe. there is however more to be desired in the area of monitoring progress towards satisfactory response to such interest and concerns from the signatory. more effort is required to obtain timely and

transparent responses from the navy and all federal facility agreements signatory. and, be further resolved that the board of supervisors reports that recommendation number r2 will be implemented because securing an independent commission and third party study of the hunters point shipyard to predict the future shally ground water surface ground water flows and potential interactions of ground water with hazardous material and plan modification to the site under multiple sea level rise is necessary and we will work to secure the resources for the independent commission and third party study. in addition, the city needs to insure that the appropriate city employees are on top of the issues presented in the report around ground water and sea level rise and it may be beneficial for the san francisco department of public health to assign additional

staff to conduct this study and to urge the california department of public health and federal regialators like the environmental protection agency and california state water resources control board do the same. we were not asked by the civil grand jury to respond to recommendation 1, but do agree a independent third party study is necessary, and be further resolved that the board of supervisor reports that recommendation number 3 will not be implemented because the city and county of san francisco does not have the authority to insure that the federal government and the signatory allow the city to participate in their decision making process. however, ground water and sea level rise has not been afforded the level of review and research necessary to protect residents on the shipyard and understanding this additional science is important in keeping people safe. the city does have the

authority to create a short term task force that will develop recommendsations to address the findings in the report and the board of supervisors will create such a task force. and be further resolved that the board of supervisors reports that recommendation number r7 will not be implemented within the time range requested, because-but will be implemented within 18 months. the independent third party y entity that conduct the study prepare the report on the recommended request for the federal facility agreement signatory base said on fiendings and deliver the report to the board of supervisors, the mayor and department of public health. and be furter resolved the san francisco department of public health will be monitoring the indefinite 5 year review from the navy to evaluate the protectiveness of past remedies to insure that their ongoing cleanup and solutions

remains protective. this process began in 2018, and be further resolved that the board of supervisors urges the mayor to call the implementation of the accepted findings and recommendations through her department heads and through the development of the annual budget. i do believe that i do need to move for the amendment that i read into record. >> deputy city attorney. so, there were amendments that you described earlier to the existing one and the additional ones you read into the record now. the new resolve clauses are extensive and is very hard for me to determine on the fly whether they conform to the format of response that is required by the penal code. i am happy to take a look at that, but i cannot weigh in on that in the moment given how lengthy they

are. to answer your question, yes, a motion needs to be made to amend it, but i'm not in a position right now to flag why wl there are concerns with the form of the response. >> can got it. >> and just to follow up on that, were the committee to make those amendments my understanding is that it is not requiring a continuance, it can be forwarded to the board. would you be able to dothat review and we can make any adjustments pending the full board considering it or-trying to figure whether it needs to stay in committee. three options, one if it is work that can be done between now and we are not ending with there hearings coming up so it could be option 1 is to finalize later in the hearing if we have to. option 2 would be to review any potential amendments before it goes to the board and 3 is keep it in committee, but i know

we are a little overdue in terms of responding to the civil grand jury and think it was important we had the hearings we needed to have, but that is just one concern about potential continuance. any advice on that? >> what i recommend is that we try for option number 1 and if you can go to another item i'm happy to look at the amendments and weigh in. it is hard to tell whether these might be substantive because they were not addressed in the additional draft but can advice whether or not they can be acted today or whether you should continue. >> thank you. any discussion of the proposed amendments that president walton shared? i want to comment and indicate my strong support and appreciation. we have

statutory obligations that dont allow a lot of nuance and here we have the intersection of federal agency, state agencies, mayor office and departments and the board. but, all that said, i think you managed to thread the needle and some ways assert as strongly as possible from the board the desire to implement these-the main and core recommendations. at least the ones within our power. i want to say if we do adopt this, and forward to the board just back to the mayor's office as i understand these amendments we can certainly process them going forward, but i just want to reiterate the recommendation 1 is like exclusively in the control of the mayor's office and the city administrator and

says appoint-commission the third party study. i understand the response-that study isn't warranted but if approved by there board it will be carried out. that would be my summary of what i heard. the thing is, we dont have the power to authorize. at the end of the day that is why the grand jury doesn't have us respond because the first thing that happens is the mayor and city administrator commission that. recommendation 2 is saying fund it. i think what we are hearing we want to fund that but that requires collaboration because we are supposed to act collaboratively with with mayor to fund that. what you are hearing the responses is yes, we think the mayor should do the first one and then the board wants to fund it and obviously the task force is the thing most immediately in our control and i appreciate these amendments would make clear the intention to

move forward. i don't know if you have anything to add or-i think for the public for all the folks who have weighed in on this to have-i think it would be great message to send to have the clarity that the mayor and city administrator will commence the process to move forward with the independent study. assuming the ement mas are adopted. now that you heard that is the board's will. i understand that is not the first response from the mayor, but i think you indicated openness if that is the direction the board want ed it go, that we could work collaboratively. i dont know if you want to expand on prior remarks or before it comes to full board if not today to have the level of clarity. you want to add anything now? understood. do

you want to move the amendments or wait for further guidance? >> i recommend you wait making the motion and i'll take a look and we can come back later in the meeting. >> supervisor preston, i believe we can close the hearing. file the hearing. >> i think-maybe we can get guidance. i think because some of the matters are outstanding that we have to-require future action, that we would need to continue to the call of the chair. >> yes, chair preston. the revisions made will require the hearing to be continued and agendized in the next 6 months. >> so, we can't address--continue to call the chair and come back to item 2? is that appropriate? >> let's make sure that's right. just to be clear, it isn't the changes being made that require a continuance, it is

that within the amendments there are future actions of the board and bodies and thrats that's why these have to be remain open and in committee rather then filed. madam clerk, or deputy city pierson, can we move the hearing to the call of the chair now and then come back in the amendments or should we just put these both over until later in the meeting? >> we remember you put the bulk over later in the hearing. whether this needs to be hearing depends on the responses are so we need to look at those more closely. >> okay, i'll state for those who may be tuning in or in the chambers that it is certainly my intention to subject to advice from city attorney to approve those amendments. i dont know if supervisor chan-i'm trying to spare folks maybe waiting for hours until we get through the next item jz call this back for formal

motion. if you have any comments. >> thank you chair preston. it is also my intention to vote in support of the responses proposed by president walton, and to continue the hearing in accordance to the proposed response so that we could come back and address it accordingly. it sounds to me initially from the response provided it is going to be-having approaching deadline of march 202 lee 2023 so that is why we need to continue the hearing based on had response proposed and it is my intention to vote in support. thank you. >> thank you vice chair chan. we will just before we wrap this up for now, just want to thank again civil grand jury and all the residents and members of the public

who weighed in here and i think that this is a great example of civil grand jury providing a independent outside thorough analysis that really helps light a fire under all of us in city government and government more generally to be responsive so thank you for all your work. do we need a motion or can we just come back to this later? we can come back. great. thank you again president walton for your leadership on this. we will come back to these two items. can we call agenda item 3 madam clerk? >> item 3 is a hearing on the city plan for comprehensive overdose prevention and requesting the department of public health to report. members of the public who wish to provide public comment on the item should call the public comment line at

415-655-0001. enter the meeting id-24844890060 and press pound and pound again. if you haven't done so please dial star 3 to line up to speak. the system prompt will indicate you have raised your hand. please wait for the system to indicate you have been unmuted and you may begin comments. when we go to public comment. >> thank you madam clerk. thank you for folks who have been waiting for this for your patience. i do have some opening remarks and then we'll hear from the presenters. in june of this year, i called for this hearing on the department of public health's comprehensive plan to address overdoses. we are all familiar with extent of the crisis, i will not go back through that now. it continues to take too

many lives in our community each day and i know that my colleagues share the feeling of urgency to implement solutions that will help us save lives. my sense of urgency on this issue has only grown since april of this year, when the tenderloin was added to district 5 through the redistricting process and as the new representative for this neighborhood, i am it committed to working with community, with public health experts and providers to insure we show a united front on implementing meaningful solutions. for the past few months, my staff and i have been meeting with public health experts, community leaders, advocates and the department of public health to urge the city in the strongest possible term s to develop and announce a comprehensive overdose prevention plan and to insure the plan focuses on what we

know works. overdose prevention centers, medically assisted treatment, treatment on demand, harm reduction services, such as needle exchanges, and (inaudible) reduce stigma. the plan released by department of public health yesterday, we will hear more about is in my opinion a thoughtful, thorough document and plan that includes much of the feedback we heard from community and public health experts. i was particularly glad to see a commitment to opening multiple wellness center that offer drop in low barrier overdose prevention services. when we call to the hearing and i want to be clear about this, the city had at that time no comprehensive

overdose prevention plan. much to our dismay. we were vocal about the need to have a comprehensive plan and i'm very encouraged with the progress leading up to this hearing. it is not often in city government that in a few short months a department not only embrace such a challenge but leans in in the way department of public health has here. they worked collaboratively with our office, with the mayor, with non profit partners, reknowned health experts and others. we are guided by the review response to public health crisis should be lead by public health experts. that approach served our city well with our approach to covid and is no less applicable here. i want to especially thank dr. hillary conins who will be speaking. dr. jeffrey hom, eileen lofren and everyone elts else who worked

on the plan compiling it and making it available for us and the public for today's hearing. we will hear from the department of public health first fallowed by alex (inaudible) of rti international. director janett (inaudible) of california drug policy alliance and therapist morese bird from harm reduction therapy center. thank all them for taking the time to join us today and want to end my remarks by thanking our constituents and community partners including members of the safer (inaudible) treatment on demand coalition and are manyy others for collaboration with our office as we repaired for the hearing over the past several months. i also want to thank my legislative aid melissa ulis

(inaudible) marshal lawler and former fellow andy (inaudible) for hard work and research and contribution to the hearing today. looking forward hearing from all the presenters and from my colleagues and members of the public today and without further ado i will turn it over to the department of public health to start off our hearing. welcome. >> welcome. thank you supervisor preston and i do have some slides. first of all, i want to thank you your office and the entire committee for both calling the hearing and issuing the challenge of organizing ourselves, the city, receiving input that has been really important as we

really both collate and analyze what it is that we have been doing, what our city partners have been doing, what community members have been doing and also to identify gaps and set forth paths forward. next slide. i think i didn't introduce myself. dr. hillary conin, director of behavioral health. i show the first slide to you and to the committee to really highlight the fact that this is a national crisis. the slide in front of you shows a graph of increasing rolling 12 month overdose deaths over the last several years dating to 2015. in 2021 we hit an unfortunate benchmark of losing more then 100 thousand people in the united states to overdose. much of that and much of the

increase you see on the slide in front of you is being driven by opioids and particularly fentanyl the synthetic that is underpinning the majority of these deaths. next slide. had second slide shows the local picture. these are data from our office of chief medical examiner in which you see preliminary overdose deaths by month starting in january 2021. what you see on this slide starting from the left is a higher monthly count which decreases later in the year and flattens with potentially some decreases beginning in 2022. it is too early to call the exact number for this year we are still in, but we know that the numbers of overdose

deaths remain quite high and at epidemic levels. next slide. it is easy as we are addressing and aiming to stop and prevent these deaths to not just talk about statistics, but in fact we need to always remind ourselves these deaths are tragic. we have lost thousands of san franciscans. we morn these deaths of people who are friends, family members, patients, community members. i also as a addiction medicine physician always like to remind us, addiction is not a moral falling it is a disease and illness that can be reversed or stopped by increasing access to a range of care and support to save lives. next slide. i want

to start by highlighting important progress being made primarily under mental health sf along with prop c funding with some of our recent successes. in the last year and a half, we have opened more then 250 new behavioral health residential care and treatment beds. most recently, the drug sobering center soma rise opens 24/7. we expanded hours at behavioral health access center and office base induction clinic and the bart market street oipioid treatment plan. established street crisis response team and street overdose response time. ofinose, the street overdose response team handled neurly 2,000

calls since last summer of august, which was inception. majority of which involved in overdose. we have launched our office of coordinated care within behavioral health and we make medications for addiction treatment and linkage to contingency management, one of the most effective forms of treatment for stim yulant use disorder offering to patients at zuckerberg san francisco general hospital. include expanded behavioral health service pharmacy services which delivers medication buprenorphine to high risk housing locations particularly in areas without retail pharmacy access. this promotes folks engaging in their treatment and being retrained in their treatment. turning now to specifically to this plan and what we

are setting forth here. next slide. our overall goal is continue to reduce all overdose deaths in san francisco while also focusing on reducing disparities in overdose deaths among people experiencing homelessness and among black african san franciscans. both groups suffer disproportionate impact of overdose deaths on these communities. the guiding principals of our plan is to build upon the many successes of advocates, people who use drugs and our many strong community organizations in san francisco. we are aiming to expand the continuum services available to people who use drugs. this includes treatment and harm reduction approaches. we are seeking to improve the health and wellness of people who use drug as

well as the communities impacted by drug use and overdose. we are aiming to be driven by the evidence, evidence based interventions, but also recognize that flexibility and invasion are needed as conditions change and as sometimes the facts and epidemiology moves faster then the science. we have sought to accomplish the plan, input from community members, providers, advocates, city staff including dph staff, interviews in the tenderloin with guests at the tlc staff, at the tlc and experts both local and national in drug policy research and social services. next slide. as i mentioned, we are aiming to reduce the profound racial disparities in san

franciscans overdose decedents. you can see on the graph on the lower right of your screen that black african americans have a expotentially higher rate then white san franciscans and while hispanic latinx residents have lower rates as compared to black african americans, i do want to highlight that those rates have increase sharply in the last 2 years. so, in addition to these general principals which i just reviewed, the plan is centered around equity aiming to both acknowledge and resolve the disparities that exist in both drug related outcomes and the unequal and often unjust ways that different populations experience drug related harms. we hope that our plan responds to and illustrates the urgency of a need for tailored and focused response informed by

community and supported with sufficient resources to make change to reduce overall and end disparities in the overdose deaths. next slide. the other framework that we have used to develop the plan is something called from the health behavior change literature, the stages of change and i am going to dwell on this for a moment for folks who might be less familiar. we are aiming to strengthen the continuum of evidence based services to save lives. as you can see at the bottom of the slide, participants or people with substance use challenges or addiction may be in various stages of change with regard to their substance use. they may be in a pre-contemplateive state. that is not interested at the moment in making a change all the way to the right you see

folks can be in a maintenance stage of change, meaning they may have had or have addiction. they have stopped using substances, and identify as being in recovery and maintaining that state. we aim to serve people wherever they are in the stage of change. knowing that every person has the possibility of change to reduce risk of overdose, to change the way they are using substances, in order to achieve the health and wellness that every person deserves. to meet those needs we are aiming to strengthen our services across the continuum whether it is overdose prevention and risk reduction for people who may be in a pre-contemplateive state, as well as

offering readily accessible treatment and recovery support for folks who might be in action phase or maintenance phase. next slide. so, in order to accomplish these goals and to carry out our action steps, we designed a four point plan. you can see the four areas that we aim to work in on had slide in front of you. we aim to increase availability and accessibility of the continuum of substance use services, strengthen community engagement and social support for people at risk of overdose, implement a whole city approach to overdose prevention, and strengthen our ability to track overdose trends related drug use metric and inform program development and to design needed change as we go. the

next cuchal of slides go through each of these strategic areas with some of the example activities. next slide. in strategic area 1, we are aiming to increase availability and accessibility of the continuum of substance use services. historically viewed as separate treatment and harm reduction are not mutually exclusive approaches, but rather exist on the continuum. we aim to make these services available to improve the wellbeing of people who use drugs and the communities in which drug use occurs. to achieve this, we are planning to establish wellness hubs as a cornerstone of the city's efforts. these hubs will provide overdose prevention services, resources, related services to improve health and linkage to treatment including drug treatment and mental health

treatment. we are aiming in every way we can to expand access and to remove barriers to treatment for opioid use disorder including of course fentanyl addiction. we are aiming to prevent additional overdoses from being fatal by supporting and broadening overdose prevention services, including mulox own to resrs overdose, fentanyl test strips to enable people to see if the substance contained fentanyl along with drug checking, same idea and safe consumption. and we are aiming to improve post-overdose outcomes preventing a fatality among people who have experienced a non-fatal overdose by enhancing overdose response teams and their ability to connect people to care. next slide. in

strategic area 2, we are aiming to strengthen community engagement and social support for people at high risk for overdose. without increasing these social supports, we think we will have limited success in reversing the overdose crisis and furthermore, the risk of overdose (inaudible) to address these challenges our activities will include more aggressive communication to the public about drug use, it's risks, risk reduction and continuum of services that are available in our city. we are aiming to conduct public overdose response trainings, nuloxon disbution using city wide approach and strengthen and collaboration with community organizations to partnership

development and are support to support communities most effected by overdose to find ways to reach folks, support them, and engage them in services and care. next slide. in the third area the goal is implement a whole city approach to prevention. the magnitude of this crisis necessitates a whole city approach overdose prevention initiative exist in all departments, cover the city geographically, tailored to meet the needs of diverse communities and successfully reduce disparities. among the activities in this area, we are aiming to establish protocols for first responders including lay responders to refer and rapidly connect people who use drugs to health resources, overdose prevention services and drug

treatment. we are aiming to make overdose prevention training and naloxon available in all city run housing facilities, embed ovdose prevention resources in a range of settings that meet the needs of people who use drugs such as social service, higher education, entertainment venues and more. and we aim to promote low barrier street base services sufficient drop in spaces that are available throughout the city. we very much appreciate as supervisor preston acknowledged the need to have public health and health leadership and we also know that this really requires a multi-sector whole city approach to tackle the scale and scope of the problem. finally, in strategic area 4, we want to strengthen our ability to track trends and related drug use metrics both to

measure success as well as to inform needed program development and change. between 2015 and 2020 just to illustrate the magnitude deaths involved fentanyl in san francisco increased 4600 percent. this illustrates the-data must be used to inform evaluate service delivery policy and advance racial equity. to achieve this goal we intend to centralize data collection on drug related metrics including fatal and non fatal over dose, we'll work with many partners in helping us and to collaborate with them. we aim to use data to improve our programming, develop materials to communicate these data including a publicly available dashboard for tracking important

citywide metrics and we are aiming to reg urally meet with community members front line staff of organizations to review data, discuss foondings, and gain input and feedback on what we can do to do better, reach more people and save more lives. next slide. i want to mention the imperative of addressing the social derminant of health. a great amount of work is already underway in san francisco and implementing we believe the strategies in the plan will save more lives. at the same time, it is essential that efforts also continue as they will to address and improve the overall health and wellbeing of people who use drugs which means addressing systemic ixues and social determinants of health

and by making a effort to engage people quhoo use drugs, agencies focusing on these social determinant and call out particularly housing will not only improve overall outcomes but support overdose prevention. we know this increasingly from the national literature where both the overdose specific and drug treatment and drug services specific work saves lives, but we also know that drivers like economic inequality, structural racism, lack of housing are among the money conditions that can increase risk of overdose and death. next slide. so, i now want to turn to our specific goal-overall goals and specific targets for services. by 2025 we have set forth the following goals: we are aiming

to reduce fatal overdoses in the city by 15 percent. we are aiming to reduce racial disparities among-in fatal overdose among black african americans by 30 percent. and we are aiming to increase the number of people receiving medications for addiction treatment by 30 percent by 2025. we believe these goals are achievable with everyone's help and with our continued and diligent focus. next slide. we have laid a course for ourselves and how we believe we get there. you can see on this first of two slides in one to two years, we are aiming to establish at least two wellness hubs with co-located overdose services and aiming to improve the health of people who use drugs. we are

aiming to open 70 additional residential step-down beds as part of mental health sf. open 40 new beds for dual diagnosis transitional care for women of the bayview as part of prop c. we are aiming to increase the number of people receiving medications for addiction treatment by 20 percent using the array of services to increase access to that care. we are aiming to increase the number of programs offering the strategy contingency management from 3 to 5. we are also aiming to establish a drop-in space with low-barrier counseling therapy for people experiencing homelessness. aiming to increase citywide naloxone distribution from 47 thousand kids to 75 thousand annually and aiming to

have nalaxonevise available in 50 percent of the housing facilities in the city. on the ex inslide we go over the longer range objectives. 3 to 4 years (inaudible) increase the number of people receiving medications for addiction treatment by 30 percent. increase the number of people participating who are in drug treatment programs or related programs to increase participation and contingency management by 25 percent. increase naloxone to hundred thousand kits. have in hundred percent of affordable training facilities and train 250 people in overdose recognition and naloxone use. we believe these

objectives are achievable and we also want to acknowledge that we will continue to modify these as we go to identify new strategies incorporate them in the plan or adjust if we feel that we are not meeting our targets. and then finally, the last slide. so, looking forward i again want to acknowledge the fact that this plan builds upon successful work underway in san francisco. it is quite possible without the continuum of services and the efforts of a great many community organizations, advocates and importantly people quhoo use drugs that we would have seen a even worse spike in overdose deaths. but none the less, we have got to do better and we think the plan incorporates the best available evidence to save lives and reduce drug related morbidity

and death. implementation of the plan will be lead by our newly established office of overdose prevention in the department of public health. additionally, we recognize that the nature of drug use and drug overdose is ever changing and our collective response will need to evolve. we are intending to revise this plan annually, again as new strategies are identified, lessens learned and we receive important feedback and input from all of the people who care about this issue, stakeholders, community members across the city. thanks very much. >> thank you doctor. if it is okay vice chair chan, my inclination is hold questions for the presenters till after they all have a chance to present. thank you. >> sure. >> next up we will hear from alex (inaudible) fellow behavioral health and criminal justice at rti international.

you have up to 10 minutes. welcome. >> thank you very much. thank you for inviting me to be here today to present to this important hearing on this important topic. i'm a resident of district 8 in san francisco since 1993 which is also when i started conducting research on drugs and drug use in san francisco. in those 29 years i pretty much studied overdose for the entirety of it. i evaluated just about all the types of program in san francisco and elsewhere that were just talked about, and have essentially dedicated my career to studying these kinds of things. if you can put my slides up, that would be great. probably move to the second slide would be great. much of what i'm going to say today is going to really

echo the things that dr. kunins just provided. my presentation is independent of the health department, but you'll see is many of the same kinds of things. when i think drug use and any health complications to drug use it takes me back to drug setting framework. this framework basically says look, that drug use and overdose is impacted by aspects of drug, which is the frequency of use, route of administration, potency of drugs, effect of the drug. the set which is really the mindset and characteristics of the people using the drugs, and then the setting is also really a important including social environmental a j structural influence on drug use and practices. and so, when i was thinking here about this hearing and about the kinds of things happening in san francisco and the types of harm

reduction type of services, if you put me on the next slide, i really divided them into the drug set and setting and the first thing here is really the drug piece and that is what kinds of services and interventions do we have at disposal to try to interact upon and intervene upon the drug piece. the first way is the safe drug supply. this means providing access to uncontaminated drugs and well delineated doses and formulations. we do this for ssra, methadone, butte mor 15, other countries do it for (inaudible) we are also in the country now doing epairments around (inaudible) a host of other drugs can be done in this particular way because we really need is a safe drug supply. that is the first thing we need. the second is something that has been happening in san francisco for a very long time, the

overdose education-the program train people how toert invene in a overdose and provide them with naloxone. next talking about drug testing and these are interventions essentially where you are trying to learn what is in the contained in the substances that people have. if you don't have a safe drug supply, what is in the drug supply that you have there? we have fancy machines now a days, stir machines, mass speck machines that determine exactly what is in the drug solution people have. there is also test strips that are point of care test strips that people can test if there is fentanyl in the drug then and there. the same with benzo dias peen. on the drug aspect is safe equipment and that is providing sterile equipment for preparation and ingestion. this is

what the syringe access programs do. this includes of course syringes, pipes, cookers, waters et cetera. for the next slide then, what becomes also important is the set piece of this and that is who are getting the services and are we prioritizing the most vulnerable populations. we know through many of the structural pieces that dr. kunins was talking about it doesn't effect drugs and drug overdoses don't effect people the same way. gender is a big issue, racism, race ethnicity, homelessness, youth, people in sex work and (inaudible) pornl vulnerable groups we need to pay attention to make sure people are getting the kinds of services they need. and finally, looking at the setting piece. this is where safe consumption sites come in. these are sites where people can bring their pre-obtained drugs to a site where

they are monitored by professional who can intervene upon them in case they have a overdose. these exist in 13 different countries. some of them have a lot of wrap around services and called safe consumption sites. others are mostly just the overdose prevention service piece opened in new york and san francisco. there are safe consumption sites as well but we are moving towards sanctioning of the sites and that is a important piece. there is drop-in sites and that includes the sobering center talked about that was just open here in san francisco. basically places for people to be. people are experiencing homelessness if they can be in a safe place that are monitored by people and services there and refer to other services that is a important piece and finally housing, housing is the most important piece of all this. supportive housing and single residency hotels you

can then by opening more of those you can house interventions there as well as done in san francisco around the brave buttons where they put emergency buttons in the rooms so people can basically call for help and you train residents in things like naloxone and so forth. next slide. i think we are a couple behind here. i'm trying to summarize where we are with harm reduction servicing in san francisco and what i like to use is (inaudible) how we do with respect to each of the services. the reach, how effectiveness, the adoption, the implementation and the maintenance. many aspects of what dr. kunins and city plan is speak to all the issues but they are

not put in the framework. what i have done then is i essentially taken an acont of the various existing overdose prevenshz services in san francisco and taken into account where they stand with respect to reach effectiveness adoption implementation and maintenance. syringe access started 34 years ago. has a high reach, highly effective and implementation is far along at this point. the naloxone program increasing is a important thing. i say medium only because i think what we have been realizing recently is that the black african american communities have been not reached as much with this particular naloxone and there is growth potential there that is important. especially looking at the data just provided. drug treatment has been

around 50 years, right? but doesn't always work. it is not everyone is retained in these. you need more access to these so i put that in the medium category and also there are certain groups we need to be careful with there as well. there is not enough service often for mono lingual spanish, not enough residential treatment. there is more treatment needed for that as with el. test strips, these are usually mostly given out by syringe access programs. that is happening now for the last 3, 4 years. the reach is great through access syringe access programs, and the reason i write medium because you can only test with a fentanyl test strip you can't say wrought what are the various drugs in the solution they are about to use. that is something we can do with drug checking and this is a new pilot program just started in san francisco just

4 months ago. they have through again through two syringe access sites have been allowing people to come there with small pieces of the drug solution and asking them and basically testing for them what that is and i think they have done about 200 of those tests at this point and that is a important service as well for people to know what is it in the drug they are putting in their bodies. overdose prevention service or safe consumption sites, these have been piloted in san francisco 9 months. the reach is low. there is only one site. we need way more sites which is something that mayor breed task force on safe injection sites back 4 years ago recommended was many of these sites in highly impacted areas, so this is is a pilot so far. so far over 200 people have been reversed over-doses reversed at the one site the city has, so we need to increase these type of sites in many different areas.

finally, the drop-in services, actually if you look at drop-ins over the last 40 years there was a lot more drop-ins in the 80 and 9 0. these service needs to exist in all the neighborhoods people can get off the street and cared for and referred to treatment and various thing thaiz can have there. so, my recommendation and many have been answered in terms of the report the health department just provided. existing harm reduction service have prevented more overdose death. we have way more overdose death in san francisco then we do so they are working for many years. we know how to reduce ovdose. we need to increase the reach, the effectiveness, adoption implementation and the maintenance of the existing harm reduction services. that is what we need to work on. in doing that, i would say then you need to maintain

syringe access service programs as they are, expand naloxone in the african american community and the brave button program. increase access to medically assisted treatment, increase modalities including residential treatment and bolster contingency management. maintain the test strips, fully implement drug checking and increase venues that provide the important service. implement more overdose prevention services in a variety of settings and highly impacted neighborhoods and finally, provide more drop-in services in many of the neighborhoods. thank you very much. that's the end of my conversation here with my presentation here and happy to answer questions at the end. >> thank you very much. next we will hear from janett (inaudible) california state director of drug policy alliance who i believe is speaking to

us remotely. >> yes. good afternoon chair supervisor-can you hear me? >> yes, welcome. you have up to 10 minutes. thank you. >> thank you. honorable members of the board of supervisors. my name is janett (inaudible) national organization working for over 20 years promoting drug policy ground ed in science, compassion, health and human rights. my testimony will focus on encouraging the board to continue to adopt public health centered approaches to the overdose crisis that are not grounded in criminalization or involuntarily treatment. (inaudible) understand thim pact drug use can have on the lives of users, families and those who lost a loved one to overdose. we are also uniquely aware of the challenges facing residents in places like the tender line and other parts of the

city for the need of public safety is a (inaudible) i will say i am also a native born and raised san franciscans who left when i went away to college and not binl able to afford to come back but would love to come back and deeply care about the city and the residents and the impact that neighborhoods are having with regard to experiencing first hand the direct impact of not only the overdose crisis but also concerns about public safety. we can't ignore the fact massive disinvestment of resources and supportive services also lead to increase in substance use and homelessness, especially in urban cities like san francisco. however, as dr. kunins and (inaudible) mentioned we are in a pivotal moment where we see a spike in overdose death attributed to

increase (inaudible) labeled as a epidemic with a unprecedented shift back to partial approaches to address the public health crisis. further criminalization is disruptive to the crisis at hand and can lead to more overdose shifting policies away from health centered approach with public safety measures actually relies on outdated war on drug (inaudible) one with a impact of communities across california. we do not have to look furtherer then san francisco how the overdose crisis impacted communities of color (inaudible) african americans and latinx community. dpa believes harshing sentencing would not reduce distribution and prevent overdose and does not reduce

the supply nor demand for them and worse can actually encourage or discourage the effective methods of dealing with a overdose crisis. a report found over 70 percent of people incarcerated for drug possession and traffic in state prison used drugs prior to the offense. these individuals distribute drugs not for profit as a way to support their own substance use disorder. (inaudible) have been labeled as (inaudible) not high level members of any organized crime unit or organization and are furnishing drugs to friends and family members. these individuals need critical access to services [difficulty hearing speaker]

substance treatment and support. we often (inaudible) criminalization and call for (inaudible) we know community driven treatment with proper social support leads to more successful outcomes insuring communities have access to syringe exchange services. also leads to individuals who are 5 times more likely to seek treatment and 3 times more likely to stop using according to the cdc. imagine what could be possible if we continue to build the harm reduction infrastructure here in san francisco (inaudible) which includes increase in health and wellness hubs that are well resourced and ready to meet the needs of clients they serve. in california last year we lost over 10 thousand lives to the overdose crisis while the state invested zero dollars to the crisis and vetoed life

saving altering measures like (inaudible) mizing the opportunity to address the overdose crisis. every death here that we continue to see is a policy failure and further proof (inaudible) simply are not working. in fact, criminalization continues to field the overdose crisis by pushing people into risky situations creating isolation among drug user frz fear of law enforcement as well as associated stigma which often serves as a deterrent and has a chilling effect to the laws enacted so more individuals can call 911 in the case of drug overdose and seek help to prevent those close to them from dying. with countless lives at stake, it is time to divest in the failed interventions of the past and look to effective approaches to reduce drug related harm by making evidence based

treatment more available on demand and implement harm reduction policy including increasing access to (inaudible) assisted treatment and facilitating drug checking to help identify substances and getting the naloxone (inaudible) in addition involuntarily treatment can result in a person losing tallerants to drugs because does not provide access for opioid use disorder to reduce overdose risk. people often go right back to using drugs when they get out of a (inaudible) experiencing a fatal overdose. individuals are 120 times more likely to die after the first 2 weeks of

incarcerate due to opioid overdose. from 2001 to 2018 the number of people who died of drug and alcohol intoxication increased by more then 600 percent. return to drug use is common and associated with lack of social support including housing employment and other services. (inaudible) cycle of criminalization and harm. in 2019 (inaudible) commissioned a study on the latinx overdose crisis in california, the first of the time study to look at (inaudible) among california latinx community. of interest to note was the fact san francisco county was categorized as top 5 county in california with the highest overdose rate for the latinx

community. the need to provide cultural appropriate service to address specific needs of the latinx community in san francisco and must include community education, outreach engagement and are meaningful access to treatment. similarly, any approach to address the overdose crisis in san francisco must look to providing culturally relevant and targeted approaches for african americans in san francisco and unprecedented number of individuals in the community who are dying from overdoses. as you heard, african americans in san francisco are dying from overdoses at 5 times the rate of the overall general population yet make up less then 5 percent of the population in san francisco. one additional area we can learn from existing policies is legal regulation and or (inaudible) which are not concept to create safer supply models and policies that prioritize public

health and reduce harm. (inaudible) illegal marketing of prescription opiates as the reason why regulation and (inaudible) critical reminder putting profit over people is bound to result in (inaudible) dpa is working with experts including people who use drugs for model for regulation to create appropriate access while safeguarding public health. just to give you a couple highlights in terms of safe supply in a broad brush stroke approach. we have a list of principals that we would follow in terms of having conversations around safe supply or adopting policy around safe supply that includes the following principals: first is to avoid crim inalization and

enforcement. criminalization only leads to harm we have seen from the drug war. it should not be used as a tool to enforce unregulated drug market activity or regulatory violations. (inaudible) legal regulation of marijuana and other drugs should include efforts to repair the intergenerational devastation (inaudible) from the war on drugs. three, respecting the role of drugs in people's lives, policy should (inaudible) for a variety of reasons including pleasure, (inaudible) [difficulty hearing speaker due to audio quality] insuring access to safe supply, harm reduction service and voluntarily treatment. a successful regulated drug market should create a safer supply of drug

eliminating contaminants and standardizing (inaudible) and promote community safety. evidence centered and peer driven public health education on safer substance use, legal regulations should also allow for honest conversation about drugs or associate risk. people especially young people should be connected with accurate information about drugs so they can make informed decisions and know what to do in the case of a drug related incident or emergency. and finally, creating equitable markets that benefit communities and consumers looking at legally regulated drug market should provide economic opportunities historically marginalized communities and lastly, collaborating with people who use drugs to develop policy all drug policies should be formed in collaboration with people who use drugs.

legal regulation and safer supply should also include automatic (inaudible) for drug related conviction and proactive measures to prevent the unjust exclusion from full market participation. i want to thank you for allowing me to testify today and for your time. i know there will be a lot of questions around (inaudible) i want to encourage this board to continue to center public health approaches to address the overdose crisis. really both strategies to do this in a way that insures we are looking at racial equity and gender equity and how we develop these policies, and really look towards alternative solutions to insure we are using every tool in the toolbox to address this overdose crisis. thank you for your time today. >> thank you very much. finally, we will hear from morese

bird of the harm reduction therapy center who i believe is appearing remotely. mr. bird, welcome. >> thank you for having me. brief introduction. my name is morese bird and i work for harm reduction therapy center, director of planning and business operations here. also a san francisco native as well. you imagine i is a lot of passion about this topic in particular. at the harm reduction center i think it is important for context to know what we do. we work with black people experiencing homelessness that have substance use issue, also mental health issues so most experience homelessness and have a dual diagnosis. i'll start by--the reason i say that because a lot of information comes directly from (inaudible) my experience in the

field. i'll start by talking a little about what i think is not working. i want to start with the statement to say, the war on drug does more harm then drug use itself. as we know, statistics have shown this for decades, the war on drugs is a war on people which means that black, brown and poor people are effected mostly by the drug war, and of course black indigenous people of color. if we follow the research we understand that folks who use-people that live in rich neighborhoods that use drugs at the same rate as folks in neighborhoods not as rich or black and

brown folks but don't seem to be arrested at the same rate black and brown folks do so i try to say clearly that the drug war is racist. if we keep pushing the policies of the drug war, which are doing we are (inaudible) using old tactics that have worked. we try to arrest our way out of the drug war-excuse me, drug use and other drugs that did not work. and we also need to understand what it is whenever you have a prohibition. we all remember the prohibition in the 20-1933. they outlawed alcohol and during that time there was a wave of crime we haven't seen in the

country. it created (inaudible) more people were dying from alcohol use then ever in history. more people were using alcohol then ever in history. people who were arrested for alcohol usurp the same people arrested now for drug use. black, brown, poor people. the president had liquor coming into the white house and he wasn't arrested and above the law if you will. and then in 33 the government said well, this isn't working people are dying, there is a big wave of crime, let's make this legal again and when they did the rates of alcohol use went down. people who had a substance use disorder the number of those people went down. crime rate went down because there wasn't a black market to exploit it anymore. and i just want us to hold on to the notion

we are in the middle of a prohibition now and those things are happening at this very moment. i think-this is my opinion that the government is directly responsible for just about every overdose we have in the country, especially with fentanyl when they decided that they are not going to regulate fent anyl and we regulate anything (inaudible) fentanyl in the country but we decided we are going to look the other way. i guess the country decided it isn't priority enough and we'll let folks die if you will. if they wanted to they could regulate it. another principle of harm reduction is end the war on drugs and decriminalize all drug use and as you heard from other folks there are models for this.

i think we have the (inaudible) we prioritize it we can absolutely figure out how to regulate it as a country and culture. i was watching the news this morning and i came across a story that said, the new da was thinking about charging people with second degree murder if they are selling fentanyl. they can be directly connected to someone's overdose, which is i believe is the wrong direction to be going. we heard a lot today about how arresting folks does not help the problem at all. we have a lot of evidence of that. if you dont read the

research, you can look how things in the 80 and 90 and 2000 when they stuffed the jails full of people and they broke the jail system. california supreme court said you got it do something about this, because they are arresting too many people. the other thought that came to my head when i heard that story, (inaudible) it means you are going to disrupt families for generations. they will be disrupting families for generations because dad and mom isn't around and we are talking about low level drug dealers who are-have been said here, are often the users themselves. they are living "pay check to pay check"

and using (inaudible) using whatever drugs they are using.

how come we are not. -why are we not arresting people in systems that allow food deserts? people end up with a heart disease and (inaudible) why don't we do that-going down that lane as well too? i just want to also acknowledge these are systems set up for a long time and we already know they are steeped in racism, sexism, classism, all the rest of those things. yes, we continue to use them, which makes me think sometimes like, what is the goal of this? is it to cause suffering and pain because that is what it ends up causing. intergenerations. like i said, i grew up here. i have friends

who's fathers never came back home because they were in prison for selling drugs. right? i know people who are using drugs as a means to-and selling drugs (inaudible) they are in prison for years and years. now you are talking impacting generation after generation, right? we know that arresting low level drug dealers doesn't work. they are drug users. we also understand that people who use drugs, 90 percent had history of trauma in their lives, and more specifically, they had what we call adverse childhood experiences and what adverse childhood experiences is, it means they were abused, neglected, all those parallel things

when they were children. a great study that talks about this and that connects trauma and drug use. if we know that, because if we are living through the science, i'm sure we all have read-folks interested in these things have read these studies like (inaudible) why are we treating people with trauma with a psychological disorder like criminals? why aren't-that is more in treatment. why don't we invest more money into community mental health organizations? why don't we think about what it looks like to have community mental health centers for people can be at? i talked a lot about what is not working,

right? before i get into what works i want to piggy back on a few things folks said- >> sorry, i want to jump in and give you the two minutes warning so make sure we have time for questions as well. >> great. i just wanted to piggy back and say, when you are arresting these low level drug dealers you (inaudible) potential for overdosing higher and people in custody, like the last-(inaudible) to talk about what does work, right? i think safe consumption sites work. people that use in the apartment is a (inaudible) harm reduction therapy works. not demonizing people and treating people with dignity and respect and to

reiterate if you do harm reduction therapy, understanding people change at their own pace and we need to keep them alive as healthy as possible so they can pursue action if that is what they want in their life. i'll end there. thank you for having me today. >> thank you so much. appreciate your work and your comments. now we-that concludes the presenters i want to thank everyone to making time to present. i have questions and we'll bring folks back up and first off if director kunins if you can come back up i have a few questions for you and thank you again for you and your team and the new overdose prevention office at dph. i think it is in itself important and i think as you assemble that team and your work is why it was possible to

pull this plan together. one thing i want to get clarity on because all is a lot of public interest and interest from our perspective is the timeline around opening the-the wellness hubs. so, my understanding and there's timelines in the press release and in the plan and we discussed as i want to get this as clear as possible on the record. i guess the question is , can you confirm for the public that the plan is to open multiple wellness hubs? that the first will be opened by december 2022 and the second will be open in 2023. i don't know if

you will be more specific when in the year. >> thanks for the question and we are aiming to open the first in 2022, the second in 2023. i don't have-we don't have a timeline yet, and we are aiming for total of 2 to 3 in 2023. >> thank you. appreciate that. and then, in terms of the number of people served, obviously we are serving approximately 400 people a day at there current tenderloin center and my question is whether you can assure the community and public that there won't be a gap in services when the tenderloin center which is scheduled to close in december, when that closes that there won't be a gap

in services and all the folks receiving assistance there will continue receiving assistance. >> i appreciate that question very much. i think we are aiming to minimize the gap in services, and what we have been doing in the 9 months among the things we have been doing in the 9 months since the tenderloin center is open is enhancing other services. you heard me mention the establishment of the office of coordinated care, the opening of the sobering center, enriching of our hours at the behavioral health access center and our office based induction center, so we concur that we want to minimize that gap and are working to do so. >> thank you. i just

want to say that i support this approach of multiple sites and while the tenderloin center original linkage center was attempt to set something up quickly and a larger facility, there is broad agreement on the need for multiple sites so appreciate that in the plan and not a new concept. the original safe injection site plan that the mayor lead as supervisor, that effort also called for there to be multiple sites so that is a point of consensus in city government and among advocates i have spoken with and appreciate that being spelled out in the report. couple other questions for you. the goal on supportive housing, the 1 to 2 your goal which was i

think 50 percent availability for naloxone and (inaudible) is that a resource issue? would we not be able to achieve 75 to hundred percent? what factors money or capacity are driving the projections and can we speed that up? >> i will base this on my own experience from new york city and less from san francisco to be clear. always when you ask systems to implement something new like naloxone distribution, it requires staff training, requires routine workflows to make sure folks are trained and naloxone is always available. we are committed it going as fast as we can and will come back

if we need more resources. i hope we have a better sense of speedf adoption in the next couple months. >> great. thank you. just want to open ended invitation to you and advocates which is make us uncomfortable with the level of demand you make around the funding and speed to implement those, especially if there is any barrier from the board whether on funding or anything else that we can help move along. >> appreciate that. thank you. >> one question that the plan described the need to pursue innovative opioid agonist medication treatment, i believe i quote that, that show promise in other parts of the country and around the world. other then methadone and buprenorphine. i'm trying to-can you

expand on what that might look like and what you reference in that part of the plan? >> couple of things, right now the only-there are three medications that are fda approved for the treatment of opioid addiction. methadone and buprenorphine most effective and injectible (inaudible) and we need more medications. one way this is referenced to and heard this in dr. carl's presentation is safe supply. in other countries like canada, like switzerland, there is a wider range of medications that are actually from the opioid class that have been found to reduce a person's use of illicit opioids and we dont have that available. this is a federal issue and dea and fda issue that needs to be worked

through i think in our view nationally in order to create more options for people to survive. >> those are not presently on the menu of available- >> exactly. >> has the city taken any position in terms of whether by resolution from the city or any other effort to support those efforts at the federal level? >> i have to check on that, and i do think this could be a opportunity for us as a city to develop and take those positions. >> great. thank you. and, dr. carl if you come up for a couple questions. first off, i know you are working currently on studying and assessing the tenderloin center from your perspective as a epidemiologist. i understand you haven't concluded that analysis and that

study, so hesitate to put you on the spot on that, but at the same time i assume you have initial impressions or maybe-any basic facts you are able to share at this time in terms of that ongoing assessment. >> we are doing a comprehensive evaluation of the tender line center that includes ethnography, that includes mapping around the area to see whether it has a impact on public drug use and even drug use equipment in the area. we are also monitoring overdoses there and what's happening with overdoses there, and our evaluation isn't complete yet. it won't be probably for-aspects will probably be completed over the next few weeks and other

aspects in a couple months. the last thing we are also doing with that is looking at crime in the area as well comparing to other parts of the city. there is a lag in data that comes from crime data, so have to wait a little further on that as well. as i mentioned in my presentation earlier, there have been over 200 overdoses reversed at the site and many of those are with naloxone and other s are simply providing oxygen, which is a even better approach to handling overdoses or opioid related overdoses. one thing that is good about that is that every time they use oxygen they actually are not required or don't necessarily need requiring that they call 911 and engage the emt in the city as well so that has

potential savings as well in terms of both ambulance isn't needing to come there and open up the ambulance to respond to other kinds of medical emergencies happening in san francisco at the same time so that is another piece i think that is really important. when you look at potentially the cost of some of the services, look at the cost savings as well and think they are much much higher in general. i did provide and conduct a study that we published in the peer review journal 3 years ago that showed that if we in san francisco did open up a safe consumption site line the main one in vancouver it would save the city one large site would save the city over 3 and $3 and a half million per year so the cost savings i think are a important part of this and think we should talk about them in terms of saving lives and improving lives of people there and also the savings that had has to the city.

>> that study that you did in the $3 million estimate that is net? that is after the cost of this facility? >> exactly. >> thank you. one thing i have been very struck by in digging into the research around safe consumption sites and talking to experts is the-i should say, pretty much every time i read an article, it is written or cowritten by you so thank you pr your extensive work in the field. the disconnect between the public discussion sometimes which i think tends to frame safe consumption sites is very controversial thing. we see vetoed at the state level and different camps on this. from my impression seems to be absent from when i talk to public health folks, i am trying to think if i encountered

any serious research or-that makes a case against safe consumption sites or not from the politics, just saying from in terms of the impact preventing overdose, preventing fatalities and wonder if you studied these extensively i think around the world, definitely around the country, can you speak to that and am i right-curious when you write a article about safe consumption and these are peer reviewed things, is there a split opinion on whether these are impactful in the way that you described it or is there a consensus or emerging closer to consensus among public health? >> yes. safe consumption sites have existed around the world since the mid-1980 so been around a long time, exist in 13 different countries. they have been evaluated in many

different countries over the years, and then our own research you were referring to evaluating unsanctioned site in the united states as well. the research is really unambiguous on what it is finding in the sense that every study that is found has found that these sites do reduce overdose deaths. in fact there is never a overdose that lead to death at one of the sites around the world and there are over 200 sites around the world. in the u.s. as dr. kunins was talking about, we are at hundred thousand deaths in the community a year in the u.s. there are none in the sites anywhere in the world. they also have been determined to and the science is unequivocal

reduce hiv risk, help titeing and enhance people who go into drug treatment so these are places that also help people get into medically assisted treatment and those type of important services. and finally, the research that both we conducted and that is conducted up in vancouver and also sydney austrailia crime goes down. there is less public drug use and less drug equipment around the sites, less crime around the sites and i think the last piece of it in termsf othe public perception piece you spoke to, in the sydney site which has been around since i think 2006 or something like that, people actually had neighborhood

assessment whether they like the sites or not before they opened the site and after they opened the site and the community approval of the site went up a year after opening one of the sites opposed to going down in any way. you are right, i never found a peer reviewed study that has shown any negative impact or effects of safe consumption sites and to the contrary, all of the studies show both benefits for the people who use them as well the neighborhoods in which they are placed. >> thank you for that clarification and information. i say i know that the generally speaking the media loves a good controversy and there are plenty things to argue about. this isn't it and just struck by that. sounds like every peer reviewed article, every study is finding

these successful and within city government i will say that from certainly mayor and i have our disagreement on a lot of policy issues, this isn't one of them and all my colleagues i have spoken with share that very so hopefully that-that is reflected and important it is reflected in the plan that dph brought forward and released yesterday. vice chair chan. >> thank you chair preston. this is a question for dr. kunins. i want to thank you for articulating the plan. i think we have been having these conversations both during the tenderloin emergency as well as during the budget process, so i am going to kind of refer back to conversation we had during budget committee, trying to help me understand just-we talk

about-which i appreciate. you talked about-because we originally at budget committee had talked what is our goal for reduction and by what percentage. if you could walk us through in context and if you actually have it on you, is the overdose death in 2020, 2021 and to date in 2022. >> let me start from the top. i'm not sure i have the exact numbers with me. i will flip to my charts as i do. i think setting targets and i know you were one of the people who set forth this challenge. if you notice, i think in the national literature that those targets often dont get set and i think it is because there are so many drivers to the

overdose epidemic and what is characterized is succession of waves driven by prescription opioids and then heroin and sythetic opioids particularly fendinal fentanyl so that challenged us in public health to set targets we think we can meet. we through a series of i would say-i dont want to diminish to say back of envelope calculations, but to say if we could get this many more people receiving medication treatment for opioid disorder we can get out this many naloxone doses that reverse this many death. we have high impact to have quantified impact. what is harder to quantify is by opening more

residential step-down treatment beds, which serve primarily to create a sense of stability while people are receiving formal treatment to address drop in centers. there isn't as much literature (inaudible) turning to my colleague. so, i think to some extent we are making estimates and looking at the last couple years and i'm getting some numbers in my phone. we know we saw a peak in 2020 of 700 that was the final count not the office of the chief medical examiner, but close of 7-11. we saw a decrease in 2021 to the mid-600. we are waiting for those final certified numbers from the state department of health and colleagues. we

try to estimate that trajectory. that was our thinking. we will revise as we go. i think we want to be self--critical if we are not achieving goals what else we can do. to your earlier points supervisor preston, we would like to look for opportunities to be more aggressive to drive those deaths down even lower, whether it is new strategies or new resources needed. >> roughly saying we want to reduce our overdose deaths by 15 percent by 2025 and i think that is a really good goal because either way you are between 700 deaths-anywhere between 600-700 deaths at least now per year and that's a good roughly hundred something people. so,

the question is, with that plan, with this plan you presented today to reduce deaths by 15 percent by 2025, roughly what is the overall budgetary investment? >> so, it is a great point that i don't have at hand for-what i think we should consider is all the current investments and of course investments are directed at opioid use disorder directly and other substance use. most overdose deaths which we have not made the point today involve more then one substance so by reduces other substance you reduce risk. as you heard from morese bird, addressing mental health concerns as well can help both youth and adults reduce risk of overdose. for the moment and we'll come back to you with more

information, we had a number of investments through prop c funding. we have in this budget year we have a number of new investments using-thank you for your approval from the mental health services act, which for the first time allows for investment in substance use related issues, and so using those funding for the moment we believe we can do what this plan lays out with what is available to us right now. i guess we'll say we'll come back and continue the conversation. >> just also help me understand about i think your four strategies-just really throughout the four strategies talk about the wellness hub. i love to understand a little more about just the approach-i think

your strategy 4 talks whole city approach. help me understand what that means when we talk about wellness hub areas and service area versus a whole city approach and i know that there is also--i think in your presentation you made a point also about focusing on area of use and/or high needs so help me understand how do we have a whole city approach but also focus on high needs and with these wellness hubs. >> i think our use of the term whole city just-and i hear feedback here, is really thinking about ways that city entities touch people at risk of overdose, directly or indirectly and to see this as overdose prevention all work on, whether in a social service

agency, educational entity, and not (inaudible) solely public health problem to solve so by whole city thinking how we can for example do more overdose prevention in supportive housing would be a whole city approach. thinking about how we might get naloxone in bars and clubs, that is a whole city approach. looking for innovative ways to reach people. working with organizations serving families who maybe the young people are low risk of overdose but maybe family members and others need to have more information about what effective treatment is. looking at ways to touch san franciscans through the reach of the city structures. that is what i think we mean by whole city approach. at the same

time, we know overdose deaths are concentrateed in 6 neighborhoods in the city and we need to in our view when we think locating services such as wellness hubs we want services convenient to people and located near where they are high risk. one of the findings from dr. carl's work and others is locating for example safe consumption we know people are willing to travel only small distances to use them and so we want to make sure regardless of what the intervention is that it is located conveniently for people at risk. >> i think you actually answer most of what my next question is. my next question is community engagement. i think you really answer most of it, but i just

wanted draw down more specific when it comes to community engagement, because i think part of it in your presentation you had talked about just education as well just for the general public to understand. i think that tackles what chair preston also talked about. just both in the media or the general sentiments sometimes that i think that the controversy on safe consumption sites also has a lot to do with community engage ment engagement and education. the question lump into i think you do talk about overdose prevention, community engagement, so then i think i want to go beyond the overdose prevention, but a little bit about overall community engagement and education that are also just those who

are maybe not users themselves, but they know the users or that they come across users that they are not-may be strangers to them, what about that piece of the community engagement? >> i want to say i agree. we need to do more community education and engagement and i think there is profound stigma around people with addiction and they face discrimination, hate, lack of empathy. i have a personal goal of helping all of us humanize folks with addiction, and many of us have family members loved ones ourselves who face this serious but treatable problem, and i think bringing community members along in that

understanding, giving first knowledge about what resource s are available, what we are doing to improve outcomes, improve health, reduce public drug use, support people getting into care is vital. i think also teaching community members action steps they can take, whether it is how to know where to help someone get help or reverse a overdose is part of working together, and we intend to do more in community engagement i think with the additional resources i just mentioned, mental health services act funding and so forth, we will have more capacity to do that more fully. i will say that our teams have been doing this. i want to acknowledge also past work, and arkticulate the commitment to continue to do more in multiple languages, multiple communities as part of

our approach here. >> will the wellness team be part of this or is this actually something completely separate? >> well, i think back to your point, i'm getting notes in my phone. i think this sp part of when we say a whole city approach is working with all of the teams and all the services to aim to have everyone be part of the overdose response, and so i don't know this specifically, but what i imagine is all our teams need to be able to have information about overdose, be able to at a minimum tell people where to go to get help or reduce overdose and including giving out naloxone themselves. >> i want to give you one example that i'm wincing in the richmond, which community i represent and i think that i want to say i'm very grateful for majority

of constituents i think they are very compassionate and trying to figure ways to support and help while you're right, there is still of course some stigma. i also think the lack of education and understanding what to do, i want to give a example. i look forward to working with your team to help us problem solve in the district. on my way to work i was driving and seeing there is a individual on the curb of the bus stop and not sure if the individual could be overdosing or just you are seeing a individual wasn't sure if this person is suffering overdosing or whatever that is. obviously half awake and half not. it is right at the curbside by the bus stop while we have a group of people waiting for the

bus. and everyone is looking at this individual and they are concerned and they were not sure what to do and i wasn't and i was thinking i need to call 311 and wasn't sure what could be happening to the individual if i make the call or if this individual was okay. just not sure that was the moment i realized the lack of education i have the people at the bus stop have that our community has. how do we be compassionate and are think they were very compassionate to just kind of concern about the individual but not sure what to do. i think probably many of us in san francisco so i think that's the reason why i ask about the community engagement question. i think that we have advocates that doing their best to help educate and also themselves out there to help and support the individuals, but i think it seems the mass require a lot

more education and i want to be-myself included that i want to admit my ignorance and i need better education as well. >> i appreciate hearing the story and the feedback and also acknowledging that we as a city not even just specific to overdose but behavioral health need to help people know concerned neighbors and community members where to call and get the help and increasingly help is available and more services are available to connect people to. >> thank you. i just are love to see more details in that plan. because i think that is part of the plan but want to learn more details on that. thank you. >> thanks. >> thank you vice chair chan. one last question before we head into public comment. dr. carl referenced the brave button program and wondering if you can

elaborate on that program, what it entails, the effectiveness and plans for expansion. that is for either of you. he referenced it, but you are at the mic, if you want-either of you. >> it may be that dr. carl has more deiltas in his head. it is a program we have supported as engaging people in-i'll stop so i don't get it wrong, but in supportive housing to become over-dose responders if someone is in trouble or to ask for help and let me turn to alex. >> this was a program that was a pilot project funded i believe by the department of public health and it was carried out by the drug overdose prevention education project that is part of the national harm reduction coalition as well as dish in two different hotels and evaluated by kelly

knight at ucsf. we were fortunate to see some of the qualitative results from that at a seminar last week at san francisco general hospital, but essentially it did involve both installing these buttons like a emergency button in two hotels as a pilot and training residents from what i understand residents in the hotels how to respond to overdoses and providing them with narcan as well. >> thank you. let's open up public comment on this item. >> thank you mr. chair. any members of the public in the chamber who would like to make public comment for item number 3? please line up to your right. remote public call in members press star 3 to be added to the queue. those on hold please continue to wait until the system indicates you have been unmuted.

thank you. please proceed. >> welcome. >> thank you. good afternoon. appreciate the time. tom wolf a recovery advocat in san francisco and a native san franciscans too. i appreciate the presentation i have a lot of respect for dr. kunin sirks and what she is trying to do. i can't help to notice all the presentations never mention the word recovery. recovery as a solution to this crisis that we are having on the streets. i used to be homeless. i was addicted to heroin and fentanyl living in the tenderloin. recovery got me out of that so we are talking about all these different things and the way we are talking about it is so ambiguous. we talk about wellness hubs. why don't we just call a safe

consumpson site. we are doing the stuff in the shadows and breeding suspension among the public. not just lack of education but breeding suspension and maybe because it is against federal law or because the governor vetoed it. not sure. if we are going to move forward with these things we have to be honest and talk about what is really happening out here. we have 500 organized drug dealers on the streetd in the tenderloin and soma. they are not drug users mptd they are part of the car tell and need to be held accountable. they are selling kilos and kilos of fentanyl that are killing people that literally meet the definition the legal definition of involuntarily manslaughter and we are not doing anything to stop. now we have a new da so might change. all the overdose prevention things i appreciate it but what is difficult to me i had a

statement but after listening to this i had to say we are not talking recovery. let's promote drug treatment. where is treatment on demand dph? you have a mandate to provide that. >> i apologize for interrupting the speaker. >> are thank you for your comments. next speaker. >> (inaudible) first permanent supporting housing provider to have narcan available at the sites as we partnered with the (inaudible) secure narcan and training for all the staff. i applaud the commitment on the board and department of public health to address the crisis but i want to emphasize the need to investm in meaningful

overdose prevention driven by the expert (inaudible) we lose residents to overdose every month sometimes every week. we have narcan available 24/7 including dispensers throughout the building. as you may remember from the budget process we have a pilot program that alex mentioned we look to expand to other sites. it was not funded fully so i want to tell you about the (inaudible) a partnership with national harm reduction coalition, dph funded one portion which was training for our residents-we want to see narcan satchuation not just in the hands of staff but residents. we want to say (inaudible) press the button and staff or another peer responder can go to the unit after they use make sure they are okay, make sure they have the support they need. those should be

standard issue just like we have fire detection, sprinklers we need these ways people can get help and we need to fully fund peer based response and trainers so pay them to do the work, they are recognized as the experts and can help save the lives in their community. alright. thank you. >> thank you. next speaker. >> good afternoon. my name is maddie (inaudible) the community development manager at dish delivering invasion and supportive housing. here to speak and add to the testament lauren just made specifically to speak on the peer responders and peer overdose responders and trainers we have at the site in connection oo the brave button program. i would like to read a quote from one of the peer responders named susan. this community has a high level of mistrust based on the background. we have been judged by so many

who know nothing about what we have been through. we may never admit to a staff person we use or need help but we will always rely on each other. being able to give my neighbors narcan and know when they need help saved lives. i can testify that at the (inaudible) reversed over 8 over-doses due to capacity to respond to overdoses specifically through the brave button. i want to emphasize peer response and education and training networks are specifically impactful different from having staff relationships. i also want to name 4 people that passed away within our dish sites. not specifically on site. i mean people of the resident community within the last week specifically. the names are oatis, cent, jimmy and andy. i believe if there were more capacity to support specifically peer lead expertise

and programs beyond just giving narcan that being able to offer residents the opportunity to educate one another and support one another in a thorough way we would be able to reverse more overdoses and prevent them. thank you. >> my name is (inaudible) president nixon that in the late 60's early 70 started the war on drugs. i researched this. he started it. (inaudible) he targeted the african americans and heroin and hippies and marijuana. going along with that-what i like to say, i think one of the things we have to find out is why they are using the drugs, because i think

the growing (inaudible) here in the city with the care-(inaudible) i think the fact we are told we cannot have posters no fliers, i remember when i came people ask (inaudible) that's fasism. (inaudible) and i like to close by saying that in (inaudible) i don't know why people use drugs, i have feelings why they use drugs, but i think capitalism is going to eradicate the reason why people use drugs.

>> thank you. next speaker. >> thank you. my name is leah branson (inaudible) 35 beds where people can sleep in the day. i'm here in support of the comprehensive plan. i wanted to address the question of recovery. recovery starts when someone walks through the door of a opioid overdose prevention site. one thing we know about people who use harm reduction sites is they care about their health. this is a great thing to know about someone you are trying to assist. it is not about taking tools out of a box, it is adding more tool s to the box to help people struggling with substance use disorder and it is time to stop listening to the contversery who are

making a living around what (inaudible) listen to doctors and scientist and people in recovery through harm reduction and the people who are working with folks every day and say this works, it is helpful, it is kind, people's dignity doesn't start when they stop using drugs. respect is acknowledgment of the dignity of the human being in all their forms. i want to say thank you. >> thank you for your comments. next speaker. >> my name is robert young. i worked for (inaudible) pest control, a company that went into sro units, people that generally got the ability from the city to sit in a room and do drugs all day long. for nothing. we get into the rooms and help clean the room out. anyway, one of the coworkers stold a large amount of money from these people and overdosed and when i

reported the employee he spent a day making fun of me for shit that happened. coming here to say i asked all the supervisors and news people if somebody can help me. i was harassed at work and there is nothing i can do and they fired the wrong person. i was a great employee. i think everybody else on the team would say i was a better employeeing just felt uncomfortable in the situation. i liked to help those epipooal. thank you for your time. >> thank you. next ecspooer, please. >> good afternoon. laura thomas, the director of hiv and harm reduction policy at the san francisco aids foundation and resident of d10. also a member of the safer inside coalition and treatment on demand coalition and want to thank for visor preston for calling this meeting and for your leadership. i know you just included the tenderloin recently in your district but you made great efforts to

understand the issues of theteneder tenderloin. i want to thank department of public health and mayor office for the fast work on compiling what the city has been doing on overdose into a overdose prevention plan and really excited about a lot of what is in there. i also want to acknowledge the enormous amount of very hard and traumat ic work done by people who use drugs harm reduction advocates people in recovery reversing overdose, distributing (inaudible) seeing a much more significant total toll if not for those folks. we need to take bold action. (inaudible) i will leave the rest of that comment. i also think that it is extremely important that we make sure the other things we are doing in the

city are not increasing vulnerability to overdose. that includes aggressive policing, market disruption incarcerating people increase epipooal overdose vulnerability. we can't do that with one hand and try to stop them with the other. finally, with my entertainment commission hat on i want to say we are very proud partner with dph getting naloxone into bars and (inaudible) >> thank you, next speaker, please. >> hello supervisors. my name is (inaudible) a public policy (inaudible) permanent supportive housing provider in the city here today as a treatment on (inaudible) urging to support the opening of overdose prevention centers in the city. in 2008 san francisco voters passed propition somewhere t yet in the last 14

years san francisco failed to provide enough low cost low barrier substance use treatment and support services to meet increasing demand. research shown overdose prevention center provide linkage to service use trument and access to primary health care which reduce public drug use. over the last few monthss we heard change in narrative about public dug use and housed community. going so far to claim passing by unhoused folks using drugs in public is more traumatizing to those housed individuals passing by. those who are living on the cold conveet streets of the city. it is time to bring public awareness to how the city one of the most expensive cities in the world failed to help our most vulnerable. we notice how the city leaders are pushing legislation to protect private property over the preservation of human lifeism we know the criminalization of those who use drugs who will not get where

we need to be and every day we delay the implementation of life saving strategies san francisco losing at least 2 members of the community. tenderloinsenter has proven the urgency of opening overdose prevention center city wide. they work, they provide safe spaces that reduce stigma of public drug use and safe hygienic places to use safely without shame and dignity. support the immediate implementation of overdose prevention program city wide. thank you so much. >> thank you for your comments. next speaker, please. david elliot lewis long time tenderloin and city resident. thank you for holding the critical hearing. we lost more people to overdose then covid. or most other causes. it is tragic i things need to be done. 15 years ago when i needed help with my own issues i needed recovery and treatment, i sought

treatment on demand and i did not get treatment on demand but i did get treatment after persistence and if i wasn't persistent and made repeated calls and vidsts i wouldn't have got connected to a treatment program but i did and finally helped and it saved my life. i wouldn't be here talking today if i did get that the treatment 15 years ago, not on demand but after persistence. we are in 2022 and we have a wellness center concept in development at um plaza that works. it is helpful to people, but because of neighborhood push-back mainly from trinity towers, the market rate building across the street and influential members was it was not refunded for next year. it closes in december. my concern is that as department of public health plans to reopen or create new wellness centers in a one to two year

timeline which is way too long because they stood up this one quickly, how are you going to handle the not in my backyard push back you will get no matter where you place the wellness center and want to ask the sitsy to stand up to these not in my back yard push back and stands up wellness centers the city needs, overdose prevention and treatment on demand without hesitation low barrier low threshold. dave thank you for holding the hearing. >> thank you for your comments. next speaker, please. >> hi. my name is (inaudible) a home rise public policy community organizer community organizer, sro tenant here to give you a dose of dope hope. envision a future where society address the root cause of social and health care consequence of drug use and overdose. let's create solutions that address social economic and

racial disparities and recognize this crisis stems from decades of generational class and racial trauma and intentional malignment of system of care justice. the spectrum of care needs to include economic reparation housing stability verses criminal code of conduct. envision the streets safe and lively (inaudible) is a living space social sphere and underground survifenl ecornomy where communal support system exist. where is the talk of replacing and supporting with something healthier for all? i hear fix already proven to be broken mean while the (inaudible) worries its way into the heart and soul (inaudible)

push for a new way of thinking about the crisis. bring about new trees of thought where we feed the heart and soul and are how we turn overdose and death into hope and growth. here are pathways to success. create a pathway economic opportunity and support that goes above and beyond survival needs. address habitth and limited space (inaudible) cultural relevant spolesh social engagement opportunities not profit driven on sidewalks vacant businesses and housing communities and prioritize solutions and alternative to substance use in social economic and health care realms and leave punitive measures for criminal issues. thank you for your time. >> thank you next speaker please. >> my name is colleen rebecca (inaudible) i wanted to speak specifically about

overdose prevention and permanent supportive housing. i want to associate my comments with those that lauren hall made earlier. i think it is really important that when we think preventing overdose in permanent supportive housing that we really have a coordinated approach with hsh, ocd and department of public health to make sure that our interventions can be fully funded and actualized for all residents not just a certain percentage of them. i think that if we dont have a coordinated plan, the responsibility for overdose prevention could fall on the already over-tax case and social workers. what about a full time overdose prevention coordinator in each building? what about actually fully funding the peer base program

lauren described earlier that actually trains peers so that other residents of permanent supportive housing have a non staff person peer who is another resident they can to for help, support, narcan and overdose prevention. making that program fullyfunded and operational in all permanent supportive housing and compen ensateing residents as a peer (inaudible) it needs to be fully funded and fully implemented not just a pilot. thanks and i hope i'll have a more robust conversation about this with you as we move forward with this new exciting plan. thanks. >> thank you for your comments. next speaker, please. >> good afternoon supervisors. i'm sarah short home rise

and treatment on demand commission and safe inside. thank supervisor preston for calling the hearing and requesting this plan from the department of public health. i'm just so pleased that it produced results that we are here discussing today. i do actually want to thank department of public health. dr. kunins and mayor for producing this plan. i applaud it since it is evidence based and racial lens and not punitive which icmas it more likely to work. some components i like about it is increase naloxone access, there is a requirement to measure demand for treatment which is consistent with treatment on demand law. it

contains contingency management programs, medication assisted treatment, drop in spaces is absolutely huge. these wellness centers we lost too many drop in spaces and i want to say here, but we really need explicitly safe consumption sites. we absolutely need to have that in place so still pushing for more there. also the drug checking, and just it is atrue public health response to a public health crisis which i was happy to see. while others are suggesting we put city resources into approaches that have been tried and failed some city leaders looking to the police to solve the problem despite the research which we heard showing the methods actually undermine efforts to reduce death. dph is taking-- >> thank you for your

comments. madam clerk, can we turn to callers. >> remote callers please send the first caller through. >> good afternoon chair and committee members. (inaudible) and a member of the safer inside coalition and treatment on demand coalition. calling to urge the city wide implementation of overdose prevention centers as part of san francisco prevention strategy. opc already exist in more in the 65 cities around the world include two successfully in new york city. the lessen from the tenderloin center demonstrate the need for the every day services in san francisco and how powerful these interventions can be. there is extensive communication in san francisco and mullple commissions and task

forces that concluded these programerize necessary and will benefit san francisco. as we heard during the hearing, there are overwhelming benefits of proven public health interventions. the city support and collaboration is required to make this happen including the mayor, board of supervisors and city attorney especially to open to scale city wide to meet the level of need. to meet the goal of san francisco overdose prevention plan the city also needs to address the shortage (inaudible) front line providers are facing the task of rationing narcan due to lack of supply. we should have coordination with local and state government so we never have to deny access to life saving supplies. lastly, grateful dph has the need for drug checking programs to empower people who use drugs and save lives.

dph should lead on all the strategies because overdoses are a public health issue. and should be able to use the settlement dollars to truly implement a very truly comprehensive overdose prevention plan. thank you. >> thank you for your comments. next caller, please. >> good afternoon chair and supervisors. wesley (inaudible) speaking on behalf of the safer inside and (inaudible) as well as the rest of district 5 office dph and mayor for the dignified user approach. i want to especially specifically recognize dr. (inaudible) engaging with the community in crafting the strategy. in support of the plan and urge the city to immediately implement overdose prevention centers. as a plan rightly states

overdose deaths are preventable knowing what works and we know what is not data informed and proven to exacerbate risky substance use and increase death. the approach of racist war on drugs does not work and out of touch with this plan. electronic monitoring as proposed by the san francisco recover resolution is irrefutbly proven to be a failed counter productive program and need look no earth ifer then a harvard (inaudible) criminalize the community leads to marginalization. (inaudible) does not make us safer. coerced treatment is not care, it is experienced as trauma. the overdose crisis you are hard pressed to find anyone not touched by the tratagy but substance use and overdose are public health issue. require the (inaudible) expanded harm

reduction infrastructure proceeding with the public health lead community driven plan implementing opc. thank you. >> thank you for your comments. before we continue with the call in members we have one person in public. >> thank you. hello supervisors. thank you so much for the hearing today. thank you supervisor preston calling for the hearing and moving towards a plan and thank you dph coming up with a plan and mayor office as well. (inaudible) cochair of the tenderloin people conference. one of the neighborhoods most impacted by the issues we are discussing today and i all most wasn't going to say anything because wes was so eloquent in the way he presented the argument now, i say ditto to everything he said but i want to raise a couple things that come to mind is one is the scale of the response compared to the actual crisis we are in. when i heard the plan today

say they were talking about opening one wellness hub by the end of the year and maybe one some time next year, it just felt the scale of that response didn't feel adequate to the need. especially when we are talking closing the treatment center. the tenderloin center before the end of the year. how is that-it feels like a net loss rather then gain. we heard they reversed over 200 overdoses at the tenderloin center. we can't get safe consumption sites but we know the wellness hubs reverse overdose and save lives so get more open and do it quicker. why can we only get one open by the end of it had year and maybe one next year? it doesn't feel like the urgency of the response doesn't feel it is there and so i ask we do that quicker and also feel i need to be fairly representing the residents that asked me to speak on their behalf which is,

theteneder loin shouldn't be a containment zone so think some folks would like to close the center so it is open deeper in tenderloin to make people less visible and (inaudible) these hubs need to be open throughout the city. >> thank you for your comments. we'll return to in-call speakers. please forward the next caller. >> hello. i just wanted to thank supervisor preston for calling this hearing. i have been anticipating it for a while now and just this morning in the new york times was an opinion piece by mia (inaudible) called the most important question about addiction. i think we need to ask ourselves what we want for the lives we save from overdoses. what do we hope that they might

look like? she wrote a wonderful final paragraph that says u people use drugs for reasons. typically those who become addicted struggle with hope lessness, trauma or mental illness, often all three. it is economic and social pane pain is the commonalty. until policy makers prioritize healing distress that makes particular people and communities facing economic loss and trauma especially vulnerable to addiction, this vicious cycle will only continue. thank you again. >> thank you for your comments. there are 19 caller in the queue. please forward the next caller. >> hi. can you hear

me? hello. >> yes, we can hear you. >> can you hear me? my name is dr. theresa palmer a local retired family physician. i used to work at laguna honda and thank you the treatment on demand commission for being a valuable source of education for me as a community member and physician. adequately staffed and integrated substance abuse and overdose prevention and treatment will actually benefit everyone in san francisco including the most privileged. look no further then laguna honda hospital, now not available to any san franciscans who needs nursing home care because of overdoses that could have been prevented. having a organized non punitive integrated ubproach to substance abuse and mental illness we will relieve all of our local emergency rooms hospitals and

long-term care facilities of a huge burden of care that will ultimately not only save money but make these facilities much more available to people that need treatment for everything else. i don't know you tried to call your doctor's office lately, but i can't tell you how long i have been on hold. there is not enough providers. everyone is over whelmed and they are sort of-rolling down hill type thing where when one thing is untreated everything else backs up and the whole city is losing for not having a state of the art integrated system. there are good examples of this in other cities that are well studied and we need to get on with doing better, and i'm thankful that i'm hearing the beginnings of this today. thank

you. >> thank you for your comments. next caller, please. >> hi. good afternoon supervisors and chair preston. i want to thank you for your leadership on the issue. it is long overdue. my name is michael (inaudible). i am here district 9 resident and part of the hiv advocacy network here today to ask to (inaudible) and support consumption sites. i think many who joined previously on overdose awareness days where we said avenue death is a policy failure. thank you for joining us and asking and pressing on the city to produce evidence based solutions. consumption sites are evidence based solutions. it is important that the city address-i encourage delegation

to actually tour an actual consumption site because what we have now is short of a consumption site. these are preventable deaths. again, i am bewildered we built the golden gate bridge much quicker then we produced consumption site because we asked for years and there is push-back and (inaudible) put more effort into that then producing a result that will save lives. we can prevent it with your support and i'm here to encourage you and thank you so much and thank you again for take thg time to hear me out. have a great day. >> thank you for your comment. please forward the next caller.

>> (inaudible) >> good afternoon caller (inaudible) please forward the next caller. next speaker, please. >> supervisors, i strongly feel that this city has made many mistakes. in order for us to have a unique model for san francisco the legislative analyst must have the

supervisors understand that these (inaudible) actually have a solution with time pp lines and goals. it is a mickey mouse way of doing things. having 3 or 4 long presentations and then bringing us the people the taxpayers to give a measly two minute comment. the legislative analyst should take a key role in giving an orientation to the supervisors how we can have such hearings so that the city and county of san francisco san franciscans can get help. instead of talking about spreading the tumor all over the city. we

need people who can find solutions with real timelines and goals. thank you very much. >> thank you for your comments. please forward the next caller. >> good afternoon. my name is dr. kelly knight, a professor at university california san francisco and i conducted research with homeless san franciscanss over 25 years and researcher mentioned earlier are in the hearing that conducted the evaluationf othe sro project pilot program. i was excited and relieved to hear the report from department of public health (inaudible) play a key

role decreasing overdose in their buildings. this life-saving program is the community members most at risk in the work of overdose prevention responds and offer a critical currently missing component to san franciscans (inaudible) as already discussed the sro project developed by the project in san francisco and has 4 components naloxone availability throughout the property, units with brave buttons to alert hotel staff and (inaudible) overdose specialist peers trained in overdose reversal with nulaunl naloxone (inaudible)

my evaluation shows the resident specialist felt valued for expertise in doing the life-saving work. opened dialogue about health concerns and critically engage hotel residents immediate access to life saving tools naloxone and brave buttons every floor and room. i encourage to support the project and all permanent supportive housing in san francisco. thank you. >> thank you. next caller. >> ellen graham. thank you for having me here today. a san francisco mother and member of the mother against drug deaths and thank you to the dph putting forth the plan. we want the type of relief