er a cup of tea and a skosh. So I'll always be thankful for that. And as so many people have said, I don't know how you have enough hours in a day to answer all the calls that you get from all of us. So many times I've been confronted with either my own problem or a friend or a colleague, some thorny problem. And we might turn it over for quite a while before we end up where we should have started, which is, I don't know, let's ask Dana. So, and you'll take the call.  Too often it's ridiculous, and yet you keep us on a path. So thank you so much for all you've done for the county and for being a part of my life. And welcome to the other side. Good morning, I'm Jason Heath. And for those who don't know me, I'm with the County Council's office and I've been there about 16 years. And for the last five, I've been Dana's chief assistant.  I really, I understand it. And I hope that you can hear it. I really hope that you can hear what folks are saying. I can't repeat it all and I won't. And I can't summarize 16 years. You know, I look at Jasmine and her entering young adulthood and taking on the world. And I think back to when you and I were in mother's song together with my son, Miles, at the age of two and Jasmine at the age of two dancing around together. And the room starts to spin and all the years collide together. I'm holding two opposing thoughts in my mind. One is that I'm so happy for you that after giving so much to so many for so long in this building that you're now able to start a new chapter and embark on new adventures that are gonna be filled with new achievements and new experiences. That's something to be very happy about. And at the same time, I'm struggling very much with watching the most fundamental relationship I've had in my personal life and my professional life as a mixture shifting, not closing, but shifting in a dramatic way. You have taught me and mentored me and encouraged me and listened to me and laughed with me for so many years and given of yourself so much, I can't possibly begin to articulate how meaningful it has been for me. And so I'm not gonna try. I'm just gonna say thank you for being you. The work that we do as municipal lawyers, as public lawyers, this is something that Assemblyperson Stone referred to is very much in the background. And that's appropriate. That's where we belong. One of the consequences of that anonymity is that people don't truly understand how much your judgment, your counsel, your guidance, your keen intellect works to help your clients get out in the world and do the good work that they do for the County of Santa Cruz. And I can only hope that in everything that's been said today, that folks, your friends, your family, your coworkers, people out in the world have even the smallest understanding of how much you mean to this County, the people in this building and the people out in our community. So I wish you the best, the greatest, everything good in your next chapter. Carlos. Dana, I just want to thank you very much for the time we worked together. You and I share the unique position of being the only two people who work directly for the board. And so that's a unique position. And the good thing about it is that we very quickly bonded and became friends and supporters. And I guess what I learned in the time that I worked with you is more than your professionalism and your ethics and your integrity is your heart for the disenfranchised and for the most vulnerable in the community. And that more than anything I admire. Thank you so much for everything you've done. Okay. I'm already on my second hand. And I apologize, but I cannot trust myself. I have to read this. I started to rethink doing this with Ellen, especially after Ellen, but thank you. Thank you. It was, I feel better now. I want to begin by thanking my family who have turned out in force here today. And I so appreciate it. My sister got on an airplane to be here. My precious daughter, Jasmine, her partner, Chrissy, my three siblings, my sister-in-law.  Which at this point is TBD because for me, this is the big party. And you are the people who matter the most. My mother was a Santa Cruz city and county librarian. And all of her children followed her into public service. Well, my brother owns a restaurant and bar, which when done correctly is a form of public service. Thank you for being here. Coming to work for this county after litigating for a multinational law firm was for me like coming home. And professionally speaking, I grew up here among all of you. There are far too many people to name who shaped and influenced my career, so I won't even try. But if you are in this room, you are one of them. Please know that I have appreciated each of you for your unique gifts. I will mention my practice of finding that certain person in each department who would always take my call, patiently answer my questions or find whatever elusive document I needed in order for me to do my job. Some were records clerks. Some were assistant department heads.  I was hired in 1997 by former county council Dwight Her. Coming from a legal environment where women were greatly outnumbered by men and the women who were there believed they had to be twice as tough as the men. It was a welcome relief to join an office that was gender balanced and led by a gentle soul. Dwight modeled for me that attorneys could be both competent and kind at the same time. Dwight also taught me never to get between a camera and an elected official. I thank Dwight for changing the course of my career and my life. First, Rangarcia and I and later Jason Heath and I tried to build on the foundation we inherited from Dwight. The office of the county council is a team of fierce lawyers and support staff doing our best work for the county but trying to do so with respect and kindness. If you are hearing this and remembering a time I was not kind to you, I apologize. I remember being devastated when Dwight announced his retirement and then again when Ron retired.  But remember that the work is the thing and it is bigger and more important than any one personality. I expect that Jason Heath will build on what we have done and make the office even better but don't feel compelled to tell me about all the great changes he has made. I am so proud of each of you and of us as a group. Finally I want to thank the board of supervisors. I thank you for giving us Carlos Palacios. The opportunity to work closely with Carlos these last several years has been incredibly meaningful to me. As for the five of you and those I served before you thank you for the opportunity. It wasn't always smooth sailing. After some controversial decision made by the board an angry letter to the editor printed in the Sentinel said the quote lesbian triumphant that runs the county has done it again. Ellen and I figured we were two of the three but we never figured out the third. Marty perhaps?  The writer of that letter did not understand sexual orientation or how county government works. All county power emanates from this five member body. There is no gridlock here. On most Tuesdays you make important policy decisions. I think it's important to remember that you are a member of the county and you are a member of the county and you are a member of the county. We are important policy decisions and we as staff have the privilege of implementing those decisions. As Susan Moriello always said staff drives the county bus. The board gives us the destination but we decide how to get there. If we forget that we are lost. In Susan's example she was always driving but Carlos... Carlos lets other people drive. My friend, Buck Delvinthal wrote I love public law because it lies at the crossroads of our democracy. I could not agree more. This is where the action is. Thank you for giving me a job I love in a community I love with all of you whom I love. Thank you for listening. Chair I would move the resolution and I also in addition to the resolution I will share with the community that we've also renamed the annual pickleball trophy after Dana is now called the McCray and I look forward to that competitive nature and I assume you'll be back for each year's game. Alright we got a motion by Leopold and a second by McPherson. All those in favor please say aye. Aye. Me deliver this. Okay very quickly a little housekeeping we are going to adjourn for 15 minutes there's a small reception out in the hallway and people should go out there and enjoy. When we come back we're going to take on our 1030 scheduled item which is the flood control zone 5. I also should note for anyone who's shown up who's interested in the item item number 16 which is the coastal element. We have continued that item until January 28th to give people more time to engage so that item will not be on our agenda today so you don't have to worry about that. So let's take a 15 minute recess we'll come back here at about 12.10 and for item the regular scheduled item. Call the meeting back to order.  We are going to move to our 1030 scheduled item which is the flood the board of supervisors shall recess in order to permit the board of directors of the Santa Cruz County flood control and water conservation district zone 5 to convene and carry out our regular our scheduled meeting and I'll ask the clerk to call the roll. Directors Leopold. Friend. Here. Caput. McPherson. Bertrand. Christensen. Turcunerty. Alright and are there any late additions? None. Are there any additions or deletions? None. Alright this is a first item is oral communications this is an opportunity for people to speak to us about items that are not on our agenda today but are within the purview of zone 5. Is there anyone here to speak? Seeing none. I will come back to item number 2 which is approval of zone 5 meeting minutes. I'll move the recommended actions. Second. Motion by Friend. Motion by Friend. Second by Leopold. All those in favor please say aye. Aye. That passes 4-0. Item number 3 as the board of the Santa Cruz County flood control water conservation district accept and file the first quarter report of the fiscal year 2019-2020 zone 5 expansion construction revenue as outlined in a memorandum of the district engineer. Thank you chair and directors. Matt Machado your district engineer. The item before you is our first quarterly report for FY19-20. The first quarter revenues include $14,250 in drainage fees, $19,080 in permit processing fees and $2,346 in interest and other revenue. The recommended action is to accept and file the first quarter report of fiscal year 19-20 for zone 5 expansion construction revenue and I can answer any questions you may have. Are there any questions? Is there any public comment? Seeing none I'll close public comment. Bring it back to the board for action. I'll move the recommended actions. Second. Motion by Friend. Second by Leopold. All those in favor please say aye. Aye. That passes 5-0. Item number 4 as board of directors of the Santa Cruz County flood control water conservation district zone 5 consider approval of the cooperative agreement with the city of Capitola as outlined in a memorandum of the district engineer. Thank you chair and directors. The proposed cooperative agreement is to allow and enable the city and other and or the Santa Cruz County flood control and water conservation district zone 5 to undertake maintenance or repair on certain facilities in the city without assuming ownership or control for purposes of establishing liability for the future failure of such facilities. I'll comment that this is a major milestone in the step in the right direction to better maintain infrastructure even if the ownership is unclear. And so our recommended action is to approve the cooperative agreement between the city of Capitola and the Santa Cruz County flood control and water conservation district zone 5 and I can answer any questions you may have. Are there any questions? This is a significant improvement a significant change. I appreciate the work both of council and of view Mr. Machado to get this done. All right. Is there any public comment on this item? Thank you. Becky Steinbruner resident of Aptos. Hearing your comment on ownership is unclear. I wonder if you can comment a little bit about that for the benefit of the public. Thank you. Sure. Yeah, briefly. Sure. So much of the infrastructure in this area is quite old. It's in the city limits but it's also within the zone 5 district boundaries and we do not have good documentation on the pure ownership but we do understand the value of the maintenance of the infrastructure. So we are committed to jointly maintaining and improving the infrastructure without necessarily taking ownership because of that maintenance. And so we don't want maintenance to trigger an ownership battle. We would rather just jointly maintain. I think it makes a lot of sense. So that concludes public comment. I'll move the recommended actions. Second. Motion by friend. Second by Leopold. All those in favor please say aye. Aye. That passes unanimously. We're now going to item number 5 consider approval of the 2020 schedule of zone 5 meetings as outlined in a memorandum of the district engineer. So item 5, correct chair? Yes. Okay. Thank you. And so the item before you is a resolution amending rules and regulations for operations of zone 5. Just quickly there's a handful of items that we're considering today. An adjustment to regular meetings. The original document listed us to meet monthly. We are now proposing four times a year. That's the next board item. So it will explain that briefly in a minute. There is an adjustment to the agenda materials to make them available 72 hours before the meeting versus the 14 day requirement prior. Order of business is being modified to include a consent agenda item, which is I think very valuable and will streamline many of our regular items. And then the next three, the election of the zone 5 board chair timelines for budget submittals and collection of zone 5 fees and audits will all are all being adjusted to accommodate the new revised annual schedule that we are presenting our next board item. But with that comment, our recommended action is to consider the changes as briefly described of zone 5 rules and regulations related to section 1.1, 1.6, 1.8, 1.11, 3.4, 3.5 and then to adopt the resolution amending resolution number 4-89Z approving set amendments. And I can answer any questions you may have. Any questions? Any comments from members of public? Seeing none, I'll close public comment bringing it back to the board. I'll move the recommended actions. Second. Let's go motion by friend. Second by Caput. All those in favor, please say aye. Aye. Opposed? That passes unanimously. Finally, item number 6, as board of directors of the Santa Cruz flood control water conservation zone 5, consider amendments to zone 5 rules and regulations related to section 1.1, regular meetings, sections 1.6, agenda materials, section 1.8, order of business, section 1.11, election of the zone 5 board chair, section 3.4 timelines for budget submittals, section 3.5 collection of zone 5 fees and audits and to adopt a resolution amending resolution number 4-89Z approving set amendments as outlined in the memorandum of the district engineer. Thank you, chair and directors. Item 6, we're on is the zone 5 board 2020 meeting schedule. The essence of the item is to schedule board meetings on March 24th, June 16th, September 15th and December 8th, all of 2020. The recommended action is to approve the 2020 schedule of zone 5 meetings. I can answer any questions you may have. Any questions? Any comments by members of the public? Seeing none, I'll bring it back. I move approval. The recommended actions. I'll second. Motion by Leopold, second by friend. All those in favor, please say aye. Aye. Aye. And so that concludes our zone 5 meeting. We will now adjourn to the next regular scheduled zone 5 meeting. We will return to our regular agenda. Thank you, Mr. Machado. We'll now move on to item number 9. But just to remind anyone who may have come to attend and hear item number 16, which is the coastal program, that item will be continued to January 28th. So you don't have to stick around for that. But item number 9 is to consider a public hearing to consider adoption of the California fire code, 2019 edition with amendments, adopt a resolution, finding modification of state housing law, reasonably necessary, adopt an ordinance, amending and updating the county fire code, chapter 7.92 of the county code, except the sequel knows the determination and negative decoration and take related actions as outlined in a memorandum of the director of general services. Do we have... Back to her office. Okay. I think she anticipated number 11 was going to be passed. And so... Okay. I don't know. We can... You want me to go around? No, no. Why don't we do this? That's fine. Well, we will now do item number 14, which is the public hearing to consider application 181263, proposal requiring commercial development permit and coastal development permit to construct a 33,010 square foot, two and three story mixed use buildings containing five retail tenant spaces and a leasing office and 33 residential units subject to a request for a 50% density bonus and two 3,230 square foot one story residential carports on a property located at 3911 and 3946 Portola Drive, a firm that the project qualifies for a statutory exemption from the California Environmental Quality Act and take related actions as outlined in a memorandum of the planning director. So do we have anyone here to present? Chair, I think that's Ms. Jeff's item. And I don't see her in the room at the moment. It's okay. I think Suzanne Suzanne he say is here. And I think that if you wanted to continue on to item. Why don't we do 11 and 12? Okay, we'll find something. Yes, we'll find something to do today. And a item item 10 if you. Okay. I remember 10 perfect. Oh, here's Ms. Jeff's. Okay. Well, you're setting up. Why don't we do it? We'll do items number 11 and 12 very quickly. 11 is to consider final reappointments of Julia Hill and Alan Smith to the Law Library Board of Trustees for terms to expire December 31st, 2020. Is there any public comment? Thank you. My name is Becky Steinbrenner. I live in Aptos. I have really appreciated the law library very much in my work as pro-par litigant against the Soquel Creek Water District. The staff there is phenomenal. The information there is so helpful. And I'm very grateful for this facility. I would ask that your board consider helping fund it better. It is funded by a small percentage of superior court filing fees. That has not changed since the 1800s when the law libraries as required by state law for all counties to have one. Their funding was established. They have a very lively scrabble game in the winter that helps them bring in a little bit of extra money. But this facility is invaluable for many people. I have spent many hours there and I've seen the good service that these people do not only in helping people learn about law and how they can represent themselves, but socially they give them the power to do something when they feel so trodden upon by the legal system or their neighbors. So I just want to put in a very hearty thank you for the law library and for these two people that you're now going to reappoint to heading over it. Thank you very much. Thank you. That concludes public comment. I'll bring it back to the board for liberation action. I move the recommended action. Motion by Leopold, second by Caput. All those in favor, please say aye. Aye. That passes unanimously. So for everyone in the audience, we are now going to do item number 14, which is the Portola Drive project. All the other items will probably now be moved to after our 130 scheduled items. So people don't want to stick around because we'll be going break and back for a 130 scheduled item. So just so people can plan the day. So I've already read item number 14 into the record. Ms. Jeffs, do you want to present? Yes. Good morning, commission. I'm to the board. Is the PowerPoint? I do apply. While just take this opportunity, just say that some additional materials have been handed to you. I received a request last night for one very minor change to the project, which we'll talk about in my presentation. The additional materials are the request for an additional concession based on the affordable density bonus. And there are revised findings and revised conditions that reflect that. But I will explain that as I go along. So the project's located on the north side of Portola Drive, one block west of 41st Avenue and Pleasure Point. It's in both the lower 41st Activity Center identified on the Sustainable Santa Cruz County Plan and the eastern portion of the area covered by the Pleasure Point commercial and mixed use corridor vision and design principles. It's also in the coastal zone. The subject property is currently developed with the committed tattoo parlor, the black pearl, and an unauthorized contractor's storage yard. To the south, east and west, the parcel is bounded by commercially zoned properties and to the north by a mobile home park. There are also non-conforming residences adjacent to the north-eastern and northwestern corners of the parcel. The surrounding commercial development consists of a mixture of one, two, and three-story buildings that include a chiropractic office, retail, restaurant, office. Residential and other uses including a vacant lumberyard. But it should be noted that a three-story mixed use building has already been approved on the lumberyard site and that a three-story mixed use project is currently under development for the adjacent chiropractic office parcel. The mixed use building will be located close to Portola Drive frontage with parking at the rear. From the street, the building will be two stories with commercial tenant spaces at the lower floor and residential apartments above. At the rear of the building, there are two stories of residential apartments over a covered parking area. The project also includes one-story carport adjacent to the northern property line. The 1.21 acre lot is located in the C2 zone district, a designation that allows mixed use projects and the zoning is consistent with the site's community commercial general plan designation. The project's been designed in accordance with the commercial uses chart which allows for the construction of residential units in the C2 zone. And as allowed under state and county density bonus law, a density bonus has been requested to allow for the provision of additional units and concessions have been requested to allow the residential portion of the project to occupy 73% of the total 33,010 square foot floor area of the development. The proposed mixed use building has been designed in accordance with all the required site and development standards, although a further concession has been requested to allow for reduced setbacks to the one-story residential carports along the rear property boundary. The mixed use building will be 41 feet from the non-conforming residential parcel in the northwestern corner and 86 feet to the parcel in the northeastern corner. Along the western property line, tall-over green trees are required to ensure privacy at the adjacent home and to provide a year-round screen. So the applicant, as I have said, is requesting a 50% residential affordable density bonus which would allow for 33 residential units and this is in exchange for the provision of four units that will be available to very low-income households. These affordable units will be regulated for a 55-year term and they'll be restricted both through rent and income limits. In addition to these four restricted affordable units, one unit is required to be designated as an on-site managers unit, which means that the 28 units that remain will be available as market-rate rental apartments. Under the density bonus provisions, up to three concessions could be granted to facilitate the development of the project. As set out in the staff report that you have seen, two concessions were initially requested. The first concession, as I've said, relates to allowing residential floor area to be 73% of the total floor area of the development rather than the standard 50%. The second is for reduced setbacks from the rear property line to the one-story residential carports at the rear of the site. However, the applicant has now requested a third concession. This would be that the payment of capital improvement fees to the county could be deferred so that payment would be due prior to building occupancy as opposed to prior to the issuance of building permits which is required in the current conditions of approval, and these are the revised conditions to change that. All the fees would still be paid. Deferral of the payment of county capital improvement fees is appropriate as it would reduce the upfront costs of the developer, resulting in a lower construction loan and interest charges, and thereby increasing the economic feasibility of the project. The granting of the two originally requested concessions is also appropriate because this would allow for the provision of commercial uses in conjunction with an increased number of residential units, including housing for low income tenants, and these would be constructed at a more affordable level. So per state and local law, the added units don't trigger any inconsistency with normal land use, designation, density, or zoning. The applicant has also requested state parking standards for affordable density project. The one-story carports will provide a visual transition between the proposed mixed-use building and adjacent single-story homes, and will screen the larger structure and views from the north. The reduction in setbacks is therefore appropriate, and it will also maximize the efficiency of the proposed parking area. The proposed mixed-use building has three levels. At the lower floor, there are five commercial tenant spaces opening onto Portola Drive, a leasing office, four residential apartments, including one affordable unit and a manager's unit, and entrances to the residential apartments above. The remainder is an elevator and mechanical electrical rooms. At the middle floor, there will be nine one-bedroom apartments, one of which will be an affordable unit, with 33 bicycle storage lockers and a laundry room, and at the upper floor, there are 22 bedroom units, two of which will be affordable, and these are accessed from a central open courtyard, and that building section at the top of the screen illustrates how those floors all stack up. The building has been designed to be visually compatible and integrated with the evolving character of the surrounding commercial neighborhood. The ground floor commercial area is open with lighting with high ceilings and extensive storefront glazing. The upper floor extends across the site frontage over the driveway in adjacent parking. The building has varied wall and roof planes and steps back at either end, as well as from the street, and includes cement plaster and natural wood siding. There'll be new tree planting along the project frontage and around the site, as well as within the parking lot, and this will, together with existing trees along Portola Drive, help to soften and visually reduce the scale of the development. The proposed mixed-use building is conformance with the county-certified local coastal program and will not impact any coastal resources or restrict access to the beach. In fact, it won't even be visible from the coast, and it's further consistent with the goals and objectives of both the Sustainable Santa Cruz County Plan and the Pleasure Point commercial and mixed-use corridor vision and guiding design principles. The proposed project will not adversely shade any adjacent residential structure, including the non-conforming residences adjacent to the northeast and northwest corners of the site. The project includes 4,915 square feet of open space for residential tenants, consisting of private balconies for the two-bedroom units, a landscape courtyard at the upper floor of the building, and a small landscape garden at the rear of the site between the carports. In addition, there'll be tree and shrub planting along the project frontage, retention of existing mature trees in the Portola Drive right away, planting around the project boundary, including evergreen tree species that will ensure privacy at the adjacent non-conforming residence, and landscaping with trees in the central portion of the site. In addition, concrete sound walls or wooden fences will be constructed along the property boundaries, and these will either be 6 feet or 8 feet in height as shown on this slide. Direct regional access to the site is provided by Portola Drive and 41st Avenue, as shown by the Project Traffic Impact Analysis. The mixed use development would result in low vehicle miles traveled numbers due to an improved jobs housing match and reduced commute distances. So as a result, the project will help to create a more sustainable community overall. The Traffic Impact Analysis also shows that trip generation by the project wouldn't significantly impact any intersections in the study area. However, as recommended in the report, to mitigate for future potential impacts at the Portola Drive and 41st Avenue intersection, the conditions of approval require payment of a fee to the county equal to the project's 1% proportional share of the cost of future improvements. This would be in addition to the roadside and transportation fees based on trip generation. The parking lot for the proposed mixed use development will be accessed from Portola Drive via a 26-foot-wide two-way driveway at the southwestern corner of the parcel route onto 40th Avenue via a 16-foot-wide one-way driveway. County code requires a minimum of 76 on-site parking spaces, which would be 53 for the residential use and 23 for the commercial use. As design, the project would include a total of 98 parking spaces, which exceeds the minimum by 22 spaces. Of the 98 spaces, 40 carport spaces will be assigned to the 22-bedroom units. 13 will be assigned for the 12-1-bedroom units and two carport spaces will be assigned to the manager's unit, one of which will be for the leasing office. The remaining 43 spaces will be available for shared use by commercial users and residential guests. To confirm that the proposed parking will be adequate for the development, a parking demand analysis was also prepared, and this study shows that based on the Institute of Transportation Engineers or ITE rates, the peak parking demands for the project are 59 spaces on weekdays and 54 spaces on Saturdays, which is significantly less than the 98 spaces provided. The parking study also includes analysis of potential restaurant uses and determined that even with the most conservative assessment, that there's sufficient parking to allow for a restaurant of up to 2,451 square feet. There's also a bus stop right in front of the property. The project is considered to be a large project by the Public Works Design Criteria and preliminary drainage plans have been reviewed and approved by the Department of Public Works Stormwater Management Division. So in conclusion, this project is consistent with all of the applicable codes and policies of the zoning ordinance and general plan and more further plan goals of attainable housing, a dynamic economy and sustainable environment. Mixed use development would provide community-oriented commercial uses together with 33 small-scale residential rental units, including four of which would be very low income and this is a housing type that's much needed in the community. Staff therefore recommends that your board determine that the proposal is exempt from further environmental review under the California Environmental Quality Act and approve application 181263 subject to the addition of a third concession request that the payment of capital improvement fees be referred into a prior to building occupancy rather than prior to building permit issuance and this approval would then be based on the findings and conditions attached to the staff report, all of which would be revised as the conditions and findings already have to reflect that revision. Thank you. That concludes my presentation. Thank you. Do we have any questions? Just one brief question and one request. The trees that are on Cortola now, will they be staying or will there be new trees? They will be staying and then there will be, in addition, there will be new trees, yes. And then just to the planning department and staff, today's meeting has a lot of planning department items. It would be great to spread some of these out in the future. That's not Ms. Jeff's issue, but there's a lot on the agenda and it would be helpful when we receive items like this that we actually get all the conditions of approval because it's just helpful to have that. I looked that up from the planning department and I'm appreciative that you gave that here today but it wasn't actually part of the electronic packet. I believe it was. It wasn't in my packet. It wasn't in my packet. Anyway, just something for us to keep an eye out for. Tree on the site now. Yeah, there are some trees. There are some cypresses that are along the frontage and those will go. They're sort of like a bush. Yeah. So these obviously are very preliminary plans. You can give me that answer later. Yeah, I would. There's going to be a lot more trees in there right now. Maybe when I get, we'll get the answer later. Yeah. Now is an opportunity for members of the public to speak to us. About 30. About this item. Would anyone like to speak to us today? Tim will be speaking for affordable housing now. I would just like to remind you that it wasn't so long ago when we came to you to push the idea of an enhanced density program. And so our tracking this is the first project from that change to come to you and you might remember it was pages and numbers and now we actually have something and the great thing about what we actually have is that the developer is doing the lowest level, the very low income units. And so this is a really great day and thank you for your previous vote to do that enhanced density program and I hope that you approve this. Thank you. Thank you. Hi. I'm MMS Rookie. Support the project, but it's like so short. Like can it be taller? Like there's a huge need for housing and like we could like how how so many more people in here. So I mean, yeah, it's good like it is hope you approve it, but like this could be taller and bigger and like we could have like more stuff in there and they'd be cooler. So yeah, hope it's bigger. Thank you. Speaker Thank you. Becky Steinbruner, resident of Aptos. I have. Thank you for the good presentation and I wonder if there are any plans to include solar panels on this structure. Will there be electric car charging stations in the parking lot? Where is the nearest transit stop in relation to this new dense project? How will on-site stormwater drainage be handled? There's a new and I couldn't really read the piece that you put up from Public Works about that, but there is the requirement that all on-site drainage be handled on-site and with it being so close to the ocean that is a very important thing to consider. And then finally, how much are the capital improvement fees for this project that the developer is being asked to allow to defer? Thank you. Okay. I think we're not going to go through each one of those because many of those were answered in the staff report, but I'm happy to ask Sure, the fees would be great. I calculated that quickly this morning and it's over 504,000. But it would still be it would just be later. Great. For that free additional community benefits that you articulated. So that concludes public comment. I'll bring it back to the board for deliberation and action. Thank you, chair. Thank you for the presentation and thank you for the work of the property owner. This is a project that was originally approved back in 2006. And at the time, our mixed use designations were pretty rigid. There wasn't a way to deal with it. And it caused problem with financing. I met with Abbas. I don't remember 2010 maybe for the first time on this project trying to figure out a way to put it together. It was not a great time to construct and get received financing. And then we've taken actions to think differently about development and provide routes. And this is the property owner has looked at a couple of different routes to get to where we are today. When there was a different proposal for this project it led to a community conversation in which our board asked our planning department to hold a series of workshops on the pleasure point commercial corridor. And those were good community conversations and I appreciate that the owner and his family attended. They were at every single one of these workshops in which over a hundred people participated in each one. And they listened to the community. And they've gone out of their way to engage the community to listen to their concerns and we have a good project here because of that. One that meets the standards that we set out in that public process that standards talk about an articulated third story because there was concern about a canyon being developed there. And I appreciate the thoughtfulness that went into the design to construct this and I think this is going to be a great addition to the neighborhood. The biggest concern is we saw from community members was concerns about parking and they've obviously exceeded the requirements for parking. And there was a additional operational condition that was added as part of the planning commission process if there was substantiated complaints about parking and I just wanted to add just one part of that. I'm not sure there's going to be whether given this parking addition but if there are substantiated complaints that we get a report at the planning commission 90 days after the complainants filed. So there is some way for people to know that someone is working on this rather than filing a complaint and nothing ever happened. To me to have a property owner who is interested in working with the community who participates in the planning process that listens well and is flexible. And there have been a number of issues that have come up. I appreciate the screening for the nonconforming house on the northwest corner. That's also I know you worked hard to make that happen as well. It really represents what good development should be in Santa Cruz. And I support this and I would make the recommendation that we do all the recommended actions and that we just add one thing on the operation and conditions E3 I think that's what it is. And just an additional sentence that says if substantiated complaints are filed a report is made to the planning commission within 90 days. All second. We have a motion. We have to add in the third concession. I would imagine it's a recommended action. So that's included. We have a motion and a second. All those in favor please say aye. Aye. That passes unanimously. Thank you very much. So a quick announcement for those watching at home. We will now take a lunch recess and return here at 1 30 for our regularly scheduled item. We will then hear item number 18 following that. And then we will hear items 9 10 12 following that. Chair with your indulgence the mobile home. I think we will have people showing up for the mobile home. So I just want to make sure we do that right after the SS3. Then we will go to those other following that will be 9 10 12 and 15. Good afternoon everybody. Good afternoon. Thank you for coming out. We are going to do our 1 30 scheduled item which is item number 17 that consider services program policy that manages secondary exchange by allowing clients who only exchange on behalf of others to exchange for a maximum limit of two people except in file and evaluation of syringe litter and direct the health services agency to return in June 2020 with recommendations to improve syringe litter reporting and response as outlined in the memorandum from the director of health services and do we have Miss Hall or Miss Herrera Dr. Newell okay great it is yes it is Miss Hall we are live and you are on as soon as you are ready yeah make sure it is on there we go apologies good afternoon I'm Mimi Hall director of the health services agency and I'm pleased to come before you today with a report back from two items that were left still remaining from our June 11th 2019 by annual syringe services report to the board today I have brought staff along with me that we didn't all have on board at that time I'm very pleased to introduce our health officer Dr. Gayle Newell she's going to be here to provide some introductory marks on the work that we've been doing since June and framing the issues as we need to consider moving forward we also have Jen Herrera our chief of public health the syringe services program sits within the public health division under her oversight we present the findings from qualitative and quantitative data that has been collected to better inform health services agency as we strive to develop impactful approaches to improving our county services and finally we have Rachel McCullis-Anden and she is an epidemiologist with our communicable disease unit under communicable disease manager Dr. Kelly DeBane and she's here to answer technical questions about data collection methodology and findings and with that I'm going to go ahead and turn it over to our health officer Gayle Newell thank you supervisors for allowing me this opportunity to give some background to the issue of opioid misuse the most common form of substance abuse disorder among intravenous drug users in our county as I'm sure you are aware our county is not alone in the struggle to adequately address this issue in 2015 the drug enforcement agency the DEA stated that drug overdose deaths from opioids had become an epidemic in 2016 the center for disease controls director called for urgent action saying America is awash in opioids in 2017 the food and drug administration called opioid addiction its biggest crisis that same year at the urging of the US Surgeon General and especially appointed commission the president declared our country's opioid crisis a national emergency every day more than 130 people in the United States die after overdosing on opioids the misuse of and addiction to opioids including prescription pain relievers heroin and synthetic opioids such as fentanyl is a serious national crisis that affects public health as well as social and economic welfare the centers for disease control estimates that the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion every year including the cost of healthcare lost productivity addiction treatment and criminal justice involvement how did this happen in the late 1990s pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers and healthcare providers began to prescribe them at greater rates this subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive opioid overdose rates began to increase in 2017 more than 47,000 Americans died as a result of the opioid overdose including prescription opioids heroin and illicitly manufactured fentanyl that same year an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers and an additional 652,000 suffered from a heroin use disorder opioid misuse and overdose are seen across the population crossing all socioeconomic strata to include the young and old, the rich and poor male and female the consequences are heartbreaking and very personal right now I'm going to put aside my health officer hat for one minute and speak as a mother three years ago I lost my oldest child to an opioid overdose right here in Santa Cruz he was 38 a beloved dentist a brilliant musician and an artist he was living at home with us in our two physician household he recognized that he was using his younger brother found him unresponsive attempted CPR and watched as paramedics tried in vain to resuscitate him his death has rocked our world our families and a great circle of friends and loved ones beyond that from the belongings and journals he left behind we have been able to piece together his path to self-destruction it started it turns out 20 years earlier as a student at Santa Cruz where he dabbled in heroin briefly before completing a methadone treatment program at UC Santa Cruz student health almost two decades later after graduating from dental school he began to write narcotics prescriptions for himself presumably for recreational use then he wrote the minist patient's name which he would fill for his own use as say prescribing practices came into practice making this more difficult he turned to mail narcotics from the US and Canada the DEA cracked down on those so he ordered from Mexico India and China when this also became impossible he turned to the streets to heroin he went back to the very same dealer he went to 20 years earlier by the Santa Cruz beach boardwalk his autopsy report lists his cause of death as an accidental overdose of opioids and fentanyl the circumstances of my son's tragic death play out over and over again in this country once every 10 minutes in fact since the late 1990s opioid use has skyrocketed across America deaths due to opioid overdoses have quadrupled since 1999 drug overdose deaths are now the leading cause of injury death in the US higher than motor vehicle accidents and the leading cause of death overall in people under 50 years of age and the opioid deaths are just the tip of the iceberg for every death uncounted numbers in our community are impacted by the misery of addiction beyond families the opioid epidemic affects entire communities and presents a grim challenge to healthcare providers law enforcement and our society as a whole not only is our country number one in prescription opioid use per capita but we use 80% of the global supply of illegal opiates in California as in our county the opioid epidemic continues to evolve and impose a serious threat to the health of all individuals in order to effectively address the opioid epidemic it's important to recognize that opioid abuse and overdose are closely tied to other trends in the state as California has seen rising rates of social inequities, homelessness mental illness and despair the state also has seen an increase in opioid abuse addiction and overdose deaths especially among those most marginalized in our society so what can we do opioid misuse affects families and communities it's a challenge to healthcare providers to law enforcement and to society as a whole it's a multifaceted problem that calls for strong partnerships to combat it we need to approach it as we would any other epidemic with prevention, containment and treatment treating it simply as a moral or criminal issue will not work the syringe services program is one part of the solution thank you Dr. Newell indeed this is a reminder of the impact of syringe services and how it is one piece of the larger system of care during HSA's syringe services program biannual report on June 11th 2019 the board provided seven directives today our board item concerns two of these directives directive number one which was to return with a plan to manage the secondary exchange program and directive number three to collaborate with the California department of public health to complete a study of syringe litter and report on the findings we requested a deferral to report on these items from September 24th to December 10th in order to have more time to complete the evaluation which has informed our recommendations today this presentation provides a high-level overview of the county SSP an overview of our evaluation activities since June 11th and our recommendations in addition to excuse me syringe services supports the entire community not just those who inject drugs they promote safety by increasing access to safe syringe disposal methods and by decreasing the prevalence of communicable disease and infections in the community published research in our own evaluation indicate that people will utilize a safe means of syringe disposal when it is accessible in addition to providing clean supplies that decrease the risk of acquiring an infectious disease SSPs collect syringes and encourages safe disposal methods to eliminate syringe litter SSPs are a nexus of services connecting a population that often feels stigmatized in traditional healthcare and social service settings because what good is a system of care if people aren't accessing it our community has mobilized through efforts like the SafeRx Coalition to increase the number of medication-assisted treatment or MAP programs SSP provides a venue to engage and re-engage with people building a trusting relationship that increases the likelihood of accepting a referral to enroll in MAP a CDC-funded study of California syringe exchange programs found that for most SSP participants contact with SSPs was the only contact they had with healthcare or social services of any kind SSPs make our system of care more effective they also promote our community's resiliency and increasing deaths associated with drug use like Dr. Newell many in our community have loved ones struggling with drug use losing our loved ones to an overdose or an infection related to use of unclean needles is traumatizing and preventable they also provide an opportunity and safe space for self-empowerment encouraging those who inject drugs to make small incremental steps towards a healthier life free focus areas in the community syringe distribution and collection safe syringe disposal and enhanced referrals and linkages for SSP participants the program operates at two fixed locations the county's Emmeline campus in Santa Cruz and the Watsonville health center each location has limited hours partly due to direction from the board for our program policy we are a syringe exchange meaning that we do not provide syringes to participants who have no syringes to return we also limit the number of syringes to exchange each participant is allowed a maximum of 100 syringes to exchange per their encounter our program does allow for participants to exchange for others referred to as secondary exchange with the same restriction of a maximum of 100 syringes per person we have unlimited syringe collection through the regularly serviced public syringe kiosk and the exchange sites at times people will attend SSP just to dispose of used syringes additionally our all staff are trained in providing referrals and linkages to social and medical services our staff consists of mat workers nurses health educators and trained volunteers as the board has directed us on June 11th we are also working on improving our method to accurately track the linkages from SSP to the county clinics mat program from July through November we have outreach to the community in order to inform our recommendations today we met with agencies who regularly collect syringe litter in the community this includes the county's department of public works the needle solutions team clean team associates downtown streets team and save our shores we outreach to all city jurisdictions in the county following the board chairs letter to all jurisdictions to encourage collaboration with us to install syringe kiosk and we conducted two community listening sessions one in Santa Cruz and one in Watsonville Rachel our epidemiologist who led the implementation of the syringe litter evaluation will provide an overview of the project thank you Jen I would also like to acknowledge my fellow epidemiologist Jessica Altman and Michaela Katen here today who did extreme efforts of analysis writings and contributing to this evaluation alongside with many other supporters I was hired to serve our county with expertise after working in Cameroon for three years implementing a nationwide HIV survey funded by the U.S. Centers for Disease Control and Prevention led by Cameroon's federal ministry and Institute of National Statistics as a proud Santa Cruz county resident it has been an honor to strategize and work with the professionals and experts we have here who care about each member of our community to implement this evaluation it has been an incredible opportunity for all of us to assess syringe litter with our tireless surveyors and inspiring downtown streets team we appreciate the board's support to both count and to better understand the origins of this litter through conducting 133 individual anonymous field surveys across the county and for focus groups in addition to the extensive counseling of the visual inspection through this we can't begin to reduce how much without understanding when who how and most especially and compassionately why I will review some of our key findings after Jen shares our community values in these past few months we have found that there are many shared values in our community one of which is the value of a safe challenges and access many individuals who inject drugs personally express concern with improperly discarded syringes similar to similar to concerns heard in the larger community as one focus group participant shared I've always been more on top of that sort of thing because I stuck myself with a needle even before I started shooting and so it kind of irked me and I go out of my way to dispose of them another shared value among the participants of the evaluation and the larger community is accountability in the words of one of the focus group participants you start somewhere just having clean needles okay I'm taking care of myself a bit sometimes that snowballs into I don't want to use as much as I have been you know it can that's what harm reduction is start somewhere lastly compassion was identified as a shared value most notably through the community listening sessions and the focus group during the listening sessions there were many suggestions to integrate robust programming in the county such as HIV and Hep C testing counseling and peer education a participant in the community listening session said it's not just about the needles make them feel like people SSPs including the county program provide education training and distribution of Narcan a life-saving medication that reverses an opioid overdose this quote from a focus group participant highlights the compassion they feel for their community by being trained to provide Narcan I can't tell you how many people I've had to bring back with Narcan in the past couple years but grateful for the opportunity to do it our outreach to the disposal organizations was centered around identifying the locations of syringe litter in the county the conversation was extremely productive and help inform the visual inspection of the syringe litter evaluation it also led to our partnership with downtown streets team the participants at the meeting noted that the majority of syringe litter is in north county that the current system to report syringe litter and community acquired needle sticks is a confusing for the public and that all of these organizations have a method for documenting syringe litter and are willing to share their data with the county the cities of Santa Cruz and Watsonville have demonstrated a willingness to collaborate with the county to install syringe kiosk additionally the city of Santa Cruz their robust syringe reporting database and dashboard a great model to inform HSA syringe litter surveillance lastly at the community listening sessions there is a clear desire to learn more about the program and for the larger public to be considered when planning syringe services there was a lot of concern and confusion regarding secondary exchange and many suggestions to improve the accessibility of SSP services in the next few slides Rachel will share key findings from the syringe litter evaluation first and foremost we're all here today because syringe litter is not acceptable we are here in part to understand the magnitude of the problem and effective steps to potentially address it with our cross sectional approach to this evaluation we had the opportunity to canvas areas of most concern in our county and compare counts to kiosks in the same area at the same time the slide says 10 and after recent recalculation the correct number is actually even lower at 7 syringes out of a thousand are improperly disposed an overwhelmingly positive statistic this finding can bring us reassurance but not allow us to rest on our laurels we will need to work with the organizations collecting syringe counts to systematize identification telling and reporting so that we are together I don't know which button to use thanks did that work okay great key finding 75% of our survey participants properly disposed of syringes three quarters of participants reported a proper disposal practice as their most common method while some participants also reported inappropriate disposal practices that could contribute to reuse or public safety hazards either way harm that we would like to support avoiding there are barriers to safe disposal hearing from the individuals disposing multiple barriers to safe disposal were common including limited operating hours and locations of designated disposal sites and lack of transportation or mobility to them as a public health professional we have responsibility to prevent, address and control disease including health conditions that can impact individuals and our community we found that fragile health is impacted by limited supplies among survey participants a scarcity of safer injection supplies was associated with riskier injection conditions like reusing their syringes when they didn't have clean ones and sharing with others housing instability was associated with reuse and sharing syringes which are behaviors often indicative of inadequate supply as we approached individuals in public spaces our survey was biased towards finding people who were unstably housed it's also a population we would like to make sure we are serving well and to understand what they are facing also with sharing needles with others we were able to establish networks of people that can both be used also in better situations when they are cleaning when they are sharing clean needles which some participants reported as well can I ask I'm sorry to interrupt but so I understand and this was we asked you to do this report quickly and so it says it's not a rigorous population study but it's a good overview of what's going on in our community so given the practices that you find why is the city of Santa Cruz just the parks department not citizens not public works where are those needles coming from where because if everyone is disposing of them what's going on or when we had the Ross camp we had disposal boxes right there we had needles being distributed on a daily basis and yet if not thousands of needles were found there there didn't seem to be a barrier there so what's going on in your professional opinion from an epidemiologist point of view I love your engagement in questions and my mind is exploding because you just asked 11 and a half and I'm like ooh we could look at it like this or like this what time period who's collecting what methods what database let's get together let's figure out how and so I'm excited to explore all of that I don't have that data on hand I don't know if any of my colleagues wanted to better answer that and I get it it's complicated but when we asked for a needle study we weren't asking for an access study we're asking for a needle litter study to really understand where the needles came from and what we're going to do about it and so it seems as though we have hard reporting of at least 4,000 if you assume all the community finds and the needle Santa Cruz finds we're at 10, 12,000 in a city of 60,000 people that's it seems like we should have some sense as to where where those needles are coming from right and that is exactly why we wanted to also ask access and disposal questions to understand why and where they're coming from to better to better answer directly your litter evaluation question and I understand we're against the clock and we've got lots of opportunities here I'm happy to describe the methods of this evaluation which were we took into account reports of considerations from community sessions from your reports from other organizations of where they're finding needles from expertise of downtown streets team from and the community organizations also described we took the lists of those neighborhoods we canvassed those neighborhoods we made polygons on maps we taught the individuals the surveyors in downtown streets team leading that visual inspection to engage on a methodical route to go up and down certain sidewalks we had tally sheets that CDPH helped us to create to tally and differentiate between syringe litter with and without needles and then what we did is we tallyed them, Michaela Caten mapped them she's very familiar with GPS and sorry not GPS, GIS and we used the resources we had on hand with google maps we counted we juxtaposed those counts against the kiosks in the same neighborhoods at the same time and we wanted to present back to the board as requested an evaluation of the litter found where it is and then speaking with the individuals engaging in injecting drugs in those same areas and asking why are they here why are they not here what are you thinking about what are your problems because we can go and count syringes all day and we don't know why and how what are we going to do about it I don't know I don't inject drugs but I'd love to understand from people who do I just think when we have a data point that 99% of needles are properly disposed and yet there are far more needles in excess than 1% that are found than how do we some important data points that we have collected that are included in the report but we couldn't put everything in our slides of key findings is that there are other sources of needles accessibility besides the county syringe services program and needles are you can purchase them there are other sources one of the things that we do know is we are not just a distribution program we are a collection program and one thing that we do know about the kiosk that was placed at the gateway encampment was that we service that 2, 3, 4 times more often than other kiosks and often it would be full we also notice that folks who are there as well as in other places if they didn't have the ability to use a kiosk they would find other methods put them all in a bucket put 12 of them in a cup so it was their method of finding help inform us of how we can improve safe disposal please continue sorry oh yeah I've got these slides okay thanks no problem we're done with that one we can go to the next one this is my last slide in a common complaint expressed by our survey participants was that the county SSP services are limited in hours and locations leading to scarcity both supplies and safe disposal options which was really rich information to hear from them about how we might be able to help one participant said there's nothing wrong with Emmeline the county SSP site in Santa Cruz right now just accept that there's really specific hours it's not a lot of hours if you're out here in survival mode and if you're on the west side and trying to get to Emmeline it's a long way to go members and leaders in our community may have different ideas about how we should address syringe litter secondary exchange and program services with this evaluations data we can agree that syringe litter disposal and access are inextricably linked when we believe our neighbors who inject drugs when we listen to what they share with us we find that our residents who use SSP are more likely to dispose of syringes properly and care about the health and safety in our community more comprehensive findings and data as Mimi was saying in our reports the summary infographic that's available here today the risk of infectious outbreaks paper that the Communicable Disease Unit put together and other resources are all available on the SSP website okay thank you Rachel Jen and Dr. Newell before we discuss our recommended actions I wanted to first of all thank the staff and all of their hard work and the community partners who showed a great deal of enthusiasm for participation and coming together to address the multitude of issues that come along with having a county syringe services program I'd like to because we didn't have the opportunity to provide this full report and it's rather lengthy although I do believe its methodology is excellent I'd like to present how we look in the board how we arrived at our recommendations recommendation one is to approve a policy that manages secondary exchange by allowing clients who only exchange on behalf of others to exchange for a maximum of two people effective January 2020 this is a very difficult recommendation for me to make as a public health professional it does not follow public health best practice in terms of aids the CDC expect of syringe services programs however we know that in the public health profession we are all dedicated to the common goal of improving the human condition we're responsible for upholding the integrity and ethics of our profession as we try to make very difficult daily policy decisions and we also have to balance the right of individuals who we're seeing in our programs to make informed decisions about their health and minimize risks with also respecting the rights of all community members who hold diverse values, attitudes and opinions the feedback that we got from the community listening sessions, the numerous emails I've been copied on that have also gone to the board of supervisors have told us that our community is concerned with the volume of syringes that are a part of our syringe services program and they're particularly concerned with the volume of secondary exchange the reason that we came up with this particular recommendation is that our data mining showed us that when we look at those who exchange on behalf of others we have three categories of clients one category is a client who exchanges only for themselves, they're the primary user the other category is exchanging for self or others so that's a combination of primary and secondary exchange the third category is exchanging only for others and when we looked at that third category the numbers of clients were very small in comparison to the entirety of our client database but the amount of exchanges were high sometimes 15 to 30 exchanges before we put caps on our numbers and what we're trying to do is a couple of different things we're trying to preserve a method for secondary exchange through peer networks through folks who are exchanging for themselves and others we're also trying to preserve the ability to exchange only for another person because we have many clients who have been coming to us for years who exchange for a loved one a partner, a family member a roommate and for many reasons people don't want to avail themselves directly of using our services and we want to keep that door open but we also have heard that the community is concerned about what seems to be a medium point in legal syringe distribution in California there are two ways to legally distribute syringes one is through a properly authorized syringe services program which is our program authorized by you as our governing entity you can also be authorized by the state the other way is legal purchase through pharmacies or online and and the feedback that we heard is that much of the work of a local coalition has been running a large scale secondary exchange program without the benefit of all of the other resources and services that we have wrapped around our staff I think it's important for me to let the board and the public know about the difference between the county syringe services program and the harm reduction coalition the main difference is that the county is the only legally authorized syringe services program in California however volunteers of the harm reduction coalition have operated under the law by registering as clients of our syringe services program the similarity is that we all work towards the same goal which is a healthier community and I believe that that's a goal that almost everybody in this community shares so acknowledging that our recommendations today do not reflect public health harm reduction best practices we also recognize that our program has limitations and those limitations result in barriers to people accessing our services our goal is that with this recommendation number one we will also work on adjusting our hours we got a lot of really good feedback from the client focus groups about accessibility in our hours and we hope that what we will do is not only affect one end of the spectrum by constraining one area but make efforts to improve access to our onsite syringe services program you will recall that in June we did come to you to expand our services at that time we had hoped to not only expand our hours but also provide mobile syringe services through our homeless persons healthcare project field services team at that time the board was not ready to approve those recommendations but we hope that with the data that we've collected today with the future focus that we are going to have using the evaluation results of our syringe study to work with our partners on a centralized system of syringe reporting and collection that over time we'll be able to come back to the board with those same recommendations of expanding access to services but we recognize that there's a lot of work that we have to do right now to provide the utility of our program with the barriers to access are so that we can come back to the board with recommendations for expansion so I have before you the three recommended actions as in this slide which are to manage secondary exchange by limiting exchange for others only to a maximum of two people accepting the evaluation of syringe litter that we've done in partnership with the state department of health and directing HSA to return with our recommendations to actually our goal we talked about this our goal is zero syringe litter and we are in line with I think everybody in the community including the clients that we serve that public syringe litter is unacceptable and we believe that we can get there with the good data that we've collected and the pledges of partnership with our community partners thank you. Thank you. Now it's an opportunity for questions from the board thank you chair thank you for the report and the research done it provided a lot of information to me which I appreciated I just had a couple questions and I'm sure off comments later you're not coming to us with any expansion of ours although all the data seems to suggest that better access to more hours would actually help could contribute to reducing syringe litter so what you talked about moving hours around but what would be the trigger to actually come forward and actually propose that we have more hours? Yeah actually we may come back to you in June of 2020 once we have a better understanding of what our proposal will be for the syringe study we'll also have a few months behind our belt of seeing what the impact of managing secondary exchange but also making other efforts beyond changing our hours to increase primary exchange it could be that this hypothesis isn't true I think that the I think that there is a hypothesis that if we manage secondary exchange we will increase those who utilize primary exchange I hope that that's true I don't know if it will be and I think that the data will show us if that's true and we're all about data it informs us as to our next steps I think earlier today Supervisor Coonerty in giving kudos to Ellen Timberlake talked about process we could come up with some solutions right now to say this is what we think will work but it wouldn't be based on good information, good data stepwise process and studying the impacts of that stepwise process so that we have a better sustainable longer-term outcome but I do expect to come back to the board after we take a look at how these changes have impacted our program with suggestions thank you one of the other things which I don't see listed in here is recommended actions and was vaguely referred to in the report was those that reported throwing their needles in public places in order to avoid contact with law enforcement and the testimony from some of the focus group participants who said they had received tickets for paraphernalia so my question is are we going to be doing any training with local law enforcement so this is less of a problem so they're aware that people can carry these around that this doesn't become a reason why people might actually dump their needles in places where we don't want them yeah I don't know if you want to answer that Jen or you want me to take it sure I can start so when we outreach to the city jurisdictions both of their in Santa Cruz and Watsonville both of their chief of police were there and this evaluation really opened up doors for us to start developing stronger relationships with law enforcement there is a lot of research that shows the benefits of having a strong partnership not just a collaboration but a partnership with law enforcement and syringe services programs and it's something that we hope to institute here really during the past five months we've just been able to scratch the surface of what opportunities are there between our collaboration yeah I think to me the data pointed to both those things better access likely through our hours and better training for law enforcement that doesn't become a reason why if we were looking for reasons so I'm slightly disappointed with the recommended actions because I'm not sure they get at the core of the problem I understand the recommendations and I look forward to getting the additional data but it just seems like we're missing some gaps in what we were told and what we're actually going to do this is a sad story and I think it's a great frustrating one first I want to really thank the health services agency for the report that they've provided in conjunction with our state and local partners as well I know it's just a new effort to see to get some important perspectives into our IV drug use in our community and those horrible statistics that were rattled off earlier I think many of you who have recognized for their cooperation in collecting survey results for us and collecting discarded needles in our community and to the members in the community who participated in our public outreach sessions as well I support the collection of more data most especially in the number of SSP clients who get referred to medically assisted treatment but we need to do everything we can to strengthen the connections we have in the county with Santa Cruz and Watsonville to help drug users get more treatment and reduce harm to families and that might be an extension of ours as was mentioned or that might be needed I'm also happy to see a better document when community members are stuck with needles in our parks and other public spaces families in Watsonville and Santa Cruz and elsewhere need to be assured that they will have safe public spaces that's something we hear day in and day out and understandably so but I also want to acknowledge that SSP is really designed to deal with the aftermaths of a massive drug addiction problem in our community and throughout the state and the nation as was mentioned in other words our HSA or health services agency really has not caused this drug addiction problem it is trying to prevent our community from the communicable disease outbreak while at the same time trying to protect the innocent public and the general public from getting stuck by a needle in public places like beaches and parks there's really a much broader discussion that needs to be had on how prevention treatment law enforcement and the court system can all work together to come to a reasonable program that we can help alleviate this whole issue and I have repeatedly heard our health services staff tell us that they would like to increase the number of IV drug users receiving primary care that's also something we need to address but the primary exchange is where folks access our professional public health staff and get referrals to treatment and other services we want to encourage that under the circumstances that we face today we have no guarantees that these interventions being offered with the secondary exchange and that is really interesting to me so I believe we need to take action today to bolster our primary exchange program and I have an idea of a motion but I would rather wait until we get other comments and certainly from the public before I make that right. Do you have any questions right now? Yeah, thank you thanks for all of you we're all are most of us almost all of us want to make things better so even people that have showed up they might have a problem with something that we're suggesting but our intentions are all in the right spot so I want to make sure that we're we're not we're not encouraging the use of anything we're just trying to make it public in general and we're not enabling it anyway someone to continue using illegal drugs just like we would not encourage somebody who has an alcohol problem by handing them a whiskey bottle or whatever so we're if I showed up and I missed the opening this is just an example and I show up and I miss the needle exchange or whatever and do any of the other clinics that we have are they able to give out any syringes health clinics like the new one in Watsonville if I miss the current hour. So in answer to your first question are we encouraging attracting enabling drug use no the people who come to see us are in the throes of addiction and what our data shows is that if they don't have clean access to a clean needle either through us or through another venue they have reported that they will either reuse a needle or share a needle so all of the research both our local research and everything else in fact that syringe services programs do not create drug use or enable drug use on the other hand they do if you don't have access to them they inhibit safe practices as far as south county we have we are the only authorized syringe services program in the county and we're authorized by the board of supervisors however we have two locations one is here at the emeline clinic and one is at the Watsonville clinic the Watsonville clinic which is on the same campus of the new behavioral health center that you visited on Friday and thank you for your presence there that has very limited hours it's five hours a week and again we made a recommendation back in June for the potential of providing needles along through our SSP program and our field services but the board did not approve that at that time we believe particularly in Watsonville that would be incredibly helpful but again we know that we have some work to do in terms of collecting data regarding safety utility those kinds of things but there is access in Watsonville through our program it's about an hour a day which is very limited and we hope that someday we could expand that okay now to get rid of the old used syringes the kiosk is open 24 hours they are some however some of the feedback that we got from folks in our focus groups and our survey were that fits in a very open location people were reluctant they didn't want people to see them utilizing them or maybe have law enforcement because of their perceptions follow them from them so as Jen mentioned some people come to our program just to dispose of syringes and they don't ask for more in exchange they don't need them yet so it's important to remember that our syringe services program is both a collection and a distribution how many kiosks would be in the Watsonville area well you talked with the city of Watsonville how many did did they identify locations already I don't think we've gotten to the point of identifying locations just interest in installing a kiosk and so far we have one in Watsonville over at the Watsonville health center okay and some participants won't use kiosks because they have to hold on to their needles until they can exchange for new ones oh so they I see much man they wouldn't drop it off because they wouldn't get the exchange right there'd be no way to exchange for clean ones okay and I guess the last thing I would like to know is when they come in does somebody tell them if they do want to quit the habit this we have other programs that they can sign up for and you know yes that's part of the exchange encounter and they have a one on one when someone comes in for exchange they have a one in one sit down encounter with one of our trained staff as we are asking what supplies they want we always first of all we always offer a safe syringe disposal bin a sharps container and encourage the use of that provide you know any counseling around if they have any challenges around using a container and we do provide linkages to any social medical clinical including medication assisted treatment services it's one of the reasons why we have integrated some of our clinic Matt staff to work SSP in order to engage with the SSP participants so that when they are ready or if they are ready to access medication assisted treatment they have a established rapport with a Matt counselor already okay well that makes me think of with the kiosk back to the kiosk if we had a few more of them somebody putting used syringes in that doesn't mean that they used them it could be the people that are upset about finding it around their neighborhood they go out and pick it up and then they go and put it in so I don't know if that's something that other people would like to do you know in their neighborhood they don't want their kids or anybody to step on them or pick them up and get stuck so I don't know if that would help or not you're the experts so would it help to have more kiosk I think our evaluation showed that excuse me because I have a call meaning I don't want another needle in exchange I just want to get rid of this stuff so our evaluation demonstrated that if kiosk are available in areas that are non-stigmatizing you know for instance not in an open street not in a pharmacy somewhere where they can discreetly dispose of syringes then participants will use them so that's what we found in our evaluation okay thank you so I think it's helpful to go ahead Supervisor Caput you also asked about where someone might be able to obtain syringes outside of our scheduled hours and so there are two ways that they can get them besides from a syringe exchange program or a syringe services program and that is that their physician any physician can write a prescription and if they have insurance or including MediCal or MediCruz the syringes will be covered by insurance or any individual may go to a pharmacy and buy them for cash yeah how much are they 50 cents a piece on Amazon in bulk they're about 20 cents a piece so I think that was a good insight from the report about where this where the chaos would be most effective let me ask did we contact the local pharmacies to find out how many needles they sell in a given year that wasn't part of the this evaluation based on the timeframe that we had not to look at but we have we have actually been outreaching to pharmacies just for our general program planning to assess who is collecting syringes and who's selling them right and obviously that would include people who much a broader population than just IV drug use but it'd be good to know that in the report I think of everyone you interviewed no one said they got them online so I'm assuming that that's not a regular source for people to all the people you interviewed yeah and I would note that the people that we interviewed as you can look at the data the majority of them are homeless so we targeted certain populations so it's not the general injection drug using population but just a cohort that we happen to interact with and did we ask the police departments for how many citations they wrote for owning drug paraphernalia again for the span of this report and the scope of just looking at the syringe litter we didn't get there I mean I understand that there may be fear and stories and perceptions I'd be shocked if barring other than a major case that anyone's ever been anyone's getting excited at all for these for having needles just having needles is the sole citation and I think we in the syringe services program look forward to working with law enforcement to look into this matter more because I can understand your comment but it is the perception leads to syringe litter yeah no absolutely and then finally I think I talked about this yesterday so Santa Cruz County gave out almost 600,000 needles last year San Mateo County Santa Clara County and Monterey County gave out 454,000 needles combined their populations are 10 times our population so on a per capita basis we're giving out 14 times more needles than all three of those are adjacent counties combined so what is going on here that 30 miles in any direction is a totally and their disease rates are lower for the most part than ours are and their poverty rates are higher in two of the three counties so disease there's no the correlation between needles and prevalence of disease isn't there the correlation between poverty isn't there like what what is going on what can we learn from the adjacent counties because it just seems that we are an order to a magnitude greater situation and that the only county that I can find that's anywhere close to the county that we are that we are San Francisco and not surprisingly we are the places where people are talking about needle litter as an epidemic and in other communities while it comes up it doesn't so like what is going on here that is different from every other county around us if I could just give a first reply on a data level and then if there's other strategic responses I did write down earlier to look into comparison data with other counties I'm also interested in that information and why and my mind immediately goes to different biases or sampling or reporting mechanisms you mentioned poverty rates if in richer counties people are getting more from online and therefore it's not reported in those numbers I'm talking about needles dispensed by the county so this is all that is needles dispensed by the county and then the disease rates presented by the county and then and then obviously the overall population but two of those counties have much higher property rates than we do I appreciate you getting a head start on that data and I can think of some reasons why some of those numbers may be related or there may be other considerations and we know that people with and without jobs access needles in different ways and can change the way numbers are looking at I would love to sit down with those numbers confer with my colleagues, reach out to colleagues in other counties I think there's a lot of questions there that need to be answered I want to sit here and pretend like I can explain all of that to you I don't know but I think we need to look into it I mean I think I'm interested in learning I think everyone here is unanimously supported needle exchange year after year after year we believe in it as a disease prevention mechanism we believe in the need of it but there's a question of do you do it and then there's a question of how you do it and then the question is do we have a 14 times addiction problem as everywhere else 40 miles away from us so is it like we had a crisis that is unmatched in the rest of coastal california so I will say I had a meeting with supervisor community yesterday where he posed this question and you stepped out of the room and then he did a little bit of research and so preliminary research that SAFARX did as part of a nationwide network of SAFARX coalitions showed that some of you may know that the opioid epidemic came in waves and in all of those earlier waves Santa Cruz county did have poor outcomes in terms of number of accidental opioid deaths a number of different factors which hint to the fact that yes in comparison to other bay area counties and that data is available on the SAFARX website under HIPC I think it's HIPC.org there's also something called the national opioid dashboard or maybe the California opioid dashboard and you can see how different counties have different experiences and so the answer to your question is yes through the trajectory of time we have had if you could call it a more serious opioid problem than our partner counties in the bay area I cannot answer why I think the answer why is more complex I urge the board to have this kind of thinking the number of syringes that we distribute which also means that we collect just as many if not more is not indicative of how well we're doing in our substance use disorder problems or the degree of there can be counties that have a great degree of addiction but for political reasons or other reasons they simply don't have an exchange or they have a very constrained syringe services program I think when we come from a public health perspective and we're trying to reduce disease transmission and risk we look at the existence of risk and that risk exists if we have people who inject drugs and we do and our data shows that we do and that risk exists when they don't have access to clean needles I mean it's as simple as that so if we can eliminate that we can eliminate the presence of needles the need for a needle exchange and my dream is that someday we get there but really the truth of the matter is data does show that we are somewhat different from our bay area counterparts I cannot tell you why and together we're safeRx working with a lot of other community partners have worked to address that problem I think I also mentioned to you that I happened to work for the county that at the time this early data was collected it was in around the 2010 to 2014 area the CDC ranked counties in California in terms of number of opioid deaths it worked for the county with the highest opioid death rate in California the highest we had more deaths in Santa Cruz county with a population a tenth the size a very rural community with a lot of hard work and effort that included a syringe services program we've brought those I'm talking about Plumas County to zero to zero so it's possible and we did it with a safeRx coalition we did it with safe prescribing practices we did it with a syringe services program but it's a multi-pronged approach and it gives me hope that the public health approach really does work and I believe it and I like as supervisor McPherson said the number of needles we're handing out that's a downstream that's a downstream indicator right and so the more we can get upstream the better it is for needle letter the better it is for people suffering from opioid the better it is for community impacts thought the whole thing but we need to understand where we are and what's going on and to our to your department's credit this morning we approved three or four major investments in medicated assisted treatment and in expansion recovery beds and other things and I think you know we're all on the same page but it just seems as though this attitude this these numbers are worth understanding what's going on again under the premise that we all believe the CDC we all believe needs to be a needle exchange we all know the costs of not having a needle exchange and we can go forward I will say I appreciate your comments and your direction this morning to come back with further information in a study session because I agree I think that there is a broader issue at hand that it's important for us to report back about especially our increased efforts around prevention as well as treatment I'm now going to open it up for members of the community and I want to make just two comments because we got a lot of emails the first comment is as I said that this board is unanimously and consistently exported needle exchange and nothing changes nothing's going to change around that the second piece is there is a community group that has put an application to the state to do a secondary needle exchange with using volunteers that is not before us today that's a different matter right now we're talking about the county's program and the rules and sort of approaches of the county's program so please line up if you'd like to come forward ready? yeah good afternoon regarding the item before you I would encourage you to consider the history shown by the board and the agencies it oversees without listening to people before you give consent to include a syringe advisory commission into the county ordinances and waste everybody's time regarding the secondary exchange proposal and this is not that state application you just referred to I would remind you that SSE in any form contradicts and therefore undermines the primary goal of the syringe services which states the primary goal of the SSP is to work in partnership with the community to help prevent the spread of infectious disease associated with injection drug use to early identification of injection testing referral to treatment community education behavioral counseling and providing harm reduction supplies through a syringe services program none of these aims can be accomplished via SSE it requires that clients actually visit healthcare professionals in a clinical setting and not encountering activists and the weeds it requires that exchange of injection equipment be offered as a gateway to county services and not the primary service offered as is and has been the practice I would stress heavily the need for county program to expend all efforts in blood screening and early identification of infectious disease and to collect this data in order to establish a baseline for best practices unfortunately this is a ground up proposal but our county's health officers much like the rest of the state do not have an efficient means to collect data on infectious disease the report before you states California according to CDPH office of AIDS 30% of syringes distributed by SSPs were through secondary exchange networks this would indicate that 70% were dispensed via contact by healthcare professionals locally however those numbers are flipped by a red flag that our program is failing with all due respect I'm a really visual person and an evidence based medical professional too so one day after winter storm I started this process a year ago because this is what I found last year with my 7 year old daughter walking on the beach I almost lost my brother to drug addiction too I was a drug user on the streets too luckily he had the Santa Cruz AIDS project he dealt with medical people, volunteers who held him accountable one to one exchange every time he came in there was compassion there was training there was professionalism there was accountability you asked a question why Santa Cruz has this problem it's called enabling we have a serious drug culture here in Santa Cruz where when you do this kind of thing nothing happens to you you see that sharp tip you see all that blood in the chamber but a family has to go and now has to take their child to urgent care they can't test this needle to tell you right away if you have been exposed all they can offer is a cocktail for the next 6 months to a year of testing so that then you can figure out if your 5 year old has HIV or hepatitis C it's unacceptable we have enough syringes since 2015 syringes have been available for purchase for 50 cents law enforcement does not cite these people go look at the data 2015 you can walk into any pharmacy right now they will give you a free sharps container with your pack of 10 syringes if you can buy a bag of heroin you can afford 50 cents for yourself this is what gets dumped in your bin community members who pick up these needles if you are aware that there is an existence a single syringe container or pocket container made to contain a single syringe it's puncture resistant leak proof designed to not easily be reopened one field and readily identified by biohazard other cautions, symbols and words with this single sharp container just snap the used syringe into the container snap it and close and it's concealed out of harm's way in California full home generated syringes must be properly discarded by placing them in a syringe kiosk or collection site such as a participating pharmacy police or sheriff department or medical facility the containers are readily picked up melted into non-infectious masses of plastic and then buried in secure areas within landfill in most other states these same full home generated syringe containers or even syringes with sealed bleach or laundry detergent containers can go directly into one's trash but I visualize what could happen garbage truck comes picks up this large container it gets compacted and it's possible it could crack spill apart and you have possibly infectious syringe litter in landfill I doubt though because of the size of a single sharp container that this was dumped in the trash we'd have the same outcome those syringe litter will never completely disappear a packaged syringe convenience kit consisting of a syringe that's sterile and its own sharp container will provide sterile syringes as convenient as possible and will help reduce loose syringe litter the California department of public health is an advocate for safe and harm reduction can I have another minute I can't do another minute because then I have to give everyone else another minute but I think as always you're always welcome to email us set up a meeting with the health department staff no I can't because otherwise everyone else can ask for another minute as well we have many items to get through today but you're missing the whole point well I think if you can find someone else who will finish it or you can email us and when we have a time to read it and I can't have people give up their time so email us set up a meeting talk about it in more depth can I have another minute please no we've got the point I don't think you did no we did we've got the point email us or set up a meeting with the department staff they're happy to talk to you in detail I also live in Seabright and I don't recall anybody asking anybody in Seabright how we felt about this Mimi seven needles this morning and 15 minutes that was just my little walk thankfully I didn't have my grandson or my granddaughter with me we have to do better this is insane thank you good afternoon concerned citizen recovering addict minute actions I would fully support item number one and item number three throttling back the secondary exchange which has poached so many clients from the main primary exchange and the accessibility to medical treatment or advice that needs to happen I would not accept the evaluation of syringe litter in item number two data is from the beginning failed because the returned needles in the kiosks are not counted they are weighted so it's a guess as to the percentages of return needles it's a guess as to whether or not it's garbage or needles in that weighed bag or in those weighed containers that's the best they can do if they're not actually looking at them and counting them you can see the ones laying on the street in item number four five you can't see the ones in that kiosk all you can do is guess the weight and hope that if they're not full of water or a water bottle that's where that data is flawed even with our best evaluations it starts off flawed as recovering addict member of this community that cares I would like to avail myself to the board of supervisors Mr. Coonerty for the committee let's have a member committee that's being established of the voice of an addict who's lived it and been through it and been able to get out of it on that committee to help balance the one-sided reporting that happens in situations like this if you would like to talk to me I'll send you an email thank you good afternoon board I retired yes a year ago from the county health department where I worked as a epidemiologist I worked in vital records I know something about drug deaths from that I worked as the HIV surveillance coordinator and so I know something about the spread of blood-borne disease from that I just want to focus on one thing here there's an ill-informed emphasis on the numbers of needles given out and on the secondary exchange and a key point with regard to both of these syringe services program takes in more needles than it gives out as you've heard pharmacies provide needles pharmacies will provide needles sometimes free I guess pharmacies will provide needles at a moderate price the number of needles being given out by pharmacies is probably responsible for the difference between what's given out by SSP and what's return the concern about the secondary exchange people talk about somebody came in for a thousand needles which seems like an insanely large number I agree the point is they don't get that thousand needles unless they bring in a thousand needles and so they're not being given needles to go and distribute to all their friends to give away and throw away they're being given needles to replace them unless they collect back needles so the syringe services program is a net benefit to the county purely in the sense of reducing needles in the community good afternoon my name is Brad Angel I'm from the Grant Park neighborhood group we've met with most everybody and it's been wonderful so we live near the inline county campus and we started Grant Park neighbors last year almost exactly a year ago largely because we began in December 2018 to directly do the impacts of the existing county programs arguably how they led to the closure of the neighborhood park and that was closed for an extended time the impacts were so bad in the park area in the park itself that many of the actual neighbors wanted to close the park and completely get rid of it because they felt like it was an attractive nuisance and it would never be remedied by anything we did but we did start volunteering and then we worked with the city parks department we also worked with the police department and then we also adopted the park as a group and we feel like it's really helped a lot and now we understand the difficult task that you guys have especially leadership in the county but we would really like to have direct engagement with the HSA in the future especially going forward and in conjunction with the city and the county leadership and for no matter what course you take sorry and then we'd also like to ask directly that you expand the downtown streets team from the inline campus down to the park if possible and then also if we could have some sort of security like we've gotten from the city on the ocean side we'd really appreciate that between the inline campus and the park and that's it thank you so much for your time thanks for your work hi my name is Lisa Bates I live on Emeline I've lived on the corner of Emeline and Button for 21 years and the last six years have been really rough I've had impacts from there being that campus of the street but when I took a leave of absence and returned in 2013 I didn't recognize the neighborhood anymore I was unable to sleep through the night because people are screaming obscenities throughout the night that's the same time period that the SSP was relocated to Emeline campus and the opiate crisis was exploding the location of that campus has a huge impact on our neighborhood which is a traffic corridor for people with addiction services, mental health and multiple other services related to health and poverty public transportation is inadequate to serve the campus currently daily foot traffic brings litter including needles and other injection kit plastics screaming obscenities domestic fights on the street shooting up in our yards thefts, threats, harassment, drug dealing and vandalism I've had people threaten me with knives because I asked them to stop cutting my flowers multiple cars stolen things stolen out of my yard shoes, packages, mail it's just two vehicles stolen, multiple hit and runs my neighbor has had no less than five vehicles totaled on the street there other neighbors have had similar totals I've had experiences of nearly being hit while walking my dog while people are trying to access the methadone clinic when it's getting close to closing they drive extremely aggressively and will not wait for you to get out of the way it's just become very stressful to live there mental health in the community down, people are selling their homes and leaving property values are down I would really appreciate mitigation of the impacts of the Emeline campus on the immediate neighborhoods surrounding it we experience much more impacts from that campus than anybody else in the city and I support the Grant Park neighbors recommendations of engagement and security thank you hi I'm bob card and I'm also with the Grant Park neighbors I think what you heard is an unintended consequence of the Emeline campus I don't think there was an intention to cause all of that but there's a tremendous disruption in that neighborhood and what we want to do as you heard from our director Brad Angel when he came up first is we'd like to more just more engagement we'd like to have maybe quarterly meetings with health service agency and the Grant Park neighbors and local law enforcement because we think that the if we're going to find that humane solution to how do you deal with all of these problems of people who have to go on to campus to get help and make it compatible with the neighborhood we think it takes a neighborhood participation for that and I don't think again there was an intention to create a corridor of special problems but that's what happened and so we're asking for some work with that thank you very much hello Kelly lifelong county resident various parts of the county former prescription opiate addict and semi-frequent volunteer with secondary exchanges I want to share some perspectives first of all thank you for all the data that's been collected it's good to have it on the books even though it's just purgatorily redundant of folk knowledge that people have known forever extended hours would be great different locations the locations are not always accessible those are the biggest problems that have existed for ages with these things but until those things are addressed I believe secondary exchanges are kind of crucial because what we are doing is not poaching clients we are reaching clients who the county is failing we are not taking people away we are finding the people who are not accessing your programs and we are serving them that's why I believe that recommendation number one is ludicrous limiting non-users exchange to only exchanging for two others will directly impede people from helping their loved ones helping their loved ones loved ones people frequently use in clusters you have people whose all their friends are addicts exchanging for only two people doesn't really make sense especially because secondary exchange we frequently interact with people who I like to think of as tertiary exchangers these are people who come to us out of the pogo nip out of other unincorporated areas of the county in the really inaccessible places and they themselves are exchanging for upwards of five people we use sharps containers we collect those things we bring them back to the county restricting that just doesn't really seem effective not going to appeal to a motion there it's just logistically ineffective hi my name is Matt Nathanson I'm here I'm a resident of Santa Cruz city and county for the past 25 years partly I'm here just as a resident and a voter to say that I support the continuation of a syringe exchange program and figuring out ways to expand it and make it work better the last several speakers really talked about unintended consequences and I think some of the conflicts you all are dealing with so on the one hand people are talking about as there are more people accessing services at Emeline they feel that it has an effect on their neighborhood on the other hand what we hear is people saying is don't do secondary exchange we want to bring more people into Emeline so there's and you know there it's just an unintended kind of conflict there I do the last speaker spoke about secondary exchange I really want to support her point which is I think as somebody who's worked as a public health nurse I think what we need to be doing is figuring out how to work with those people in the community are doing the secondary exchange because they are actually people who can extend our ability to outreach people in the community of people who are using substances and in doing this work if you can't build trust with people you're not going to get them into treatment you know I wasn't able to get people into treatment because I was smart about treatment or I'd gone to nursing school I was able to because I worked with people I met them where they were at these are folks who are doing that too so I think rather than saying how do we cut off secondary exchange I think we need to figure out how do we work with secondary exchange to expand our reach as a county it is sad and crazy to me that the that you know I read this report and it says you know restrictions on secondary syringe exchange are not supported by evidence based best practices or findings of the syringe access and disposal but so it's sort of politics over science so my politics says I'm going to vote for a board that supports doing this work right thank you hi my name is Nicholas Andrews I've been living in the county for about 45 years I'm a member of the Grant Street Park neighbors and I'm here to really speak to what's happening downstream that was mentioned and how it's impacting the neighborhood and proposing some of the solutions are anything with regards to expanding the hours of the safe injection needle exchange and part of that would be transportation was mentioned and the idea that there is no transportation that these people are unable to come to the needle exchange and so what's happening I would we would support some kind of studied for transportation needs as well as again the expansion of the downtown streets team to help pick up the litter and the detris that follows the people that are coming to the needle exchange okay and we'd also would like to support security expansion the security that is also available at street to be part of the Grant Street neighborhood because the idea it is the behaviors that are associated with the needle exchange beyond the needle syringe litter that needs to be addressed and be considered by the board by any expansion of the needle program and that's why I'm here here thank you thank you hi my name is Kate Garrett I am a volunteer member of the harm reduction coalition of Santa Cruz County and I'm just here to speak in support of the county SSP and I know that the recommendation made by the county is only to limit just essentially exchange of people only exchanging for others but I just want to say that I beg you to not restrict that middle group of the peer support network that would be horrible that group of people who exchange for themselves and others is critically important peer support is critically important secondary exchange is enabling peer support which is I think a great thing to enable and I heard it mentioned earlier that was like oh these other areas have more problems for less are giving out less needles but they have higher poverty rates but Santa Cruz County has one of the highest homeless youth and child poverty rates in the area and that is a really strong indicator of when there's going to be drug addiction problems I've been a lifelong resident of this county I'm a former drug user and I started using when I was a teenager and I think it's pretty shameful that people who really have mental health problems who are struggling who deserve dignity and our parts of our community are repeatedly shunned as being lesser or that they should be more at risk and that they should just deal with having what I think are basic human rights restricted and limited and there's a lot of people who honestly can't afford needles and like you say oh if you can afford heroin why can't you afford needles I think that that's like pretty ignorant of poverty and like the very very limited budgets that people actually operate in and I just wish we had more compassion for these people who really are at the lowest points in their lives and if we just gave them a little bit of a helping hand they could get up and yet we just keep pushing them back down and I don't really understand it so yeah thank you. Hi there my name is Danny Drysdale sorry I didn't bring any bottles of dirty syringes I prefer to dispose of those properly as we do with the harm reduction coalition of San Cruz County by the thousands and thousands every single week and I want to like lift that up for secondary exchanging and all the different ways that people access the SSP other than primary visits all of those are really critical points for people to be able to dispose of dirty syringes which means less syringes on the street so the more restrictions you put in the more caps that go on to the number of syringes people can get the less people will use the program the more visits will actually go down and the more needles will see on the street and as a addict and as a queer and trans person it's a deeply important issue to me continuing to fight disease fight HIV fight hepatitis C and also just to give addicts like myself some sense of dignity when they are being served they are being given these services you know and it's just really frustrating to come into this room and see all of this dehumanization all of this anger and it's putting a lot of people like our county health staff who are doing terrific terrific work and brought back an amazing report it's putting them in a really difficult position they are totally against best practices like it's just an absurd way to be doing public health and it's really hard to watch thank you good afternoon supervisors monoconic first district a successful needle exchange program doesn't just provide needles it provides information, treatment and connection to more services and I want to just point out a couple shortfalls I see in this report around this so let's talk about testing today's report is long but we still don't know how many patients have received an HIV and Hep C test what are the numbers without testing data we don't have we without testing data to go on all we have are self reported cases and we really don't know if the syringe services program is meeting its goal of preventing the spread of infectious diseases without testing we are also failing to give patients the invaluable service of information imagine you are an intravenous drug user in a tent in the woods with your friend Sally with one needle left between you at 11pm at night what better way to prevent the spread of disease from you to Sally than knowing you have a disease what if I told you that not only is the syringe services program only open three days a week but disease testing is only available on Mondays we should expand that to every day the syringe services program is open treatment is the other part of helping patients and in June of this year this board requested that the program report the number of patients successfully referred to MAT treatment Medicaid assisted treatment today's report says that we can expect that data in 2021 two years later I believe we need that information within a month of today so that we have a baseline for understanding program performance I'll just finish by saying that we should design this program to go to the users of injection drug go to injection drug users rather than forcing them to come into the MLI neighborhood and provide patients with complete care when we do see them thank you thank you so much resident of Santa Cruz county medical family physician have been working with SAFAR in our community in 2015 with the intention of decreasing death in our community related to opioids we've expanded our mission to include all substances I want to appreciate the work of our county and I think the county has been very sensitive to some of the political pressures that you are all expressing where your constituency are asking you to decrease secondary exchange and to not offer evidence based approaches and I really appreciate that tension it makes me very sad that we haven't done a good job we medical providers have not done a good job at sharing what science has told us in terms of addressing epidemics such as the one of the HIV epidemic that we were all part of just a few years ago we need to bring up what we've learned from the HIV epidemic and bring that to the SSP but I really want to honor the integrity that our county has put forth here for you today they're really following your directives and trying to work collaboratively collaboratively with you but I would like to go further and hopefully follow what the CDC and the California Department of Public Health recommend in terms of secondary exchange I think of collaboration and education together I encourage all of you to come to our SAFE Rx meetings so that you can all learn Bruce McPherson Mr. Caput about the questions you asked and what you asked as well let's work together please and use evidence based principles to guide our SSP thank you so much Hi my name is Patrick Fitzgerald I live in the San Lorenzo Valley I'm a graduate from Cabrillo and UC Berkeley and I don't really have an opinion on this needle exchange thing I just want to say that in a lot of ways I don't recognize a lot of what's happened in this county over the past 20 years or so going to Cabrillo here in the 90s I remember we had a little bit of a heroin epidemic there in the Pogo Nip I remember hanging out here in the 80s watching the Mexican gangs move into the beach flats and take over selling their hard drugs there and I don't know what to do about the needles but I'd just like to talk to you supervisors and say the first thing I'd like to see is something about enforcement and get this heroin off our streets get these hard drugs including the methamphetamines out of the hands of our young people and our kids early so they don't become addicts and we don't have this problem that's my take on this whole thing I don't know what to do about needles on the beach it makes me sick to see that my beautiful town and county has come to this it's kind of a sign of our compassion to let everybody come to Santa Cruz and welcome them with open arms but then you have to welcome everybody the addicts, the street people the homeless I don't know what to say that's it, thank you so that concludes public comment I'll bring it back to the board for deliberation and action thank you everybody for showing up today there's no question this is a very intense subject there's a lot of different thoughts but my goal is to return to primary exchange levels stronger levels our primary exchange has dropped as secondary exchange rose or increased and I think that isn't a good target I would like to make a motion in following some of the recommended actions that are up on the screen the recommendation one to do to follow what that says but take out the word only who exchange on behalf of just take out the word only there and I'd like to make a motion also like to see if we could add two additional hours to both the Santa Cruz and Watsonville sites that these exchanges take place accepting the evaluation syringe litter that we've heard from is fine, number two a third recommendation would be to HSA to return to the board on or before February 12 with the contract or contract amendments with providers to collect additional needles in the hot spots and we know where they are we're pretty well identified in the community the downtown streets team has done a tremendous job I don't know what the cost of that would be but I'd like to know that and then I'd like to have an additional section to set a future board study session by March 20th, March 2020 on the IV drug crisis facing our county to include requesting presentations from the sheriff's office the superior court the health services administration on law enforcement a criminal justice system treatment and prevention efforts being made data being made to address this crisis I think we need a collective direction to address this issue which is very complex and so that would be my motion I'll second that and I guess the only thing I'd add is I think we need we need more people interacting with our professional staff because we need to get people and we need to expand treatment options I think expanding hours to see if we can meet some of the need is important and I well I do believe it's the best practice I am told every week by a mother or a grandparent that they no longer take their kids to parks I just was told yesterday by mom that took their kid to a park here there was a needle in the sand and she'll never take her kid to that park again and when we have 60% obesity race obesity rates among our children it's evidence based that you create safe places for them to go and that you create neighborhood parks that they can walk to and we have I am I hear it all the time that the community that I grew up in the parks that my wife went to a quarter mile from here parks that I went to a mile from here as a kid the people I grew up with will no longer take those kids to those parks you heard it from grand street parks where the neighborhood was actually advocating to close a public park to get rid of a city park because they felt like the impacts were too great so while there is evidence based in one category this is a complex problem that we need to look at from a community wide perspective and while we absolutely have to have a needle exchange we have to get more people connected with treatment we have to understand what's going on with some of these numbers and where the gaps are in treatment and what we can do to fill it we also have to understand and have a plan and in place at the county's cost to get these needles picked up it's not the citizen's job to be out walking beaches parks picking up needles it's not the parks department workers jobs to be out picking up needles it's the county's job to be out there across this community and I think this interim step right away a contractor whether it's the streets team or another team to be out there in these hot spots is a good relief but we just this current situation is completely intolerable from a public spaces point of view and we need and in a declining contact among our professional staff for testing and treatment and we need to make some changes in order to do that I the four of you have listened to what they're saying out there and it's hard to it's hard to figure out exactly what you know is going to be the solution but we're going to try and all I can say is that we listen to what they're saying and we try to you know figure it out now what what exactly did you want to change as far as put in the direction okay well to follow the threes that are up here with the elimination of the word only on that number one and then the addition to return before on or before february 12 with a contract or contract amendments with providers to collect additional needles in the so-called hot spots in the community that's really centered in Santa Cruz and Watsonville and then additional direction to set a future board session to by march 20 with the sheriff's office the courts the health services administration to give us an overall view for how we can address this crisis okay what about scott's valley or whatever well I did that up to the so-called hot spots that I don't have the all of them identified but normally I know in my district up in the Felton bridge area by the river usually it's by rivers that's where it is I think in Watsonville as well so I think there are some identified hot spots that needle collection primary I mean the most needles are collected in the community just a quick comment on the parks I agree with you and one of the problems real quick is the schools now are fencing off the schools and locking the gates so kids are actually walking past school grounds and they can't get in and then they keep walking and walking and then they're all going to a park so by limiting the amount of park space we're concentrating it on our parks if the schools would open up their gates on the weekends and after school that would disseminate some of this you know piling up at one spot okay thank you thank you chair thank you for the testimony today thank you for the presentation I I had the good fortune of accepting an invitation to the park neighbors to do a cleanup I see Nicholas here who I was on the street with and I came back with a real clear sense and talk with our staff and we're going to be starting a downtown streets team effort there in February and so that's a long line of what my colleagues suggested the impact of the neighborhood is real I don't doubt that it's hard near any public facility and I think that I was hoping that the maker of the motion might take as a friendly amendment that HSA have some regular meetings with the grant park neighbors to provide an opportunity to exchange information and ideas I'm not sure it would just be limited to HSA but you might have HSD in there as well because the impact is not just from one agency it's obviously from all the agencies that are there would you accept that as a I'd accept that that's one of the spots I was thinking about yeah I also I think that I'm going to go along with this because of the conversation we had at the front end which is we're going to collect some more information and we're going to come back I was glad to see my colleague suggest a modest amount of hours increase because I do think that that goes along with what what we heard in there in the information I think that this is super challenging and I'm not an epidemiologist to have a better sense as to why more needles here than other places I can think of lots of different reasons I don't know what the pharmacy sells here I don't know if there's more pharmacies there I don't know if they sell more needles I just there are lots of different ways that this could cut and so I you know I understand the frustration but I also