Okay, so good morning, everyone.

Like to call the health committee to order for June 8th.

Clerk, take the roll.

Supervisor Tam.

Present.

Supervisor Miley.

Present.

All right.

Any instructions?

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And for remote participation, follow the teleconferencing guidelines posted at www.acgo.org and use the raise your hand function.

So if you can just join me in the Pledge of Allegiance.

Pledge of allegiance to the flag of the United States of America to the public for just undergoing indivisible with every day at Justice Floor.

Okay.

So the our first item today.

And I know they're going to be pretty lengthy, but our first item is something that I've been waiting to have a follow-up update on county staff when we first when we first discussed this months and months ago.

So I'm really pleased that we're having this today.

An update on PFAST and how we might consider approaching this concern.

So I think we're gonna be starting.

I guess Dr.

Moss, you're you're kicking things off, and I guess we've got a whole line up here.

All right, let's do this.

Thank you.

Good morning, supervisors.

I'm Dr.

Nicholas Moss, Alameda County Health Officer, and I'll be leading off the PFAS update.

Thank you for having this session.

While we're um just getting set up here, the purpose of this presentation is to share additional information with the committee and county residents on PFAS with a focus on drinking water.

We last presented in June of 2025 on considerations for possible county actions related to PFAS.

Fostering partnerships, education and outreach, and policy advocacy emerged as potential areas of focus.

We're returning today to provide additional information about PFAS impacts and response, having engaged several of the experts on the front lines dealing with PFAS and drinking water here in Alameda County.

And then we'll hear about PFAS health effects.

And then we'll hear from two of our local impacted water districts, Zone 7 and the Alameda County Water District, and then we will get a community perspective on PFAS and health, and then I'll close out with just a few more county health updates.

I'll introduce each speaker as we go, and we'll do our best to move quickly because I know it's a full agenda today.

So just um a brief refresher on PFAS.

PFAS are PER and polyfluoroalkyl substances.

I'm on slide five here.

And they are a family of molecules characterized by carbon chains with multiple bound fluorine atoms.

They are uh human-made and they are very resistant to decomposition regardless of heat, uh water, oil exposure.

Um, and they have been in wide use since uh they were uh synthesized in in um uh around about uh 1940.

Because they are resistant to decomposition they accumulate in our environment and foods and in our bodies.

Next slide, please.

Oh, that's me.

Apologies.

So this slide shows a uh a list of examples of uh common products that contain uh some of the many thousands of man-made PFAS or human-made PFAS chemicals.

And from these products, they find their way into our environment, into our water, into our landfills, farms, and our food.

And as I mentioned, our bodies.

So on that note, I'm going to introduce our first guest speaker, Dr.

Chris Banks.

And I believe Dr.

Banks is online.

Dr.

Chris Banks is a senior toxicologist and chief of the water toxicology section at the Office of Environmental Health Hazard Assessment or OEHA with the Cal Environmental Protection Agency, where he conducts human health risk assessments for chemical contaminants in drinking water.

Dr.

Banks has a PhD in environmental toxicology from the University of California Riverside, and he's gonna uh talk to us about health effects from PFAS.

Dr.

Banks.

All right, thank you, Dr.

Moss.

Hi, yeah.

So as he said, my name is Chris Banks, and I am a uh senior toxicologist at the Office of Environmental Health Hazard Assessment, and I'm going to discuss a little bit about the uh health effects of PFAS.

So next slide, please.

So I just wanted to say that uh the work that we do at the California Environmental Protection Agency, which is comprised of various organizations, the ones that are in blue here on this slide, and our sister agencies, including the California Department of Public Health and the California Department of Food and Agriculture.

We've all been very interested in PFAS for the last decade or so, and we've been all working on various aspects of PFAS to kind of understand their impact on California.

And so my work at the Office of Environmental Health Hazard Assessment has been focused on the health effects of PFAS.

Next slide, please.

So I am the chief of the water toxicology section, and we have done a lot of work in uh deriving drinking water advisory levels for various PFAS components.

Um, and these include public health goals.

And so, what a public health goal is it's the level of a chemical contaminant in drinking water that does not pose a significant risk to health over a lifetime of exposure.

So the idea being that you can be exposed to chemical at the level of the public health goal and not experience any adverse, significant adverse effects.

And for carcinogens, we do set a risk level at one in one million extra cases of cancer over a lifetime.

So public health goals do undergo scientific or external scientific peer review and go through multiple periods of public engagement.

So it is a uh process where we do listen to feedback, we do uh reach out to the public to get their um to get information from them and get their thoughts on our process and everything as well.

So there is a lot involved in it.

And the public health goals serve as the scientific basis for California's maximum contaminant levels or MCLs, which are set by the state water board, and those are the regulations for those chemicals in drinking water.

Uh we also at OEHA develop or we derive notification level recommendations for the water board.

So notification levels are health-based advisories for chemicals that do not have MCLs that are set by the water board.

And with the idea being that if a chemical level exceeds the notification level, uh the water board recommends that the governing body notify consumers of that water that there is has been an exceedance and what the potential health effects are.

Uh the water board also sets response levels uh for carcinogens.

This is 10 times over the notification level and well, I'm sorry, for non-carcinogens, 10 times over the notification level, and for carcinogens, 100 times over the notification level.

And if the response level is exceeded, the water board recommends that uh the water be taken offline or there be some other interventions being put in place to uh reduce exposure.

Uh next slide, please.

So we have developed uh public health goals for two PFAS, uh perfluoroctinoic acid or PFOA and perfluorooctane sulfonic acid, PFOS.

And uh we derived both uh the PhDs for cancer effects and we derived health protective concentrations for non-cancer effects.

Uh they're basically the same thing.

We chose the lower the lower value as the public health goal to be the scientific basis for the MCLs in California.

So uh next slide.

Or highlight.

Yes.

So we are um I'm gonna talk about PFOA first.

So the public health goal is set at 0.007 parts per trillion.

So that's very low value.

And our non-cancer health protective concentration is set at three parts per trillion.

It's based on liver toxicity.

And I'll talk a little bit more about the cancer effects on the next slide.

So next slide, please.

So when we were working on our driving our health advisory, we evaluated so many studies.

And we found a really strong association between PFOA and cases of kidney cancer in humans.

So the epidemiology data were actually pretty strong.

And we found four very good studies that show an association between kidney cancer and PFOA exposure.

And those top two studies, the Sharer study and the Vieira study had good data that we were able to do dose response analyses on, and we were able to actually derive a public health goal from these data.

So it was actually quite fortuitous that we were able to do this in humans since uh humans are the direct target that we're interested in.

And unsurprisingly, because it is in humans that did drive the number very low.

So 0.007 parts per trillion is an incredibly small amount.

Next slide, please.

So in addition to cancer, there are a number of additional toxicities that are associated with exposure to PFOA.

And I'm not going to go through every point here, but what I want to illustrate is that many different physiological systems are impacted by PFO, including the immune system, livers, there's liver toxicity, we see perturbation of lipid homeostasis.

There's toxicity of the thyroid, developmental reproductive toxicity, and other additional toxicities that we see.

And one interesting thing about the PFAS that have been well studied is that we do see a lot of similar trends across them.

It's not exactly the same types of toxicity, but uh we do see lots of uh toxicity across multiple systems.

So basically it seems like PFOA and other PFAS have a very high toxic potential.

Okay, next slide, please.

Okay, uh for PFOS and uh next slide.

Uh we also did a public health goal for PFOS, and this is also based off of cancer.

So the public health goal is set at one part per trillion, and this is based off of liver and pancreatic tumors in animals.

Uh and we also had a health protective non-cancer health protective concentration of two parts per trillion based on increased total cholesterol in humans.

And uh in the next slide, I'm gonna show a little bit of the cancer data so you can see this.

So next slide, please.

So uh the human data for PFOS were not quite as strong as PFOA.

And so our best cancer studies came from an animal study, this Buton Hoff and Tomford study, where uh rats, both males and female rats were given PFOS in their diet for two years.

And uh in the male rats, the data is shown here.

Uh, we see a significant increase and a positive trend in the hepaticellular adenomas, and we also see a positive trend in the pancreatic eyelid cell carcinomas as well.

And so, based on these data, we were able to calculate a uh public health goal of one part per trillion.

Uh, next slide, please.

And much like PFOA, we see a myriad of additional toxicities associated with PFOS exposure.

Um, you know, immune system toxicity, liver, thyroid developmental, um, lots of the same types of toxicities that we're seeing.

You know, the general message that is important here is that you know, once again, PFAS infects lots of different physiological systems.

So, next slide, please.

Uh, we did develop um also three notification level recommendations for the water board for three other PFAS, including PFPS, PFHXS, and PFHXA.

Now, in generally speaking, these compounds are were less toxic than PFOA and PFOS.

Uh, PFBS is a shorter chain uh PFAS, so it's only four carbons long as opposed to PFOA and PFOS, which are A carbons, and it has a much shorter half-life in humans as well.

And as you can see, the uh notification level recommendation that we had was about 500 parts per trillion, so it's much higher than PFOA and PFOS.

Uh for PFHXA, the one in the bottom, the bottom row, uh, we had a notification level recommendation of 1000 parts per trillion.

Uh for PFHXS, um, that one is also quite toxic, and so the notification level recommendation was pretty low.

We recommended uh notification level of two parts per trillion, and the water board actually set it at three because of the analytical method that they are using.

Uh, with the method that they're using, the minimum reporting level is three parts per trillion.

So that's what it was set at.

And we are actually currently working on a public health goal for PFHXS.

That chemical is pretty prevalent in California drinking water.

And that is something that we are currently working on.

As you can see, there are additional health effects as well, but the most critical, the most sensitive effect were thyroid effects or thyroid toxicity in all of these compounds.

And that we found that very interesting.

And we are looking to expand our analyses from going one chemical at a time to looking at groups and thyroid toxicity might be one key to be able to allow us to extrapolate data to other PFAS and look at uh notification levels as groups or do advisories as groups.

Um one other thing that I just want to point out is that uh there is no evidence of cancer for any of the other PFAS that we have looked at.

Now, that doesn't necessarily mean that the chemicals are not carcinogenic, we just don't have the data to support that because no uh carcinogenicity bioassays have been done for any other PFAS except for PFOA and PFOS.

Um, okay, so next slide, please.

So just to summarize uh PFAS toxicity is associated with numerous adverse effects in multiple physiological systems, and those are often consistent across PFAS.

So we see liver toxicity, thyroid toxicity, developmental immune system.

We see all sorts of things.

And um OEH has completed multiple PFAS assessments using both human and animal toxicity data.

We've developed public health goals and notification levels for various PFAS, and we are continuing to work in the realm of PFAS, and uh we are actually trying to expand our role and um drive um guidance values for many other PFAS in a short manner of time.

So just stay tuned and more information will be forthcoming.

Uh, next slide.

And that's it for me.

So I'm happy to answer any questions if anyone has any.

We have about uh supervisor Tam, do you want to ask questions now or after all presentations?

Okay, so we'll wait and ask questions after we finish all the presentations.

All right, thank you.

Uh thank you, Dr.

Dr.

Banks.

Our next two speakers are from the state and regional water boards.

Stefan Kehina is uh supervising sanitary engineer in the division of drinking water at the state water resources control board, where he manages the north coastal section.

The division regulates all public water systems in California, helping to make sure they provide safe, reliable drinking water to their customers.

And Kimberly West is a water resource control engineer at the San Francisco Bay Regional Water Quality Control Board, where she works to investigate and clean up discharges of pollution to the local environment.

Supervisors really appreciate you having us here and being interested in the subject.

Um so we can go right ahead to the next slide.

So we're gonna just briefly talk today about what the water boards are up to, including both the state water board where I work and the regional board where Kimberly works.

Um we will touch on the drinking water rulemaking efforts for PFAS.

We will talk about current action levels for PFAS, um, what we are doing in the way of monitoring the public water systems, and um then the region will talk about source results for PFAS, potential sources, and our next steps.

So as far as rulemaking goes, at the state of California, we have the ability to make rules for ourselves here in the state.

We also have the responsibility to adopt and enforce federal rules.

And the federal rules for drinking water are made by US EPA, and they do have a PFAS rule on the books now.

Um this deals primarily with PFOA and PFOS.

And so our responsibility, once the feds have done a rule is to adopt our own version of the rule, which is at least as stringent as the federal rule.

In this case, we are going to do a two-stage approach where stage one of our rulemaking effort will make sure that we adopt the federal rule and that water systems are complying with it.

Um, but as I said, the federal rule only addresses a few compounds, and in fact, with a recent decision the feds have made to not pursue several of the compounds, it really is only going to address PFOA and PFOS.

So this we consider the tip of the iceberg when it comes to PFAS compounds because there are literally thousands of them.

And we aren't going to get to more than the tip of the iceberg looking at just those two.

So our second stage, California will do its own rulemaking that goes beyond the federal effort.

One of the things we will look at is a total mass-based approach so that we could look at the perhaps the total PFAS compounds present rather than trying to play whack-a-melt mold with just whichever newest one comes up.

And since we can't ever hope to monitor for every single one that comes out, we may consider a treatment technique type of approach where we could have like a sentinel or indicator compound that would give us the best idea that we are dealing with all or almost all of the total mass of PFAS that's likely to impact human health.

So that is the rest of the iceberg.

And it'll it'll take a few years, but we are very committed to finding a way to address the rest of these compounds.

Next slide, please.

So just a few words about levels.

Dr.

Banks already explained very helpfully and better than I can what we mean by the public health goal and the notification response levels.

What I'd like to point out is that the notification levels and the response levels and the public health goal itself are non-enforceable in that we can't take enforcement against a water system because it exceeds a notification level or a response level or PHG.

The notification levels are helpful in that there are some requirements for notifying the governing body, you, the board of supervisors in Alameda County, if a source exceeds an NL if uh a response levels exceeded, we really lean on the water system to do something about it, either to take the source out of service at the very least to make sure that their customers are well informed.

And then, of course, the PHG sets the stage for us to do rulemaking and ultimately adopt an MCL, which is legally enforceable, as a maximum amount of contaminant that can be served.

Next slide.

So this slide just summarizes what our current kind of scope of action levels are for PFAS, and we're using action level here informally.

These are just levels at which some kind of action might be recommended.

So as I've already mentioned, for PFOA and PFOS, we have federal MCLs, which really take precedence here since those are officially adopted and enforceable numbers.

Those are at four nanograms per liter.

The public health goal that OEHA gave us is at 0.007, as you already heard, and for PFOS F1, and we have adopted our own notification and response levels.

The notification level for PFOA and PFOS coincides with the federal MCL at four nanograms.

Now for PFHX, we are interested in rulemaking here.

So the public health goal is going to be very important to us.

We have a notification level of three for that compound.

And over on the right hand side of the slide, you'll see some numbers in red, and those are what the US EPA had proposed as MCLs for these contaminants, also a hazard index considering a combination of these contaminants.

And the federal government has recently announced that it is not any longer going to be pursuing that rulemaking.

So we'll stay with PFOA and PFOS at the federal level.

California will move forward with PFHX.

And we think that between PFOA, PFOS, and PFHX, I mentioned the idea of indicator compounds earlier.

These, from the data we're seeing so far, appear to be by far the most frequently occurring of these compounds that have significant health effects at low levels.

So that's something to keep your eye on in years to come.

And we will continue to look at that mass-based approach as well.

Next slide.

So we have ordered water systems in California to do a certain amount of monitoring.

Typically, when there's an MCL, water systems have to monitor for something if there is just a notification level or just a PHG.

There's no required monitoring.

However, the state water board does have the ability to issue orders when we think that a contaminant might be present at levels that could affect public health.

So we started this out in 2019, just kind of looking at places we thought PFAS was likely to be present, airports, landfills.

2022, we did another order, kind of casting a wider net based on where we had gotten detections from the first order.

2024, we actually got funding to go out and pay for sampling to happen at disadvantaged communities.

So that was a wider yet look, and it was a look at sources where we had no particular reason to think PFAS might be present.

2025, we we have just recently issued an order that affects all public water systems and will ensure that they comply with the monitoring requirements of the federal MCLs, even before we have officially adopted them here in California.

That federal monitoring requirement is supposed to take place between January of this year and April of 2027.

Next slide.

That said, uh a fairly large percentage of sources, well, well over 40% have detections for at least some analytes.

So we know that this is a very widespread issue in California, by no means confined to Alameda County.

We are seeing this stuff all over the place because it has been used all over the place.

One more slide for me, I think.

And just a snapshot of the findings here in Alameda County.

It won't be a surprise to you that we we've got hot spots in the Pleasanton Livermore area and the Fremont area.

And that is what we're here to talk about and deal with today.

Thank you.

So at the regional waterboard level, we work to find and manage the sources that contribute to water contamination in the first place.

We know that PFAS are used in many products that we use in our homes, and we don't have authority to regulate that side of it.

Oh, yeah, I'm a little shorter than everyone else.

Is that better?

Great.

Thank you.

Right.

So what we can do, however, is that we can regulate the industrial sources that discharge PFAS to surface water and groundwater.

We are prioritizing sites where groundwater is used as drinking water.

In coordination with the division of drinking water and local water agencies, we have identified drinking water supply wells in our region that have been impacted by PFAS.

Once we identify impacted wells, we look for potential sources nearby that could cause these impacts.

The types of sites that we identify as possible sources of PFAS are facilities that are likely to have used PFAS, either currently or in the past.

So potential PFAS sources include things like any sites where fire fighting foams have been deployed.

Those could be things like airports, refineries, and bulk fuel storage terminals, fire fighting training areas, and fire response sites.

We're also looking at industrial facilities that are likely to have used PFAS in their operations.

And those could be things like large commercial laundries and textile manufacturers, semiconductor manufacturers, chrome platers, facilities that use high volumes of inks and paints and coatings, and paper and packaging facilities.

And we're also looking at facilities where PFAS may accumulate.

And those could be things like recycling facilities or landfills.

So the map on this slide shows PFAS investigations within Alameda County.

There are about 35 sites in Alameda County that have conducted initial PFAS investigations.

Based on that initial data, further investigations are progressing at many of these sites.

Our strategy for managing potential PFAS sources is number one, identify potential source sites.

Number two, require the owners and operators to collect data.

And those initial site investigations typically include testing of soil and groundwater for PFAS.

Number three, then we look at that data to try to prioritize the sites.

So if a site has high concentrations of PFAS, or if a site is near a receptor, like a drinking water well or an aquatic uh aquatic habitat, then we would require further investigation at the sites.

And number four, we're going to require cleanup.

And for that, we're focusing on stopping discharges.

So what's next for the water boards?

The State Water Board and the Division of Drinking Water.

Last December, as Stefan has mentioned, we issued orders for initial monitoring to all public water systems.

So we are going to continue to collect and evaluate that PFAS data.

In the fall of this year, we expect the, we expect to move forward with the PFAS stage one notice of proposed rulemaking for those federal MCLs.

And we're in the process of developing broad spectrum testing methods so that way we can measure a broader range of those PFAS, not just the PFOA and PFOS, and conducting sampling at drinking water treatment systems.

At the Regional Water Board, we're going to continue to identify, investigate, and clean up potential sources.

So this slide shows our online GIS tool.

It's called the GeoTracker PFAS map.

All of the data that we've discussed today, including the drinking water data and the groundwater data, are publicly available through this online tool.

You can look at the data, you can zoom in on particular areas, you can use filters to get more information on the data that you're particularly interested in, and you can download all of the data from this online tool.

The water board's mission is to preserve, enhance and restore the quality of California's water resources.

We understand that groundwater is an important drinking water source for Alameda County.

We understand that PFAS is a very important issue, and we're working to find and eliminate sources of PFAS and ensure that the public has safe, clean, and accessible drinking water sources.

Luckily, we are not working on this issue alone, and we really do appreciate the continuing collaboration with our partner agencies.

And that is our presentation for today.

We're happy to take questions at the end.

Yeah, thanks.

Thank you both.

Our next speakers are from two of our local water districts.

Ken Min is the Water Resources Manager for the Zone 7 Water Agency, where he's responsible for managing Zone 7's water resources, including sustainable management of Livermore Valley's groundwater basin.

And Michelle Walden is the groundwater resources manager at the Alameda County Water District, where she oversees the Division of Engineers, hydrologists, and technicians that sustainably manage and protect the Niles Coomb Groundwater Basin, among other things.

She's a graduate of San Jose State University with a degree in civil engineering and has over 20 years' experience with groundwater management.

Thank you for that.

Good morning, Supervisor Tam and uh Supervisor Miley.

Thank you for the opportunity to be here today to uh discuss very important issues for Almeida County, particularly uh Tri-Velly area, and we have been uh working on these issues for last five plus years.

So I'm happy to report uh what we have been up to and and get you acquainted with the uh our approach of PFAS management.

There we go.

There you go.

Thank you.

So for today's discussion, I would try to uh cover what we have done in the past five years in short 20 minutes or 15-20 minutes, uh starting with the PFAS management timeline for Zone 7 and the strategies that we employ to manage the PFAS for now and for the future and takeaways from what we learned from that process.

So, we started um voluntarily uh monitoring PFOS in 2018 when the state water resource control board um put out the um order to start collecting the information.

So we started 2018, and then 2021, we needed to that that was that the time that we had uh the severe drought, second year of the drought in 2021.

At that moment, we received the order to comply with the PFPF HXS uh from the water board.

So with that, to be complied, we need to shut down one of the production wells, which is a 16 million, which is a 16% of our uh production capability, and during the middle of the drought.

So it is when we really have to deal with this issue very deliberately because it's definitely affecting our water supply and production and meeting the local demand.

So we put on uh the um PFAS treatment system within a year or 18 months, and that become online in 2023.

We start treating PFAS right there, right then.

In 2024, when we have uh EPA uh NCL come up, we are already in process of treating the PFAS already.

In 2025, we add an additional treatment facility, and currently we are working on the third and final treatment facility for the region.

So when we approach PFAS, we approach this with uh well-rounded um strategy that will cover not just present uh PFAS issue as well as the uh future PFAS management needs.

So it start with the monitoring.

The monitoring is important so that we we understand where the PFAS issues are or concentrations are varying over time.

So we do the monitoring first.

And once we understand the sources and PFOS concentration, we have to figure out whether we can blend it down to the level that is acceptable to divisional drinking water, or we have to treat the water to meet the standards.

So with that in place, for long-term PFAS management, we have to understand how we're gonna manage it for further degradation of the basin water quality.

So that is where the PFAS management comes in.

And finally, we have to diversify the groundwater sources, not just uh focusing on what we have.

We have to diversify available sources so that we can meet the demand.

So monitoring-wise, uh we've been uh monitoring since uh six years ago, and starting with the 67 wells, currently in 2025, we are monitoring over 150 wells currently.

And we are sharing the data that we received, we collected with the regulators and regional board as well as the traditional drinking water and public uh in our trivalley area.

And we also report to the Department of Water Resources through uh Sigma compliance uh annual reporting process.

So our goal is to make sure that one of our values for Zone 7 is uh transparency.

So we have to make sure that the data is available, not just available, make it uh transparent for everybody who is willing to uh review that.

Uh so we've been doing this uh consistently.

So this is just illustration of how pervasive our monitoring program is.

So our monitoring program has 200 about 260 wells all across the tri-valley area.

So there are different wells for different reasons.

Some were measured semi-annually, some are annually, some are monthly.

But all in all, we have over 260 wells.

And zone seven investing significant amount of resources to make sure that we are uh monitoring and tracking the PFAS situation.

So this graphic illustrates uh our water production infrastructure, groundwater infrastructures for our uh Tri-Valley region.

Let me remind you that normal year we have if we have enough state water product supplies, we are in good shape.

But groundwater becomes particularly crucial during the time of droughts.

And second or third year of the drought, we have to depend on groundwater as a last resort for almost 40% of our demand.

So, more than any entity, zone seven has a first and foremost interest in making sure that PFAS is well managed and well make sure it is treated so that we can meet the federal MCO as well as state MCOs.

So, this is showing that our current um uh well field that we have and monitoring well on top of that.

So, when we know what it is and we have to figure out how we're gonna uh meet the MCLs, there are two ways of meeting it for zone seven.

One is blending, the other one is treating.

The blending is um a valid method where we blend the PFAS concentrated water with the other fresh water in that way that the the product water will be below the MCO.

When we put it in our distribution system, um the water will be below MCLs.

That is what division of drinking water regulates, and we meet PFAS concentration requirements at the point of compliance.

So the other way that we are trying to meet, um, we are meeting the PFAS requirement is that by way of treating uh iron exchange facilities that I just spoke about.

We put in such a significant amount of investment in those facilities.

Um, it's up to right now, it's more than 50 million that we invested in those two facilities right now, and we are investing additional 35 million or so uh for the third facilities.

So talking about managing PFOS by pumping and treating, this graphic illustrate the contours or flow direction of our groundwater basin.

Basically, you will see different control lines, but basically it's flow from east to west.

So let's say we put in the first treatment facilities and that treatment facility capture the water from shown as a green blob.

That is the area of impact that that facility can have to extract the water and treat it.

And if we look at it, if we build a second one currently, that is a chain of lakes uh PFA streaming facility that will cover that much amount of uh area.

So by uh pumping those uh well field with the PFAS treatment facility, we are trained to we were able to control the gradients or hydraulic movement of the uh the PFAS groundwater flow as well as the extracting and treating as we produce the water for the uh consumption.

So that third blob is the one that we are trying to build, the third facility that should come online in 2028.

If we do that, then we have more coverage to uh treat the PFs.

So before we develop our strategy, what we have done was we run the groundwater model with the contaminant transport uh features in it, and we try to see how would those facilities could help managing the PFAS.

So we have a two aquifer unit upper and lower aquifer, and what it shows models show is that if we develop those facilities and pump it accordingly, then we'll be able to manage the PFAR concentration of footprint in the basin.

So you can see here uh the green blob is moving to show um how it got shrunk over time by pumping it.

So this is the area of view of our service area, and I just like to show that a facility that we put in in 2023, this is stoned facility, costs about 16 million.

Uh and we build the second facility in 2025, that's about 28 million, and we are currently developing the MOTO treatment facility that will be the third facility that we are building, and when it's come online in 2028, we have a great coverage for managing the PFAS.

So let me illustrate what PFAS treatment can do for us and particularly the iron exchange uh treatment system.

So you will see the EPA federal MCLs for PFHXS10 and PFOS and PFOA at about four, and you will see that the blue dotted, the blue line with the dots on it, that is an actual data from our groundwater.

So as you can see that it is way higher than even the California response level of poor PHP HX.

And when we put in the stream facility for that site, we put in that blue dotted line water from the influence side, and when it's come out of the treatment facility, as you can see, it is below two parts per trillions.

What it does is that is a method detection limit.

But the current available method cannot detect lower than two parts per million trillion.

That's what the lab results show as a method deduction limit.

But we believe it is extremely effective.

And same thing with the PFOS.

If you put it through the system, the ending results is shown on the end of the arrow, it is treatment uh uh detection method detection limit at two parts per trillion.

So this is the footprint that we uh developed based on the data that we collected in 2021.

And let me remind you, this is based on the available data that time when we were developing.

So the more we monitor, the more we observe some of the PFAS concentration, this is in 2023, isn't not necessarily grow.

It is just showing that our uh basin PFAS concentration in different locations because we increase we double up the uh uh monitoring program.

So we see more of those.

So this is in 2024, as you can see, its shape has changed uh for better.

And this is 2025.

As you can, if you focus on the uh the dark uh color blob, you can see that over time that this is after the treatment system is put in place and we start pumping and treating it.

So that's how we uh understand about the PFAS, and in terms of our managing groundwater quality, to the extent possible, we're gonna prevent the water quality degradation and potential mobilization.

That's our goal.

And we have done uh those facilities put in place, and we recharge the groundwater basin with the fresh water that way that we were able to uh improve the water quality and ongoing action goes, we'll be um adding the more uh one more facility and and we have to increase water quality protection by more stringent well pumping, so that we are the well-plumping agency as well.

So the last but not the least, this is what is important for us is diversifying groundwater resources.

Currently, the all three well fuel that we have happen to be in the PFAS um concentration area.

It is very close to the sources, so that the PFAS is very um uh challenging for all three facilities to uh deal with.

So we need to diversify the groundwater resources.

That's why that we are planning to put in the um the couple of groundwater monitoring groundwater production well in conjunction with the CO Pleasanton and City of Pleasanton's uh city area.

So, in addition, what we're gonna do is we are developing the chain lake convenience system that is a service water storage program in our service area, and we are participating in site reservoir project, also convenience system, and we stay engaged with other future uh D cell and portable reuse project.

This is just to go to show that this goal to show that zone seven is not um myopic or just looking at the one issue.

We are looking at very broad issue.

We diversifying water resources so that we can meet not just current demand as well as the future demand.

So that is what we approach the uh supply sources.

So key takeaway for me to like what I present is that um PFAS is everywhere, it is ubiquitous.

Um it is in the environment, it is in our consumer goods, it is everywhere, but it is not in zone seven water.

That is extremely important to point that out because we monitor PFAS way before federal requirements taking place, just like Stefan just presented to you.

Actual federal requirements is this uh next year to monitor it.

So we started monitoring six years ago.

On top of that, our board of directors believed that if PFAR is bad, you know, it will be bad not in the future, is already bad currently.

So they decided to make sure that they invest enough capital to make sure that we provide the PFAS free water to our community.

So I'm proud to say that we've been providing PFAS-free water to our service area and our community uh since the first one that we put in place that was about four years ago.

And it's come from legacy sources and come ongoing discharges that that's why it's extremely important for us to work with the regional board.

Like Emily presented earlier, we work very closely with the regional board to make sure that we prevent future major discharge or eliminate the current sources.

And one thing I do point out is like I showed you earlier that more monitor some sometimes it could reveal the previously unknown PFAS location.

And PFOS management strategy that we are employing seem to be working really effectively.

So we do have very intensive public outreach program through our websites and our flyers and our YouTube channels as well as the social media.

We are pushing out the PFOS related information and reassuring the public that the water that we are receiving is PFOS-free.

And one thing I like to emphasize is that I have shown you different graphic of the PFOS conservation basin, but what importance the most is the point of compliance.

That is where Stefan division of drinking water and force us to make sure that we meet at the point of compliance, otherwise they won't uh it won't be acceptable to the state of California.

So we meet currently at the MCL at the point of compliance.

We ahead of 2029 compliance date.

And we are continue to work with the regional board uh to make sure that uh we share the data, we um meet and confar and and strategize how to manage the known sources and how to work together to so that we can achieve the common goal of protecting that basin, as well as the division of drinking water.

So that is my information for you, and I'm more than happy to answer any question you may have in the line down the line.

All right, very good.

Good morning, supervisors, county staff, members of the public, and other agency staff.

Before I give an overview of how Alameda County Water District or ACWD has responded to PFOS within our service area.

Let me give you a little information about ACWD in case you aren't familiar with us.

Our mission is to provide our customers with reliable, sustainable, high-quality water service at a reasonable price.

ACWD was established in 1914 to protect the Niles Cone Groundwater Basin, in which we overlie, as well as the Alameda Creek watershed.

We are governed by an independently elected board comprised of five board members and funded primarily by user rates and fees.

We serve a population of over 350,000 customers, and we are the exclusive groundwater sustainability agency managing the Niles Cone subbasin under the groundwater under the Sustainable Groundwater Management Act.

We're very fortunate at ACWD to have three different sources of water supply.

The first is our local supply, the Alameda Creek watershed runoff, and that comprises about 40% of our water supply.

And then we import state water project water that could make up another 40%, and that's surface water.

And then we also get water from San Francisco Public Utilities Commission, and that's also imported surface water supply.

Having this diversified water portfolio gives us a lot of flexibility, both in how we plan for our water use and optimize costs, and also in how we respond to real-time operational challenges.

Here you can see the outline of ACWD within the Alameda County, top right corner of the pop-out.

We're located in the southwesternmost portion part of the county.

The Niles Cone subbasin or Niles Cone includes the cities of Fremont, Newark, Union City, as well as the part of Southern Hayward.

ACWD is able to recharge the groundwater basin by diverting water from Alameda Creek to our recharge facilities located at Quarry Lakes Regional Recreational Area in Fremont for those that have visited the park.

The Hayward Fault, shown as the Black Dashed line, divides the Niles Cone into two sub areas that are more commonly referred to as the Above Hayward Fault subbasin, and then to the west, the below Hayward Fault subbasin.

The Hayward Fault is an active fault with low permeability that impedes the lateral flow of groundwater.

The differences of groundwater levels of either side demonstrate the relatively impermeable part of the basin.

In 2020, ACWD elected to undertake voluntary sampling to monitor for the presence of PFAWs and groundwater and our surface water sources, as well as treated water being provided to our customers.

It was voluntary because we didn't have any known potential sources of contamination.

The testing confirmed that no ACWD customers are receiving water with concentrations above the notification levels, the MCLs weren't established yet.

However, results showed low levels of PAWs detected in groundwater production wells on either side of the fault.

The range has been from non-detect to about 15 parts per trillion.

After the 2020 initial sampling of the production wells, we expanded sampling to our groundwater monitoring well network, quarry lakes, as well as Alameda Creek to determine the extent of PFAWs in the Niles Cone, most of which has been characterized today.

ACWD's water provided to our customers continues to meet or exceed all state and federal standards.

So this is a figure that shows a couple of our facilities.

And in 2022, the Division of Drinking Water issued new PFAS monitoring orders to numerous water agencies, including ACWD to monitor for groundwater sources effective January 1st, 2023.

So at the most eastern part, you can see our blending facility.

And ACWD has two well fields on either side of Hayward Fault or that are Peralta Tyson well filled and our Mallory well filled that have eight wells each for a total of 16 wells that send raw groundwater to our blending facility where raw groundwater is blended with the San Francisco PUC purchased water to reduce hardness.

Then towards the west of our service area, we have our Newark desalinization facility.

That takes brackish groundwater impacted from legacy saltwater intrusion, which is pumped from our six aquifer reclamation program wells and is treated through reverse osmosis.

ACWD has existing water treatment facilities in place to effectively safeguard our water supply with the reverse with the use of reverse osmosis technology at our Newark DSOW facility and the blending of groundwater and surface water at our blending facility.

Both methods are already implemented at our treatment facilities and are operated to keep the detections below notification levels, thereby ensuring the treated water supplies to our customers meets all the health-based standards.

While ECWD proactively adjusted operations to ensure water delivered to our customers is below the California notification levels.

This reduced our production capacity at ACWD's blending facility, which blends raw groundwater from the well fields with the imported surface water, as I mentioned before.

In addition, in anticipation of the US EPA's MCLs for PFAS, ACWD designed and built a treatment facility to address PFAWs and groundwater at our blending facility.

That has been in operation since 2024.

The facility can currently treat up to 6 million gallons per day of PFAW's impacted groundwater and was built so that it may be expanded to treat up to 15 MGD in the future if needed.

ACWD's long-term water resources planning efforts continues to rely on adaptive management in order to optimize groundwater and surface water supplies.

So this is a photo of our recently built 6 MGD PFAS treatment facility.

It is an ion, it uses ion exchange to remove PFAS from the raw groundwater.

You can see the treatment vessels in the back.

The pointer works.

Nope.

Okay.

There are six of them, and the empty pad behind them to the left is where we can expand the facility by adding another eight vessels, which will provide up to 15 MGD of treated water.

So in summary, ACWD has been proactive in its response and transparent with our customers from our beginning.

We're constantly updating information on our website, including the results from various sampling efforts.

We are updating our operational plans to account for treatment and continue to monitor both groundwater and surface water supplies.

We are also very appreciative of the assistance and help navigating PFAWS while working very closely with regulators, such as the state's division of drinking water and the San Francisco Bay Regional Water Quality Control Staff.

So that's it for me.

And I'll be happy to answer questions at the end as well.

Thank you both.

Our next speaker is Jill Buck here to share a community perspective on PFAS and health in Alameda County.

In 2002, Jill founded the Go Green Initiative, a global leader in environmental education, operating in all 50 U.S.

states and in 73 countries.

Jill's the host of Go Green Radio, a weekly program on VoiceAmerica.com and is co-author of the book, 47 Things You Can Do for the Environment.

She holds a BA in English from the University of Illinois and an MS in Education from Cal State East Bay.

Thank you so much, supervisors, for hearing us today.

That's my water supplier.

They have demonstrated with their time and their treasure how important this issue is.

While it is true that PFAS chemicals are ubiquitous, they are in a number of consumer products, and they can be found in a number of different areas.

So I want to make sure that we delineate the difference between the kind of exposure you might get from wearing a Gore-Tex sweater and the kind of exposure and the kind of health risks you may bear by consistently drinking tap water that is contaminated.

And so that is why I want to discuss the hot spots that the California water board members brought up and show you that these two hot spots in Alameda County are not the same.

The levels that the PFAS wells were showing in the Pleasanton area were quite a bit more significant in terms of the exposure than what was happening in Fremont.

When you look at the California Water Board's data base online, when I first looked at it, in fact, I didn't find out that we had PFAS in our water from our water agency.

I had Rob Ballot, the lawyer who actually discovered that these chemicals were being manufactured.

The EPA didn't even know it at the time in 1998.

And he was on my radio show, and we talked about the human health implications of PFAS, and I thought when we were done, I wonder if that's happening in my hometown.

So I Googled PFAS and Pleasanton and found this was in October of 2019 that Zone 7 staff had already briefed the board in April of 2019, but and they told the city of Pleasanton at that time was their retailer that this was happening.

I went to the very next city council meeting in November and said, when were you going to tell us?

And so that's when things started happening on the consumer end in Pleasanton.

As you can see, the those of us who drink our tap water, and a lot of us do because we've always trusted our tap water, was significant.

And I just wanted you to see how many times higher some of our max exposures were.

These are levels that have been normed across the country.

And as a result, in 2022, the National Academies of Science put out some recommendations based on the kind of health implications that people get at various blood levels of these combined PFAS chemicals.

They have recommendations for doctors to do certain types of testing, especially even for children.

And this is where a lot of my concern lies is that people who lived in Pleasanton who were children before, you know, the water was being cleaned and treated, ingested in their tap water and could be in their breast milk as well.

This PFAS chemicals, which at the time that they're children and their bodies are growing and cells are multiplying at a higher rate than they will their whole lives, that they were ingesting chemicals that are what we call bioaccumulative toxins, meaning they build up in your body, they don't just flush out.

And that carries with it the causation of some of these health risks that we're seeing.

So even though our water is being treated and zone seven can say with confidence that our water currently doesn't have PFAS, our bodies still do.

And that's what I'm here to talk about today is the role that the county health department might be able to play in helping people learn what I know.

I know what my blood levels are, and my doctor knows, and he can order tests that he might not otherwise in a routine physical based on the recommendations of the National Academies of Science.

And so one of the things that I wanted to highlight, just pulling a snippet out of their recommendations, is that for somebody with blood levels like mine, which is on the left hand side, there are a series of tests that they would recommend my doctor order for me at certain cadences and certain ages.

For others who have higher blood serum levels of combined PFAS toxicity, there are even more aggressive and at younger ages testing that they recommend physicians order on their patients.

This is not something that the average person in Pleasanton or even Fremont, even though they had lower exposures, knows.

I'm not convinced that doctors know this, and that's the role that I'm asking the county health department to play.

And I just want to bring to light what a resident's plight is in all of this.

We've been exposed to PFAS without our consent, without our knowledge.

We still in Pleasanton don't know the source of this contamination.

So for all we know, we're going to be continuing to pay to clean up somebody else's mess, and that's important.

Our doctors are not advising us in keeping with the recommendations of the National Academies of Science, so that if we develop a health problem as a result of our exposure, it can be dealt with before it becomes severe.

And we are incurring additional costs.

Our water rates are going up.

Part of that is because we need to treat the water, cleaning up somebody else's mess.

Testing, if people even know to test their blood, is expensive, and a lot of people don't know how to get that testing.

Those of us who have medical conditions that may or may not be linked to PFAS, but are in line with some of the things that they're finding, have higher medical bills.

And much of the guidance for reducing our personal PFAS exposure is very costly.

Most people cannot afford to put in a filtration system in their home or to filter their water, or to rip out their carpet and put in other flooring, or to get rid of their Teflon pans and their furniture that's Scotch guarded.

All of these things come with a price tag, and the confluence of those expenses become a hardship.

So I know that the county can't solve all of our problems, but what I'm asking for, sorry, are these three things.

If we can make testing accessible and make it common knowledge that some of us should be tested.

Because we carry this in our bodies and will for years.

That perhaps the county would monitor the health of these hot spots.

I call them families, homes, communities.

Some people call them hot spots.

I call them human beings.

If the county can keep an eye on us, I think that would be good.

And I really would love to see the physicians who are in the communities who've had a significant exposure, become educated on the recommendations from this 2022 recommendation from the National Academies of Science to do this proactive testing on their patients who have suffered a significant exposure.

Thank you so much for your time.

Thank you, Ms.

Buck.

I'll now close out with a very quick summary from our agency side.

The areas that I'll highlight in brief are current policy activity, website planning, I want to address a recent inquiry about wastewater monitoring, and then uh engagement with water districts and regulators.

I don't have a separate slide on the last bullet, but I wanted to note that today's presentation is a direct outgrowth of that engagement.

Um over the past uh uh year since our last presentation here.

Um, on uh the policy front, uh we have tracked PFAS related bills, and the county has taken support position on two bills in the current two year session that would have provided financial support for PFAS mitigation activities.

Um, unfortunately, neither of these has made it into law.

Um I believe Supervisor Miley, your staff also took the lead on one of these.

And then right this minute, we are drafting a comment letter opposing the federal EPA's proposed rescission of new regulations aimed at for uh the um four uh PFAS chemicals that you heard mention earlier in the presentation that the EPA was um was appeared to be backing off uh from.

Um this still will need to go through our position process before it can be formalized.

Um on the website front.

Uh we one thing that we wanted to do, which only um partially addresses uh some of what you heard in in Ms.

Buck's uh presentation, is that we wanted to really support both residents and medical providers with better information and information tailored to Alameda County through uh uh through just a local web page.

And that was uh web page development was on hold as we transitioned our whole agency to a new site, but now as of I think April that's passed, and I'm working with our comms colleagues, communications colleagues on this right now.

We're looking at models, including Los Angeles's, which is well, you see a screenshot here.

And I apologize, the link below is actually to a different county's PFOS page.

Um, but it would likely include background information, frequently asked questions, guidance for medical providers.

We wouldn't develop our own guidance, but making sure that they have access to, for example, the National Academies of Science Engineering and Math and Medicine guidance that uh you heard this buck refer to.

Um, lastly, I wanted to touch on PFAS and wastewater.

I believe this was an inquiry made at a recent health committee, and as you are likely aware, PFAS is found widely in wastewater as our wastewater is downstream from many potential modes of introduction of PFAS, including food and agricultural products and commercial industrial uh commercial and industrial products and waste.

Um PFAS can be detected in wastewater.

There are many possible chemical uh targets and different testing approaches, not unlike what you heard discussed for drinking water.

There is an ongoing project to test for PFAS levels of Bay Area wastewater, including in effluent from East Bay wastewater treatment providers led by the Bay Area Clean Water Agencies and the San Francisco Estuary Institute.

And I believe as part of that they are looking at testing for uh trends over time.

My understanding is EPA is also doing this, although I'm not aware that I wasn't able to identify that any of that is happening locally.

Uh we do wastewater surveillance for communicable diseases, which rely on uh testing for genetic material of specific pathogens.

So it's a different testing methodology than what is uh used for PFAS chemicals.

And we currently are choosing from a menu of options that our vendor has developed that are specific to the communicable disease use cases.

These are things that uh change on a daily or weekly basis, and so the public health response activities are guided by those day-to-day changes or week-to-week changes.

Um, and our understanding of PFAS monitoring and in wastewater is that it would be more useful in a more longer term time frame to get a sense as a proxy for the levels of exposure that community members are um experiencing, in particular for things outside of the drinking water, which is being measured directly.

I think what we need to be on the lookout for is if those other sources of information about PFAS and wastewater go away are not going to be sustained.

Is there a role and added value for us doing it on uh on that uh longer-term time scale um uh so right now that's that's where we are with wastewater testing.

I'm happy to address further questions about that.

Um, and then lastly, I just wanted to uh before we get to questions, acknowledge um and thank all of today's speakers uh for dedicating their time and expertise uh today.

And I wanted to also just acknowledge all the people across Alameda County Health who've um helped me uh to support this work.

Well, thank you.

This is um this has been very fascinating and informative.

Uh we've had about maybe 70 minutes of presentation, which has been really good.

And I know I have some questions and comments.

I'm sure Supervisor Lena Cham will as well, since she is an engineer and has formerly uh worked with uh East Bay Mont.

But before we go down that road, we're gonna take a five-minute break.

Five minutes reset.

The clerk would call the role, supervisor Tam present.

Supervisor Miley.

Present.

Okay, so let's so that like I said, that was a fascinating presentation, and I thank all the speakers too.

I mean, clearly, you know, being a policymaker, like an official, kind of like a jack of all trades.

I got you know, I'm an ace of a few things, but um PFAS, quite frankly, was something that was introduced to me.

You know, full disclosure, Joe Buck is one of my closest friends and advisors.

Um, so uh Jill talked to me about PFAS many, many years ago, and so we've been trying to um move this along.

We've had meetings uh with attorneys with county council, in fact, as well, and with county staff around PFAS, so we could see what role uh the county might play in this um, you know, public health potential uh concern.

Uh some of you know back in um the like 2012, 2010, something like that.

Um, you know, the years just fade at this point, but you know, the county was on the cutting edge to deal with medication management because we had, you know, all the medications being uh discarded, um, people storing them, hoarding them, uh, people flushing them down the toilet, this throwing them away, etc.

So the county, you know, we were at the forefront of trying to address um medication disposal and medication management, and um, and make sure that responsibility fell on the um the manufacturers.

Um so that's something we pushed, and we, you know, we won that uh eventually in the United States Supreme Court and became basically the law of the land, so then medication disposal management could be appropriately addressed and the manufacturers of those product of you know those medicines, those pharmaceuticals, whether over the counter or um prescribed, would be uh taken care of because we all need these these medications, just like with P with PFAS, it's ubiquitous, it's in all the products.

So what um concerns me is you know the health issues, but then the cost of who's gonna pay for that, and um you know, I've kind of told County Council at the moment, I'm not uh prepared to um suggest that the county begin to challenge the industry around this because it's so ubiquitous, but I do want to look at um practical ways that the county can play a role in helping to deal with uh with PFOS.

And I think the information you all of you've provided today, I think will provide some um illumination on our ability to you know continue our efforts at um uh addressing this in concert with with all of uh with all of you and other uh appropriate um bodies.

The um and I want to just acknowledge Dr.

Moss, because I know as he said, we had this before the health committee in June of last year.

Um so it's been almost a year, actually, has been a year.

This is June, yeah.

And I know um I kept kind of talking to Aaron, my chief of staff, my deputy chief of staff, uh handles this policy area of health and the uh agency director, uh Dr.

Moss.

When's this coming back to the committee?

When's this gone back to the committee?

So I see you've done a lot of uh preparation, and I'm glad you acknowledge all the county staff who worked with you on it because I think it really uh showed today uh with all the speakers, um, the fact that you've pulled this together in a manageable way, so that as a committee hopefully we'll be able to uh provide some recommendations on what we like to see done next.

So, with all that being said, like I said, I have some questions, but before I go to my questions, I would like to turn it over to my esteemed colleague, my learned colleague, who knows more about these matters than I will ever know because she is an engineer and she did work for Spain.

Supervisor Lena Tam.

Thank you, um Chair Miley, and thank you and your staff and Dr.

Moss uh for organizing a very comprehensive presentation and update.

Um I mean, based on what the speakers have said, we're doing everything we can in terms of identifying, monitoring the root cause, and then all obviously looking at some um downstream issues that I think Ms.

Buck talked about that would be tied in with the public health department.

So I just have uh just more clarifying questions uh from the presentations.

So just to um uh just be clear, the detectable levels of PFAS that are in the bloodstream, uh, they are primarily from you think um uh from drinking water and and the accumulation is over years because obviously it doesn't you said it does not go into the waste stream or it gets filtered through our kidneys and other organs.

Uh it certainly does end up in the waste stream, and it is in our wastewater.

Um but um so uh and if uh Dr.

Banks is still on um and he wants to chime in on this, um uh he can certainly uh also weigh in.

But uh my understanding is that uh the where we get exposed to PFOS in terms of in our bodies is through uh drinking water or ingestion of other materials for perhaps it's uh produce that's been grown in ground where there's PFAS but ingestion or ingestion of dust that's contaminated we don't we don't normally eat dust but it gets on food or things that we're you know we put in our mouths so that ingestion is uh is the most important source and and obviously drinking water as we focused on today is a is a big part of that and a big part of our understanding of PFAS's health effects um inhalation as well my understanding is that's more of an issue perhaps for people who are maybe occupationally exposed as opposed to the to the general public and it's a little unclear at least my limited understanding of the literature whether just sort of touch touching materials can can add some some additional risk because it is in so many commercial products we use you think about we're we're constantly touching things that probably have different kinds of chemicals in them but certainly different kinds of PFAS.

My understanding is it's mainly ingestion.

So you might touch something and get dust or material your hands and it ends up in your body that way.

Does that answer the question?

Yes that's helpful.

So and Dr.

Banks may want away as well as the toxicologist just want to give them a chance.

Right and you are correct Dr.

Moss that ingestion is the primary pathway for at least the PFAS that we know the most about uh the dermal and inhalation exposures for chemicals like PFOA and PFOS are pretty minor compared to the ingestion ingestion is the most important pathway you mentioned in food and water and dust and then consumer products those are you know some of the major exposure you know sources for us.

Thank you.

Okay.

Yeah obviously it's ubiquitous and pervasive uh which is different than the lead contamination that we've learned about um through the generations so when we looked at um the drinking water MCL like Stevens is in Alameda County and they were the hot spots were in the Livermore Pleasanton and Fremont area do you believe that the primary sources from like the landfills because everything goes into the landfill especially equipment and how far does it end up traveling because some of the um water agencies um like zone seven they rely on groundwater primarily during droughts um fremont new working city alamed county they rely on the state water project are are they are there detectable levels in the state water project sources as well and because we're not seeing it like for example around the Oakland airport area.

So first I want to see if um Kimberly or somebody from the water boards wants to comment on the sources landfills versus other that is a great question.

We are currently still trying to figure all of this out as well but we have started by looking at some of the things that are going to produce the highest concentrations of sources and those are largely fire fighting foam sources.

So we have state board orders that have gone out to uh airports and landfills chrome platers um what else I feel like I'm oh uh refineries and bulk fuel terminals and we are finding uh PFAS at all of those different kinds of sources and PFAS in the groundwater at all of those kinds of sources um I can't really speak a lot to the state water project sources I I don't my area focus happens to be groundwater and site contamination okay great yeah um but um we're still identifying the sources to be honest um we're expanding the kinds of industries that we're looking at and we also do know through studies from the San Francisco Estuary Institute and and Bacwa the the area clean water agencies, that um they've stepped out from wastewater treatment to look at sewer sheds and test PFAS in sewer sheds to figure out what where the sources might be, right?

So they've looked at various industries that um might be contributing PFAS into the wastewater.

And they have identified some industries that had high concentrations.

They found a large portions coming from domestic wastewater.

And that's something that of course is really hard for us to control.

So there are a lot of sources.

So there are required testings at these potential sites that you mentioned the landfills, the chrome plating, the airports in terms of discharges.

It is not uh ubiquitous to be honest.

It is the the ones that we have identified and that we've uh requested a required testing at, and we are actually focused for the site cleanup where we're focused on the sources that are getting into the groundwater.

So we're having them test the soil, the groundwater, the stormwater, the releases to the environment that are then going to go into the groundwater, that's then used as a drinking water supply.

So we are not necessarily focused on the effluent discharges coming from that, but we are focused on what might be happening at the site that's then getting into the groundwater that we're using as drinking water.

Thank you.

Yeah.

Thank you.

Thank you.

I conferred with the um our uh water district colleagues, and apparently the the California water project is their their that water is uh been is non-detect for PFAS.

So they said, Yeah, that would make sense if they're using uh state water project water to blend.

Um so the last question I had on treatment was uh, you know, even with ion exchange, you're basically removing the particles or even when you have RO systems or reverse osmosis in your uh your tap water, you're actually filtering something that is a particle.

So you end up disposing of whether the RO filter or the ion exchange molecules that you you have magnetize and attract for PFOS, they have to be disposed somewhere.

Where do they go?

I don't know if our water district colleagues want to comment on how the large scale.

And how do you once they get there, how do you prevent it from getting back into the stream system?

Uh sure, and so incineration.

So when we purchase the media or iron exchange medium, that the contract involve um not only the uh delivery of those material as well as the disposal is the one of the part.

It is a hazard and material and manage it very carefully.

And there are only a couple of ways of destroying the um PFAS lays those uh resin.

And one way is uh incineration, even that the science is not still not clear on what happened to the V bar of it.

So that is just to be turned in, but we do not do it internally.

We contour it out and that the vendors uh is responsible for disposing it.

Okay.

Um so Dr.

Moss, just from a policy standpoint, uh we've been asked by the Girl Green Initiative uh to look at making testing accessible to monitor the communities with significant exposures and to provide education to the clinicians, uh, because a lot of them when they order blood tests, they don't typically, at least my doctor doesn't order um testing for PFOS.

And then but uh what we've been doing is, you know, we've been looking at it from the legislative end, we've looked at it from the wastewater end.

Um how much of the work that uh basically on the downstream end that was identified by uh Go Green have we explored?

Yeah, I mean, I'll I'll be transparent.

We have a ways to go there, and I think it's a bit of a cascade of actions.

We really would um to make sure that we've um we don't issue our own guidance, but we want to make sure providers understand what's out there and impacts Alameda County residents.

And we want to do that in a static way, but what I mean by that is it's very hard for us to get their attention.

If we just flash out a talk or an email, it comes and goes, we may not reach so many people.

So that's why, although it sounds sort of you know simple, if you will, having the website as the anchor is probably the first step.

So that then they can refer back, we can push that information out.

We have something to push out that's living, um, that providers can use as a resource.

And then when people come into their offices and ask these questions, because they're learning about this from us from these presentations from their community from the news media.

PFAS is out there in the news media, that they um that the providers are ready for those conversations.

And if you do the if you do it the other way around and the providers aren't ready, it's not going to have the desired result.

Um and then downstream of that funding testing, I think is is more complex.

We we don't have really a mechanism for that.

We're not a we we neither um pay for care nor do we provide care as an agency.

So we would that would be a more complex task and a heavier lift.

Um, I think under the, you know, what's tricky with, and you saw this, I think in this buck's slide.

What's tricky is there is a barrier to access that's inherent in some of this.

Like some people can afford to just go pay for testing themselves, and other people are relying on insurance or might not even have insurance, and so um, and then some insurers may not pay, or they may pay only under certain circumstances for this testing.

Um obviously, if you just do it, pay for testing for this on its own, then um you can avoid some of those gaps, but there's still logistical challenge with working with providers' offices to do all that.

And I think it sets a bit of a complex precedent in terms of what we know, other things that people might look to us to support.

So I think it's a very complex issue, and we want to approach it carefully, but at the same time, ideally people with these exposures are able to get tests and that testing is reimbursed.

Um, before we get to that place, there's a lot more that we can do as an agency to make sure that our providers and our public understand what they can and should be doing.

And I think you saw that presented very well in the Ms.

Buck presentation.

Some of the things that uh you mentioned in terms of our advocacy um at the state legislative level, why do you think um like that the two bills that we supported ended up getting vetoed or they died?

So, yeah, I mean, I wasn't in those meetings.

I think it's probably money that those there would have to be a budget attached to those, and and that my understanding can be a barrier sometimes to legislation proceeding.

Um, I know other PFAS bills have advanced in terms of sort of product regulation, so a lot has happened at the state level, and we we covered some of that last uh summer, um, and we'll continue to track it and and bring updates back as opportunities arrive.

So things are being regulated at the state up to a point.

These chemicals are everywhere.

It's I think barely scratching the surface, to be frank, but um, but things that cost money out of the state budget, I think are a heavier lift right now.

So, how pervasive is this statewide?

I mean, we we looked at um the two water agencies that are in Alameda County, but is it like pervasive in the Los Angeles basin area uh which is the largest I'm gonna invite Stepan Kekina from the um state uh division of drinking water?

Yeah, that's a great question.

And uh unfortunately these are very pervasive statewide.

I would say that we we've probably got the strongest occurrence in Southern California.

Orange County has had huge impacts, Los Angeles County.

Um not surprisingly, I mean, we're we're used to seeing industrial contaminants affecting those bases uh more so than up north here.

But we have a lot of data now on groundwater.

We're going to be getting more of it as the current monitoring order, which deals with the federal requirements kicks in.

The important thing about the current monitoring order is that it also takes in surface water.

And I don't know if I made it clear enough, but we really had been looking at groundwater up to now.

So, you know, you asked about the state water project.

Um, you know, luckily some testing has been done, and you know, we we've got an idea that that's not a big problem, but we're gonna start getting that from all of the different drinking water sources, including surface water.

So we will get a better idea.

You can um, as my colleague pointed out, go on to GeoTracker and you know, look all over the state at what kinds of results we're seeing.

And uh, yeah, as I pointed out in the testing we've done, you know, we didn't find um PFAS compounds in over 50% of the groundwater wells that we tested, but we did find it in you know, well over 40 percent, so you you can consider that you know there's a fairly significant distribution around the state of groundwater sources that are affected.

Okay, thank you.

Do you do you last question?

Do you see this issue similar to what we had dealt with in the past with lead and where they led to abatements and settlements?

Because uh I mean it's kind of hard to pinpoint one specific um industry.

I I can hardly comment on you know the the legal outcomes that that might be potential.

I mean, there's been you know, a settlement offered by some parts of the industry to water utilities.

Um it was a choice whether they wanted to participate in that, um, but as you point out, it's it's extremely nebulous, it's hard to get a hold of, it's so widespread that um finding individual responsible parties to go after is it seems like a huge challenge, but it's that's not it's not part of what we do, we just kind of accept that it's there and we've got to deal with what's there.

Thank you.

Okay, thanks to pretty much Dan for all the questions.

So I'm gonna try to ask my questions based on the order of the presentations.

So I just want to make sure uh with Dr.

Banks, he gave the health effects of PFAS.

And you know, I went to uh college and law school, so I didn't go to medical school and I'm not a scientist.

So can I say that PFAS is a health concern?

You know, unequivocally, it's a health concern.

Yes, I would say definitely a health concern.

Absolutely.

Very good.

And now, do our people who are in the legislature in Sacramento, do they know that it's a unequivocally a health concern?

Yes, I believe that they do.

We have had a lot of discussions with PFAS with legislators, so yes.

And now second thing, and I thank you, Dr.

Banks, for all that thorough information, because I'm sure um folks who are smarter than me are definitely gonna uh be interested in looking at that information to establish the foundation and the framework uh around uh PFAS being a health issue.

Now, in terms of um the water, the water board.

I really appreciate the rulemaking.

Uh let the uh water board um Stefan.

Yeah, come on up.

So I really appreciate the rulemaking.

So, what can Alameda County do to support um because you said and I think it came out that the federal government is not looking at one of the chemicals or compounds or whatever.

So, what is there anything we can do to help?

Help with this because I think Dr.

Moss mentioned that we were going to maybe send a letter.

Is that would that be helpful or do we or is it other stuff we can do?

We we love to get that question.

Um the uh yeah, the good news in California is that we are not limited by what the federal government does.

There, there are states that have laws on the books that say they can't regulate any more stringently than what the feds do.

In California is the opposite.

We have to be at least as stringent, but we can do more.

And so, as you've heard, we've requested a public health goal for PFH excess since we know that that is a constituent of of major concern, um, and we'll move forward with that rulemaking, and if we can figure out a good way to do it, you know, a broad spectrum mass-based approach that we can try to get a uh handle on the whole universe of PFAS compounds.

Um, the thing that that probably helps the most is that when the rulemaking officially starts, there will be multiple public comment periods.

Um, that that is a fantastic time to weigh in.

Um, you know, you you could formally comment um during that time in support.

We we don't necessarily need legislative support to do rulemaking we we are we are enabled already by the legislature to to carry out rulemaking.

So it's it's not so much you know the the legislative lobbying that's needed right now just the support during rulemaking because there will be public comments you can bet that challenge us on things like cost and um you know the impact on all of the water agencies that will be affected.

When do you anticipate the the second stage of the rulemaking to occur?

I wish I could my some of my colleagues could probably tell you the exact years but I think we are looking at the over the course of the coming year to two years we'll be getting stage one done where we get the federal rules adopted probably looking out past you know 2028 2029 20 2030 um to move into our next phase okay so uh so dr moss when when you mentioned in your um policy activity uh did you anticipate the um a comment letter coming to um the environment I guess the environmental protection agency who who's that letter going to go to that that's uh comment period is open now I think until sometime in July so that's to the Fed the Fed yeah but we're prepared to track and send comment letters to the state as well when when those windows open up okay so would it be helpful if the board were to pass a resolution or something or or have pal.

I mean what it does what do you need from us to frame this I I look to our um our internal uh legislative team to make sure that everything's in order and then it works its way up the system to okay how I believe yes all of our uh public comments that get submitted will make their way through okay because I you know the Supervisor Tam disagrees I really want to make sure we get that comment letter into the EPA from the county on the board that's you know we sign off on that plus um the water quality um control board in terms of the state in terms of their efforts at moving forward with their rulemaking that we get on record supporting that yeah okay let's see are you okay with that supervisor dam okay oh let's have Stefan come back up too so I was really interested with the uh monitoring um so at the moment we don't see any significant concerns about PFAS in disadvantaged communities um what I'd say about disadvantaged communities is just that we you know we were luckily able to get that monitoring done at no cost to them because there was there was public funding made available for it uh I can't say that there are no impacts I I would say that you know the the data has shown that there are some of those communities where PFAS show up and some where they don't I don't really know enough to tell you about the distribution you know is there is there proportionally more impact on disadvantaged communities than on more affluent communities um I I don't know I don't I don't know that there's any significant correlation there.

Will the monitoring continue um I think you indicated in your presentation that there's a broad breadth of monitoring will that be will that be continued or is it now um concluding because of a lack of funding?

Well that the the monitoring that the state conducted at disadvantaged communities was not just disadvantaged but all over sure um yeah so the funded monitoring at disadvantaged communities was was a one time thing but with the federal rule taking effect um that initial monitoring period that's that's going on now, that is required for all public water systems.

And then like all of the the regulated contaminants, there will be ongoing monitoring, whether whether it's you know once every three years or perhaps once a year for systems that have detection.

So that is going to continue at groundwater and surface water sources at at all, at least all community water systems.

Okay, thank you.

So let me see.

Let's go to Kim Kimberly.

Because I'm working my way down the list.

So the managing potential PFAS sources, you outlined four steps.

Identify the site, require data collection, prioritize sites based on high concentrations, near receptors, and required uh cleanup.

So is the it how extensive will this be?

Is this just for those 35 sites that you identified in Alameda County?

We are continually expanding the different sites that we are requiring initial investigations on, and then the further investigations are dependent on the initial data.

We like to make data-driven decisions, of course.

Yeah.

So it is not just those 35.

Right now, it started with those 35, and that list is growing.

Okay.

Now Jill brought this up, and it's clearly something of my mind.

Who pays for the cleanup?

It is the responsible parties, which could be any landowner, property owner, or the operator of um the industry, the facility that discharge the PFAS, and that could be current or passed.

Okay, okay.

So it's not the taxpayers.

It is not the taxpayers.

No.

And um the water quality control board, you have the um regulatory authority to require that.

We do, yes.

Great.

Okay.

See here.

And I was really impressed with your geo tracking.

I mean, my goodness, that's pretty pretty extensive.

So people can get this information, the public can.

Yes, that is a state water board website, and they actually scrape our databases one time a week, is what I believe it is, and update that map weekly with any new PFAS data that comes in that's submitted to the water board.

Very nice.

Thank you.

Of course.

Yeah.

Let's see who's next to my list.

Sure.

Come on up here, Dylan.

Environmental health.

So um we also introduce yourself.

Oh, sorry.

I am Dylan Rowe.

I'm chief of the land and water protection division for environmental health.

We also do cleanup program site oversight uh and work with the regional water board.

Um, and I just want to say that um we find PFAS sites, hit or miss.

Uh for instance, uh AB and I site has PFAS, quite a bit of it.

We just found that, right?

So it's gonna be this interesting uh world that uh when there is a reason, and the reason we had the uh uh the water tested at the ABI site was because of auto plus towing and all of the um burned out and wrecked vehicles that were there and uh sediment and uh things blowing into sediment and uh into an industrial supply well that was not abandoned.

So I think we're gonna continue to find stuff.

Um some of that information is on GeoTracker, and it's not at every site that we test for it, but uh it is starting to show up in in places that we're not sure why we have it there.

So interesting, okay.

Okay, and I think Dr.

Moss kind of talked about the supervisor James question that this is all iterative.

We're gonna keep layering and rolling stuff out as we become more and better informed.

Okay, um, let's see here.

I think with with Ken.

Um let me see here.

I think I had a more a question for you.

I appreciate all the work that's being done by zone zone seven, particularly around the transparency and the data collection.

Um the facilities that you had to build, uh was that something the taxpayers had to pay for?

So rate payers.

Right payers, yeah.

Yes.

Uh the first facility we apply for the DWR grant, and we got awarded 16 million 16 million of our supposedly first facility.

So that's pretty much cover the entire uh facility and a little bit more with the second facility.

Cause I think you said the other one's 28 million.

Yeah, 28, and the the last one we were planning is 35.

So as an agency, we issue we have to finance it.

So the ratepayers have to pay for that at the end of the day, yes.

Wow.

And at the moment, I think a couple folks have pointed this out.

We don't know the source of that contamination, do we?

Well, uh our colleagues at the regional board identify a couple of major sites.

One is the Livermo Airport, other one is a fire training center in Pleasanton.

And there are a couple of incidents in the past using a triple F, which is uh Aquarius Firefighting Foam, which is known to have a higher concentration of PFAS discharges.

So those two sources are significant, and Kim and Kimberly and the regional board they are walking on uh correcting that.

So if it's the firefighters training facility, the airport, and um what was the other one?

Just two sources, two-meter sources okay.

Well, the airports, is that a municipal airport out there in Livermore?

Yes, exactly.

Yeah, okay, so I'm just trying to get it.

Would it is it should the ratepayers be paying the total cost of these facilities?

Obviously, you need the facility to do the cleanup and provide the good water.

And you said there's no PFAS in zone seven water, but should the ratepayers be stuck with that bill?

I know it's yeah.

If you can't speak to it, because you cannot speak to it.

The policy makes that can't speak to it, but I think these two facilities are owned by uh cities.

Um if they are charged with cleaning up, um, they have to find a way to get the funding.

Because somebody's got to cover the cost, right?

Yeah, and then I and then I appreciate your your key takeaways.

So would you consider the takeaways from the zone seven work?

It's kind of like a best practice that could be emulated elsewhere.

Absolutely.

I think uh particularly our strategy shown to be effective, and as you can see, it is very common sense uh collaborative and very adaptive management um strategy that we adopted, and we're more than happy to work with um anybody that's interested in sharing the information.

Okay, thank you.

Okay, so I think I think the last person is the shell.

So what I was interested with your presentation, Michelle's really um succinct and informative.

But the um the facility, so is this a typical facility?

I think you have um, and not you, but Alameda County uh water district has one.

I guess uh this similarly in zone seven.

Is this a typical facility?

I'm no expert, but I would say they all pretty much look the same when you Google it online if they're gonna use um IX treatment, yes.

And how much did this facility cost?

26 million, but remember we also planned ahead to possibly expand the facility.

So if you expand it, is the cost already covered?

So some of it has been, yes.

Who paid for this?

Rate payers.

Do you know the in in Alameda County um order district, there's no PFAS?

In our treated water, yeah, correct.

It well, it's everything meets state and federal standards, so it's non-detect through the sampling.

So do you know this?

Well, once again, uh is there any source of PFAS in any of the water?

So we do not have a source.

Um, that's why we expanded our sampling from when we first saw it in nearly all of our production wells.

We went to our recharge ponds and we found it there, and we also found it in Alameda Creek.

So there is no one responsible party, so to speak.

So we don't know we did not know.

And there's no way of tracking that to your knowledge, huh?

No, but we do work with the regional board um with the sampling for whenever a site pops up at having some sort of historical use that warrants the sampling, just like Kimberly explained.

And so we're looking for possible secondary type of influence source, yeah.

Okay, thank you.

Okay, um and then I know Supervisor Tam hit on this.

So Dr.

Moss, with the recommendations that um Joe Buckin mentioned from the Go Green Initiative.

Um the testing, the monitoring, and the education.

Um if money weren't an issue, is there any impediment to us doing this?

Well, I mean, uh the other issue is um less uh there's the money issue, and then it's providers who are independent practitioners that you know deliver medicine according to their training and guidelines and things like that.

They're still gonna make independent decisions.

We can't sort of you know, we don't we respect that that is uh something that's done at the provider level.

Um that said, with guidelines that are available and with the the money, and um I think that that really helps a lot to make it easier for providers to serve the needs of impacted people in their clinics.

Um because with the testing, I think you talked to Supervisor Tam, you said maybe some of it could be covered by insurance providers, some others that might have uh the ability to pay for it themselves, but I don't I don't know for sure what is covered by insurance or and what is not, and it tends to vary by insurers, especially when you you know, there's some things that are widely covered based on you know federal guidelines or or you know best practices in this area.

I think it's you probably see some variability.

Yeah, and you've kind of hit on what I was gonna say.

So why wouldn't we indicate that we think a best practice would be uh making testing available to the you know the pop the public, particular children maybe?

I don't know.

Yeah, uh well again, I think here it's helpful to point to the to the National Academy of Science Engineering Mathematics Guidelines because they do really lay out some pretty clear stuff that we can relay to folks who say this is you know we agree with this, we think this is a reasonable approach.

Um, and um, and so um you know that that's a clear next step for us.

So Jill pointed out the National Academies of Science Recommendation, recognition 5.1 as communities with PFAS exposure identified government entities, um, Center for disease control, uh prevention agencies, uh agency for toxic substances, um, disease registry, public health departments should support clinicians with educational material by PFAS testing so they can discuss testing with their patients.

So would we um take this because I'd like to see this committee get a menu of what you think the best practices are, so we can sign off on this, and you can also publicize that on your website as well.

We can do that, and I think that slide is a great starting place for that discussion.

Yeah, and if there are others, yeah, okay.

Yeah, there's there's more in that document than summarized there, but I think a lot of the key points are in there.

Okay, um, and let me see if there's anything else.

Oh, what about monitoring the health of communities with significant exposure right now?

I guess we only well the water quality board kind of indicated 35 locations, but I don't know if it's all 35 or if we have certain targeted locations beyond like you know, Freemont and um the Tri-Valley.

I I just don't know.

If I understood correctly, that was you were referring to people's health outcomes, so actually understanding the sort of epidemiology locally of of um the uh illness that could be related to PFAS.

And and I think that would be wonderful to be able to have that information.

We we you know, we would likely, and we talked about this a little bit last year.

Um there are different ways to approach this.

One one way that might be potentially very fruitful would be to partner with somebody who does this work to come in, and but you still, you know, you need to get people to participate, um, and um looks a bit like a research study in that regard.

Um, and I think we as uh as a health department could have an important role there, but we would need somebody to actually you know go out and do do all those things.

So once again, unless Supervisor Tam disagrees, can we also look at coming back with having them uh flushed out a little bit further?

Um sure certainly we're more than happy to come back with uh additional um um steps um for to address this this area.

Okay, and then educating clinicians.

Um how would we go about that?

I mean, you're a doctor.

What do you what do you really how do we go about educating clinicians?

I know you guys have forums and conferences and all that kind of stuff.

Has PFAS come up?

Yeah, so clinicians get educated um first of all in their training, and then once they're in practice, um, usually through continuing medical education, um, either sort of self-directed or or through things that their institution puts on or through training conferences that they go to, maintenance of board certification.

That's how it normally happens.

I'm gonna put you on the spot, Dr.

Dr.

Moss.

Um you're the health officer for the county, right?

You've got a lot of influence and authority, and you've got I don't know about that, but there are other health officers in the other counties.

Yeah, have the health officers discussed this, and would it be possible for the health officers to, you know, take this to one of your conferences and talk about it and that happens among health officers.

What is very hard, and what we really have a very limited slice of the attention of medical providers, despite our role and our authorities or my legal role, things like that.

They actually are focused on delivering the medical, you know, their day-to-day work to to their their um patients.

And we get a little bit of a chance to grab their attention about things, and so what has made the most sense to me for this is to try to package it up as part of outreach around chronic disease more broadly.

What we will think, you know, reminding people what they should do for diabetes.

They know this stuff.

This is bread and butter medicine, but diabetes, high blood pressure, cancer screening.

Here are some other issues affecting Alameda County residents, and what you can do about a PFOS, because we can't go get their attention for things on a piecemeal basis.

They don't have time, and they're not listening.

In my experience, unless we're really loud, like a COVID pandemic or uh, you know, major issues, then we get their attention but for a very short amount of time.

So we really have to be strategic in how we how we engage them.

Well, let's not lose sight of that, because obviously you know, you know how to approach your colleagues in the industry, the medical industry better than I do.

But I would definitely let's not lose sight of that um and kind of um give us a sense of how we might further kind of do take steps to educate clinicians, yeah.

But I do think a website and some static resources, we need that first, so that we always have that, it's always live, and we can push that out every time we have the chance, and and that is a reasonable strategy, and it does work.

Okay, and then the wastewater, you talked about that, and we'll continue to see if there's bills that come up in Sacramento.

Um, and I think Supervisor Tam asked the question, and I think we got an answer.

This problem of PFAS isn't just localized Alameda County, it's it's it's a concern worldwide all over the state and the country worldwide.

Okay, and then it um a question was answered that I had the PFAS.

We're more concerned about the ingestion of it into our bodies as opposed to being exposed to it uh through contact or something like that, through products and things.

That's my understanding.

I think the the issue with all of the consumer products that it's in is that it's a continual source back into our environment.

Even if our exposure is mainly through ingestion, it's in our environment, it's in our homes, and it's getting cycled through the um environment and it doesn't break down very easily.

So even if we're maybe I have a Scotch guard rug in my house, for example, or some some other you know, consumer product that hasn't it, you know, maybe I'm eating some of the dust, but also I keep buying consumer products that have this stuff in it, it keeps being part of the sort of cycle of things that are in our environment, and it makes its way into things like drinking water and soil and things like that.

So it's I don't want to take away from the idea that we're in contact with it all the time.

I think that is part of the story, but it it is ingestion.

You're eating and drinking it, is my understanding is the big risk.

Okay.

All right.

Well, this has been very comprehensive.

What would um be the next step in terms of bringing, you know, following up with the committee?

I I mean, I think for us uh there's a uh a clear next step in terms of building out what we're doing in terms of medical provider engagement and community engagement regarding their the you know health PFAS related health testing and and just understanding, and so I think that's probably what we need to get some work done on and bring that back here.

And of course, we would do a policy update as part of that as well.

I think that's always evolving.

And then the letters comment letters to the EPA and the City Water, exactly.

I we expect to have more to report on some of that even before you know coming back to the committee.

Okay, and when do you anticipate coming back to the committee?

Um I think uh right now this is uh pretty much project managed by me personally, so um, so it it may take some time for us to come back with I would say meaningful reportable projects.

It's not a two or three months kind of thing, but um hopefully in the next six to twelve months.

Okay, but it's a bit once again.

I'm impressed.

You've pulled together a good team within the agency, you've got outside uh colleagues now, so you can have yourself a pretty significant working group that can help further your thinking when you bring it back to the committee so we can adopt some you know some next steps moving forward.

So thank you.

Um, you have any other questions before I see if there's any public comment, any any public comment on this item.

I have no speakers for item one.

No speakers, okay.

Well, once again, I want to thank everybody.

It's been very, very informative.

Um I can't say it enough.

Very much appreciate your time and attention on this.

Uh, and as I said, I knew a little bit about PFAS over the last few years from you know, Jill talking to me and meeting with attorneys and others.

Uh, but today it's been very, you know, very informative, and and I think hopefully Supervisor Tam has become informed as well, along with the public if they watch this um uh this meeting, and then the next steps we take moving forward.

So uh thank you all and don't hesitate to contact our staff or my office, Supervisor Tam's office if there's anything you can think of that would be helpful for Alameda County to do prospectively.

Thank you.

All right, so now we have one other agenda item.

And this one is the Alameda County Health Systems preliminary budget for fiscal year 20 6 27.

Yes, and thank you for your patience.

Thank you, Supervisors.

Mark Fratsky, chief Operating Officer, subbing for our CEO today, James Jackson, who's taking a little PTO time.

I'm sure he wishes he would be here and could be here.

Um, we're gonna present where we are with our fiscal year 26-27 budget.

I want to thank our four Board of Trustee members for being here today with us.

Just two real quick comments.

Um, and Kim will state this as well.

This budget is a work in progress yet.

Um, and lastly, our board of Trustees had a chance to review it last Wednesday at the Board Finance Committee, and it'll be reviewed again this Wednesday at our full board meeting.

So I'm sure the comments and any information you have today will help inform the discussion on Wednesday.

So with that, I'll turn it over to you, Kim.

Thank you, Mark.

Good morning, supervisors.

Well, it is still morning.

So I am presenting to you our draft budget for Alameda Health System.

And I thought I would start with our budget priorities.

You can advance the slide.

Thank you.

So the budget is intended to preserve the essential services for the county safety net population.

So the focus here was on preserving the trauma and other programs core to our mission.

We also are striving to fund capital investments to ensure that we can provide patient care.

And we don't want to invest in things that are not consistent with the AHS mission.

We are striving to meet all of the joint commission and CMS standards.

We've just had several surveys.

We're waiting for official findings so we can respond appropriately.

This is a program which will involve all of our physicians.

A lot is happening with the way we schedule patients, along with some new electronic tools.

We are we want to make sure that we're able to restore the auto assignment of alliance Medi-Cal members to all of our clinics.

Next slide, please.

So this is, as Mark said, you know, a draft, and it is a moving target because we're working on this real time.

So what I'm reporting to you today is an operating income loss of 38.9 million or just about 39 million.

We have increased our revenues by 23.8 million.

Unfortunately, our operating expenses are up 43.2 million, which is creating that deficit.

Next slide, please.

So this second slide brings us down to our net income, which currently sits at a loss of 42.8 million.

We use EBITA as a quasi for cash flow because it represents pretty much how much cash we generate from operations.

Right now we have an EBITA of 8.9 million negative, which is which means we're not generating any cash flow to pay for capital, which of course we do need to be sustainable.

Down at the bottom, there's a couple key metrics.

FTEs, we're at 5,024.

That is a reduction right now of 11.

Um that relates to the fact that in this preliminary budget, we still have the deferred RIFs included.

Um our adjusted patient days are down 2.8%.

That is uh our estimate of from HR1.

I have a few slides uh that we can get into later if you so desire.

Next slide, please.

So this, a lot of colors, a lot of noise maybe, but it's the one-page simple way to explain how we get from the current year to our budget year.

So we start with taking out a few one-time items that we don't know that will happen again.

So we're starting out with an estimated loss of 26.4 million for this year.

We have pretty substantial net income increases, 34.9 million.

That comes from our commercial contracts, Medicaal, Medicare fee schedules, and a big huge amount this year because we settled the FQHC for Highland with the state of California.

That lawsuit started back in 2011, and we have come to terms, and we are as a result of that increasing rates at Highland FQ.

So that is a nice pickup this year that we don't normally see.

We still have IOP as going away in the current budget.

So that revenue is $4.6 million.

That is just the revenue because the staff costs, which are most of the costs are included in the deferred RIF, which is coming up here in a couple bars.

We have HR1 impact for this budget year at 17.8 million.

Again, I've included all the supplemental graphs and some slides on HR1 if we get if we want to get to that level of detail.

Our supplemental revenue outside of HR1 actually went up 8 million.

Our performance initiatives, as I mentioned to you, so far we have 28.4 and we're still working on it.

We have the deferred RIFs.

This was the 1870 FTE.

This number is changing and moving as a result of attrition.

And then we had to true up people that were hired last year for a full year, which is a reduction of 13.9.

We have some additional costs for clinical and ambulance services, 5.1.

The biggest negative factor there is the CPI for labor.

That's all labor costs, including health care benefits.

It is sitting at 66.5 million.

We've got some additional insurance and legal costs of 3.4 million, and a bunch of smaller things that total 3.9, getting us to the current state of 42.8% loss net income.

Next slide, please.

So these are the performance improvement initiatives that are currently in this budget.

And again, we it's moving.

We're not done yet.

This is the preliminary budget.

So this is where we are on the initiative of 100 million together.

We knew we had the 100 million deficits, so we've been working on this for some time, and I would say some of these are stretch goals that we have included that we believe we can achieve.

First one there, and by the way, this is all revenue side on this 5.6 million.

We're starting with charge capture optimization.

This is not in the FQ because the FQ, of course, is a fixed rate per visit.

So what we're doing here is we're going to all of the areas in the system for outpatient and looking at are we optimizing our charge capture.

We've been on this journey.

This will be year three.

We've met every one of our targets to date, and this one is an additional one million.

Number two, ambulatory access and revenue improvement.

We want to get our patients in in less than 10 days if they so desire.

To do that, we have to redesign all of our scheduling templament templates, and we want to make sure that we can charge for on the fly encounters when a physician has a video visit.

So this is an additional 2.1 million.

Third one is charge capture on professional inpatient rounding.

This came as a result of the ad hoc meetings and meeting with our physicians.

Many of them said that when they're rounding on an inpatient, they don't necessarily have the ability to bill.

So based on the information they've given us and the current rate for one physician rounding charge, we've come up with about 250,000.

Next item there is accounts receivable.

So there is a group of charges that are aging.

But there's about 43 million dollars of gross revenue, which at our collection rate is about uh 4 million.

However, we do have to pay legal fees, and when we go before the administrative law judge, it is a settlement.

So some claims get thrown out, some get accepted.

It's a whole process we go through that takes sometimes years.

So we've only got 250,000 in this year's budget, but we think it could be around 4 million.

The fifth one there is Alameda Alliance that also came during the ad hoc process.

Alameda Alliance has offered to give us a 1% fee increase starting July 1, and then another 1% on January 1.

So we just got the uh the amended the amendment, but at this point I have 1.9 million built in the budget.

And then my team has identified copay collections from our patients as another opportunity.

This would reduce the bad debt that we have, and that's $36,000 for the year.

So that totals $5.6 million.

Second slide here is our expense items.

Um the first one is overtime.

Uh we have currently a baseline of 5.6%.

We want to decrease it by 15% to 5%.

So that's $3.4 million.

We also have meal and break penalties when someone can't take their scheduled meal time.

We think we can manage that better and get $725,000.

We have uh guide house looking at all of our contracts.

That's an outside company or consulting firm.

So far, they've identified $4.9 million of reductions.

Many of these happen when we renegotiate the agreement.

So we will purchase our supplies through a new TPO, and these do not include pharmaceuticals, and we think we can get 2.5 million this year from that.

We do have the delayed reduction in force in here.

That on this schedule is 187 FTE, which we actually built into the budget.

We know that number is less due to attrition, but I'm leaving this on the schedule the way we put it in the budget at 35.3 million.

The next item there is non labor budget cuts.

Uh, we asked every one of our department leaders to identify savings in their budgets.

They came up with 8.8 million.

And the last item there is a decrease in opportunity days.

What we're trying to do is discharge patients closer to the expected length of stay.

Um, and then we are identifying 1,500 per day.

That would be at the end of someone's stay of savings, which are 2.6 million.

So grand total there, 63.8 million.

And again, if you take out the rifts, we're at about 28.6 or 28 million rounded as we put in the, as I uh stated earlier.

The next set of slides relate to our projected cash flow and what we believe will the balance on our net negative balance or line of credit will be with the Treasury.

So starting here with our budget, the second column, you can look in the middle there.

You see our current deficit of 42.5 million.

And what I'm doing now is adding back the non-cash items depreciation, which gives us that deficit that I showed earlier of 8.6, which is the indication that we do not have funding for capital so far.

And then I'm rolling the 42.5 to projected 28 as the starting point.

And I'm doing that as a reminder because AHS does not have a long-range financial plan where we actually build out multiple years in terms of including salary changes, you know, inflation, all of those kinds of things.

What I'm doing is I'm just saying we're not going to get worse.

That our adjusted net income this year, if it stays the same, I can estimate the HR1 impacts.

They're going to grow to 67 million.

We know that we have some positive supplemental impacts of 22.2.

We know that our skilled nursing pass-through funding is going away, so we're going to lose that funding in 28, bringing our adjusted net loss to 110.7.

Adding back the non-cash items, our deficit would grow to 76.8 in terms of cash.

And then I did the same thing for 29, just taking that 117 up to the starting point.

Adding back non-cash gives us the cash flow deficit of 110.2 for 29.

I'm going to roll these EBITDA numbers forward.

So if you would go to the next slide, so this is at the top.

So you'd have a comparison.

But sticking with budget 27, we're starting with the EBITDA cash flow loss of 8.6.

I've listed the cash from supplemental programs here.

And I could see how this may be confusing, but cash is not net revenue.

So I wanted to lay out the cash flows for some specific reasons I'll talk about here.

And then you have to offset what's in our net income.

So if you look at the net supplemental cash flow there, you can see in 26, which we've talked about a few times, we got hit pretty hard.

61.4 million of negative cash flow.

So our net income was higher than our cash by 61 million.

In budget 27, it's going to help us because it's actually positive.

We're going to have 37.2 million more of cash than we had revenue.

And in 28, we're going to have the thing that happened in 26, we're going to have uh less cash than net income by 34.6 million, and then it flips back in 29 where we'll have more cash than net income, 32.

So just to bring you to 28, you can see the realignment funding, the 53.7 million negative.

That's what's driving it in 28, and it's also what drove it in 26.

So then there's some other activity there.

Um, and then I've got capital.

Um right now I've only got the average spend of 20.6 included.

We know as a system we want to spend more like 30 million each year.

We haven't done that since the implementation of EPIC, so I just left it as our current spend levels.

You can see the cash surplus deficits, and then we we live on that line of credit, that net negative balance.

So I'm taking that deficit and either reducing or increasing the net negative balance.

You can see for FY26 and 27, we are going to be compliant with the revised terms of the permanent agreement and the net negative balance in 28 and 29.

However, we will exceed it or we're projected to exceed it if something does not change.

So next slide, please.

Next um slide, I included just to give some more information about where what costs what in our system.

Patients come in the ED, they go to the hospital, they go to clinics, they go to OR or operating room, and so we don't.

Alameda had a beneficiary of the one-time uh SNF money that we received.

That was a pass-through where the state of California paid the local share.

So beginning in 28, that goes away, but it made it made the Alameda contribution margin positive for both 26 and 27.

It was actually three years that we got that additional funding.

So thank goodness to Measure A, which helps us keep our doors open, uh, and um QIP and GPP supplementals.

Next slide, please.

So this is the HR1 and other state impacts.

Um this is the slide that just relates to 27.

Um, I'll just make a couple comments here.

Always happy to answer more questions or get into more detail.

But the first item there relates to the app map drop.

It goes from 90% to 50%.

So we'll see expecting to see a nine million hit in 27 rate range uh reductions are tied to less medical, meaning people falling off of Medi-Cal benefit 4.1 EPP has been capped, so we're no longer gonna see the cost of living increases we've seen before, and then the expiration of the 1115 waiver for GPP, that's the Medi-Cal waiver.

Um, so the safety net care pool will no longer be available, reducing the amount of funding.

Uh, however, we expect that Medi-Cal dish will continue.

So the impact is 3.5.

We think in FY27, those total 17.8, circling back to my first slide about the impacts for 27 compared to 26.

The next slide, um, I go out uh four years here, and that's in those numbers tie back to the uh cash flow projections that I just went through.

Um, and next slide is the budget calendar here, and I've got TBD down there at the bottom because we do still have a deficit.

We're still, you know, working hard to close it.

Um we will, as Mark Fratsky noted, take the revised the next version of this next reiteration to our board on Wednesday to review from a logistical standpoint.

We want to make sure that we have a budget loaded for our managers for the month of July, so they have targets to hit and they can see their budget.

So we're gonna want to make a decision about that soon on whether we are in a place to where we can go ahead and roll that out to them, even though we may not have an approved budget with the uh deficit solved.

That's my presentation, unless you'd like me to go into all of the budget assumptions, which I can do, which is the next set of slides.

Um what is our is the supervisor's uh desire?

Thank you for the presentation.

I have some questions, but it may actually be for my esteemed colleague and chair of the health committee.

Um you mentioned that on the um list of performance improvement initiatives that the um Alameda Alliance contribution on the one percent rate uh that came from the ad hoc committee.

So I'm just trying to get an update on what are um options that the ad hoc committee are also hearing uh from the different um stakeholders because I did meet with um local uh 10 to 1 last Friday, and um I have to say that based on what I'm hearing, the issues that came up during the Bulenson hearing don't seem to have been completely uh addressed in terms of what the ad hoc committee was planning on looking at, and they were most concerned uh, even though it's not a big huge part of the budgeting um shortfall, was the IOP program, and uh you mentioned that it's uh 4.3 million or 4.6 million, and so I wanted to understand from our Alameda County Health Department, um, which I have been working really hard to provide support uh to the tune of like eight to nine million dollars.

Alameda Alliance has provided 3.2 million over the two years.

So what do you think, even though it's not a large part of the budget, can be done with the IOP program in terms of like morphing it into a model that's more reimbursable.

Um thank you for that question, supervisor.

So uh as we've discussed at the ad hoc as well as in conversations with our AHS colleagues, um, our behavioral health team has met with the AHS team to end one of the things that we wanted to explore was whether uh that program can bill Medical in its current form, as that's a newer option under the uh state's medical billing for specialty mental health.

Um, and my understanding is that based on that conversation, uh, because Medical will always pay less than Medicare and it currently bills Medicare, uh, that it's not financially uh feasible in terms of ongoing impacts to be able to do that.

Um I think our team remains open to further conversations with HS if uh they want to talk about other ways to look at that program in terms of transitioning people to other levels of care, or you know, looking at various um opportunities to make sure that the the trying the clients have uh the transitions available to them.

We I do just want to be clear, it's never been our intent to be able to uh support that program or to take it over because um I think anyone who's been engaged in those conversations at this point sort of under you know, just the way that the program itself functions.

Uh it's just from a peer billing point, it's not a sustainable piece um help me understand this a little so um the way the program was described to me by a lot of the therapists that met with along with 10 to 1 was that it seems like a more longer term care where uh people who have um basically uh um chronic uh mental health care conditions uh use and see the ILP program at the hospital at Fairmont as a it's it's more like um a sustained period over their entire life it seems more like a long-term cure rather than an outpatient where you go in and you know see a doctor and get an antibiotic and go and hopefully get um some relief so are there um medical programs that provide for that like you know like we have with SNF units and with uh uh assisted living and long-term care facilities supervised before mark shares a little bit more I mean not being a clinician and uh but I I will note that most programs um do require some level of throughput uh in order to be sustainable right and so if uh that would be part of our goal for conversations with AHS would be to think through like are there places for people to step down or are there other places for people to uh receive a next level of care um because theoretically there are people who um have a much longer recovery span uh and there might be others who have a shorter recovery span but I'll let one just thank you um we have looked at different models to close an eight million dollar gap and none of the models none of the payer mixes that we've worked with given the volume that we're seeing um close that eight million dollar gap materially um and to Anika's point the patients in this program have to graduate and have to transition through this isn't a lifetime program.

They need to move through the program eventually graduate and maybe get into an outpatient um like episodic um provider care in some fashion so the good thing is um I'll be meeting with the Alameda Alliance this week because I'm it's my understanding that they have developed a whole Medicare network now and so we're gonna be meeting with them to see what the opportunities might be there to transition.

I'm also very pleased that the county is working with us in terms of how we do transition our patients given that there isn't any gap, you know, money to close that gap that we're aware of at this point.

So okay that's helpful we are looking at the D SNEP program um for Medicare at Almeida Alliance.

So from what has the ad hoc committee been up to well we definitely said to um HS labor to get to the bargaining table and and figure out a plan hopefully consensus around the plan that would address we got about 81 million that we've got to deal with at the moment right.

So without the the RIF we are actually at uh don't want to misspeak at all.

So without the RIF we're we started 100 million got 28 identified at 72 million.

So we're down to 72?

Yep.

So we kind of at the end of our meeting last Wednesday, that was kind of where we left it.

We really need to have both sides at the bargaining table figure out what they can come up with that would hopefully have consensus around reducing the 72 million and then come back.

We're gonna schedule another ad hoc meeting.

I think Supervisor Gass and I were thinking about maybe June 17th for another ad hoc committee so we could kind of hear the result of any bargaining uh to determine where the county might be able to be supportive because there's certain things from obviously the bill and hearing and our 17,000 obligation that we want to make sure that you know we're adhering uh to that.

So if we can get labor and HS to come up with a plan that further reduces that 72 million, then we'll see where we're left with the county as it relates to our 17,000 obligation.

That's kind of uh the way I see it.

Uh, and we are very much concerned about keeping the IOP uh program going uh while the study is underway so that we can determine what's going to happen in the future with uh with IOP.

So we don't want to see that go away.

We want that to continue.

Okay, so um just to clarify the 42.5 million dollar deficit that you show here, that is with the RIFs, yes, and the 72 million is without the RIFs.

And you're trying to at the ad hoc committee reach consensus through performance improvement initiatives to close that 72 million dollar gap.

Is that the plan?

Or it could be it could be any combination of things, additional efficiencies, um revenue uh enhancements that uh labor feels either their questions haven't been effectively answered relative to revenue enhancements, none of these things are mutually exclusive.

It could also be with um deferring, not um eliminating, but deferring the um call the cola, um, or portion of the cola, it could be um riffs, but not to the extent because right now uh AHS is saying it's um 187.

Maybe it's less than that, you know, so partial rifts.

So I'm not at the bargaining table to negotiate this, but we've said to them, figure it out.

Yeah, but it could be that as well as any other things as well, okay.

Yeah.

So we're trying to remain, at least from my perspective, um, I think Supervisor Bass is with me on this.

We're trying to remain flexible and open to possibilities without necessarily um what's the word, seeing a reduction in labor, seeing a reduction in safety net services, particularly 17,000 obligations.

Yeah.

If you don't mind, Supervisor Miley is correct.

Um, we're looking at a whole host of options.

Um, so I appreciate uh the comments about flexibility.

I can say this month, and Supervisor Miley was clear to us and the unions that let's use June as a month to get to the table to negotiate some ideas.

Those ideas from our perspective is all have always been about three or four major ones.

One the cola that you mentioned, two the medical premiums, you know, staff paying 10% of their monthly premiums for um for their medical, um, and then furloughs are another one on the table that's on the table.

Um, so along so we've done, you know, a lot as it relates to revenue, and to Kim's perspective, we'll continue to drive toward looking for revenue opportunities, but the great majority, I think, of the ideas need to come through expense reduction at this point, and 75% of our expenses are labor at staff expenses.

So we need to um really dig down in.

We have started reducing our FTEs by way of some of the internal processes we put in place, but there still is work to do.

And I think all of those ideas were have been discussed um at the ad hoc with those three I mentioned taken out um for discussion at the bargaining table.

From this list of the performance improvement initiatives, one of the recurring themes that I kept hearing seems to be addressed.

I mean, and from what I have seen, the collections at Alameda Health Systems are in at least the I mean the top 10% of institutions in terms of collections.

What more do you think can be done on that front in terms of generating the revenue that I think labor was talking about?

Well, we've been um we've come up with 5.6 million here of of items to work on.

Um we are meeting with our staff and the epic representative to walk all of our employees kind of as an education um session so they can ask any questions without me or my uh the senior leaders with of revenue cycle in attendance, so that hopefully people will feel safe.

They can ask all the questions they want.

They can go through work queues, they can, you know, uh look at who has you know responsibility for different queues, so that we can hopefully tame some of this.

Um if you look at the epic scorecards, we are top performing in almost every metric every time you run the report.

So our physicians, many of these ideas like the inpatient rounding charges, that came from us going out and talking to each of the um specialty groups.

We're gonna roll that out even more, and we're gonna go, it's a 90-minute meeting with every single leader over every single specialty.

And we're gonna take, I'm gonna take the data that I have that basically looks at what they're charging compared to everyone else in the country.

We're gonna compare that.

We're gonna listen to see what they see and hear, and out of that, there could be some more items that come out.

Um, but it's in regard to the revenue cycle and how it's operating.

I believe we're doing very well, but that doesn't mean that there isn't some opportunity because somebody we haven't put something into the system to build, so to speak.

But once there's an account, all the charges go on it based on documentation.

So we're gonna go through that process.

It'll take a you know quite some time.

Um, but we're partnering with our physicians.

I'm really excited about it because I think that the positive is in revenue and also in quality.

So I'm you know, I think it's a a really good process that we're embarking upon.

Okay.

Um I mean, you're obviously scrubbing and trying to look at every avenue to make sure that your collections are um at what it needs to be, and it's it's just it not clear to me that you're going to be able to close a 72 million dollar deficit based on that alone.

Um the other aspect that I've been trying to struggle with is uh you identify savings through engagement with guide house.

I hope you're not paying for an efficiency firm, like you know, four million dollars just to save two million dollars.

Um I don't know off the top of my head how much the contract is.

I don't know if uh Mark does, but we engaged with them probably it's been it's been a while now to look at all of our contracts to see if we could negotiate better rates because based on the on their expertise, they know what the going rates are, and they can also help us negotiate to get to whatever the appropriate rates are for a whole wide um range of contracts, including physician contracts.

We've got well over 2,000 contracts in our organization, and so the guide house contract, I don't know the monetary details, but it's not set up to pay them more than the money we find.

It's just the opposite where they find all the money and they get a small percent of what they find.

So it's just the opposite, uh supervisor of what you said, and we're very optimistic about it given all of the contracts we have.

So thank you.

That's helpful because we were approached by a company to look at efficiencies that would charge us initially more than what we might potentially get in savings.

The the other question I had is um so we had increased the NNB limit uh in our last discussion.

So I I'm just trying to um because I sit on the budget and finance committee for the board, trying to align with the county's budget because we are trying to close a 91.5 million dollar budget deficit that came down from like 184 million because of prior investments we made on the pension front.

Um we so are there any um savings that can be done through like the pension um deferment?

So not that I am uh aware of um the change to the NNB did help us.

So for the next two years, we believe we will be compliant.

Um and that again, I we've included the RIF in all of these projections here, the remaining RIF.

Um, in regard to deferring, I I don't know, we could look and see and talk to a Sarah, um, most of our other plans, it's probably not that I would be aware of because we've committed to our employees to match, and so I'm not yeah, I meant in terms of paying your pension obligations.

A lot of I mean, Alameda County is unique that were like 82% probably funded or close to 90 percent, whereas other uh jurisdictions may not have that.

Um, like if you don't have a uh a good year, you don't pay as much into your pension fund versus uh in other years you you accrue that obligation.

Yes.

Yeah, so what I have here is based on the actuarial information that we had um for the ASERA plan.

If there, you know, is some opportunity with the Sarah to not fund as much this year.

I suppose we could look at that, but then we are just kind of deferring ultimately the impact on you know the organization in more debt, basically.

Yeah, and like you said, I think they're they're scrubbing their books looking for every possible angle.

And you know, I think both Supervisor Bass and I felt progress had been made over the last month or so.

Um, you know, obviously, they found some efficiencies, 28 million dollars worth of efficiency efficiencies.

So the deficit has gone down, and we're not letting uh HS off the hook, they're saying it, they're gonna continue continue to look for more stuff that's expected.

Um, we made it clear that we're all in this together.

This isn't an issue of, you know, HS versus labor uh versus the county collectively.

We're all in this together to ensure that there's uh sufficient resources to maintain um the safety net, seventeen thousand obligation, maintain, you know, the front line employees um maintain labor peace um and have a balanced budget and not just a balanced budget this fiscal year, this fiscal year, but look, you know, 2728 that you know down the road.

And we do think that the ad hoc committee can serve a role to try to facilitate communication, because sometimes the communication between the parties is is challenging, and I think uh we can help facilitate communication uh to kind of maybe get to the bottom line on some of these matters because I think with the epic hope I know there's uh disputes around whether or not you know certain information can be provided through EPIC.

Hopefully, that meeting's taking place this week, right?

Yeah, um it's coming up.

June 19th, oh okay.

It's June 19th, it's coming up very soon, yeah.

And we're still working to see if we can have you know union representatives in the meetings um but so we're still haven't gotten the answer on that but we're happy to have all of our revenue cycle people participate that are employees so um we are you know I'm I'm I'm looking forward to that because I think there's been a lot of misunderstanding about what how the work queues work because uh you know one claim can be in three work queues right and there could be three separate people that are responsible for those work queues so if you're staff and you're working you you may not know what's sitting somewhere else and who's taking care of it but you know what how I describe it is we've got 62 or so days in AR and that's everything and that hasn't moved so we're not growing in work queues things move and there is millions of dollars if you think about it over time going through Epic right or a 1.5 billion dollar shop and one billion of it is charges.

So yeah that's a lot of money and work queues and it it one charge can be in three different ones so it brings it up even more so I think I think it'd be really good for the staff because I'm sure none of them have ever had the opportunity just to see everything within Epic.

So um and if if we come up with something great you know that's that's how I see it.

Yeah so what we've been trying to do through the ad hoc is push for better communication and put an in push for an understanding around some of these areas of dispute like the work use Epic etc so even if once again um um the answers are not what HS wants or the answers are not what labor wants at least people are saying yes we trust the information we've gotten accurate information that's no longer an issue of dispute we don't have that communication issue and then we'll see where we land in terms of what else needs to be done to address the the you know the deficiency in terms of resources and um budgeting.

So we're trying to drive that agenda very strongly um and as I everyone knows uh once again I've constantly saying this the county's not at the bargaining table you know we're not in closed session to know what's going on we're not so we can only take what we hear from both sides.

Um that's one reason why I'm trying to push for this governance uh change not to throw everything out health or skeleton because I think that would be irresponsible but to try to get um a little bit of wiggle room around the the governance piece but um we do think a role for the ad hoc continues to drive an agenda so we do probably want to have another meeting on June 17th to see where we are we're also interested in knowing um and I don't know if you got information about um the RIFs if we can do anything relative to the risks legally or is that information you can't disclose presently James because James Jackson said he would have an answer today.

We were waiting for as you remember from the ad hoc committee um an opinion from our legal council and we will be going to our board of trustees in closed session this Wednesday to make a determination.

Okay all right because we you know we want to see what kind of flexibility we have around the risks of the RIF notice and either um uh uh you know deferring it um um you know doing other things that might add to uh flexibility associated with it um so hopefully that'll be something that we will will will be beneficial and maybe that'll be something they'll be able to use uh in their communication uh with labor um and you know and the bottom line is because we all are in this together, AHS, we gotta make sure that like they do everything possible to try to address the budget situation, and that labor has an understanding that they've done everything possible, um, that they no longer have an issue with um some of the revenue enhancements that labor's talked about, and that this is the true um indication of where we stand, and then now what can we um either what type of concessions can be made to help balance the budget this year and maybe next year um because I know labor's not gonna make concessions until they have their answers, I mean the uh answers to those questions.

The and then I can't in good conscience have the county or at least suggest the county come forward with additional resources to until we have a good understanding of that, that labor has an understanding of that, HS has anything of that, and there's consensus around that.

Um, because then we'll know if we're if we're talking 30 million dollars to get us, you know, to a balanced budget, okay.

Then we look at that.

Um if we're talking 15, if we're talking 20, what what are we talking once there's consensus around that?

Um, and the other thing is uh clearly with the 17,000 obligation, um, we don't want to see, we don't want to violate any of our responsibilities there.

And we, you know, we you know, we do have resources that we can look at, you know.

Measure W, if we have to, we can look at that.

We don't want to go there if we don't have to, but we look at that, and clearly, if we're going to look at getting measure W reauthorized in the future, we need to make sure we're using Measure W around not just home together and housing, but we're in homelessness, but we're using it to support essential services, so we do we can tinker with that if necessary.

How much money do we have in measure a reserves?

Uh for the county's portion, yes.

So the county uh receives 25%, and we aim to have at least a 10% reserve.

Um, but I can tell you that this year we're probably below that, so for about uh $50 million budget or so.

Okay, so we can look to you know, measure A, or we can, and if we have to use the measure A funds, we need to make sure we don't just rob Peter Pay Paul.

So we would still need to look at how we're gonna address stuff on the county side if we were to put more of Measure A money into AHS because HS receives, I think it was like 170 some million last year at Measure A monies.

Yeah, I think we've budgeted 145.

145, yeah.

So they receive 145 million to Measure A.

Um, and overall, I think from healthcare's um analysis, uh the county's putting about 300 million, is it 300 million annually in HS?

Yes.

From all sources, yeah.

So, but once again, clearly we're not saying that's the the ceiling, but we don't want to go above that without everyone rolling up their sleeves and really working hard to figure this out.

Um obviously this the pain that we're experiencing is not pain that was self-imposed, it's pain that you know is coming from you know the federal administration.

So we just have to do the best we can to figure it out, and then if we've done all that and we're looking 2728, 2829, and we have to look at potential other enhancements through a ballot measure or something, then I've made it clear before I feel comfortable going to the voters, we have got to have done all of this, and also indicated that we spent you know that we've used our resources um uh to the best of our ability before we go to the voters.

Because you know, I led the effort around measure A, I led the F around measure A3 authorization.

I've been involved with measure W, was involved with uh measure A1 with housing, was involved with measure C.

We know the the temperament for voters for ballot measures is not like it used to be, so we really, really, really have to be very um solid on saying we need more money.

Uh and this is why we need more money, and we can demonstrate why we need more money because we've done everything possible, yeah.

And then finally, if we take money from the county side, we've got to make sure we can shore that up because you know we continue to have needs.

If it's not around mental health, it's around the federal qualified clinics and it's around other services as well.

So clearly the needs going to continue to be there.

Yes.

I just wanted to, for the record, the measure A budget we have is 148 million.

Okay.

All right.

So hopefully that provides a little bit more context, Supervisor Tam.

We're not finished yet, but we're rolling up our sleeves and working as hard as we can.

Yeah, with all sides.

I have every conference news.

Supervisor Riley.

And I do know that we um under 17,000.

We have the um the indigenous care population, and frankly, health pack is that uh funding of insurance for last resort.

And I know that the AC director, AC Health Director has looked at potentially bolstering some of that with measure W, and the bulk of the health pack funds do go to AHS.

So I think there are their support there, but I don't know how much we can tinker in terms of um closing such a huge gap at the moment.

We have 19.6 built in there with uh um which was we just heard about actually, so that was good.

That's the HPAC amendment.

Sorry, Kim, there's a couple of different uh health pack line items that we have then there's the base card, the base one as well.

But that was additional funding that we just heard about.

Okay, so um we're gonna have a comment on this, but like I said, I appreciate HS bringing this preliminary uh update to us on your budget.

Um, like I said, um I consider all of you friends, I you know, some uh friends in labor, friends in the board of trustees.

Um, and I think you know, we can we can figure this out, but it's not gonna be easy, it's gonna be hard, but we you know we can figure this out, so uh don't disappoint me.

Thank you for your partnership and your support, really do appreciate it.

And I know a 72 million dollar deficit is daunting, but um this process has been informative, and I just want to express my appreciation for you in particular, uh Supervisor Miley, who's been um pretty much making sure that we're we're all in line to get this corrected, this imbalance corrected.

Yeah, and I I should just say I shared with um uh Supervisor Bass's chief of staff, uh Dave Brown over there.

Uh I really I really miss his former boss.

Not to take anything from Supervisor Tam, but Supervisor Chan.

We could just turn our loose and she'd make things happen.

Um, so much, Mr.

So much, yeah.

Um, as well as Supervisor Carson, because I don't I wouldn't have to be involved with this.

I'd like them to do that, and then I could just come and you know be part of the team.

Okay, so let we have any speakers on this.

Drew, you're on the line.

You have two minutes more on item two.

Great.

Hey everyone, hi supervisors.

Uh my name is Drew Scott.

I'm a therapist at the Fairmont Intensive Outpatient Program, which as we know serves clients with severe mental illness.

And I just want to respond in terms of throughput.

We do have many clients who graduate from the program and are discharged into the community.

And internally, we also have our own step-down process within the program where clients move from five days a week to four, then three, then one day a week, and even once a month, depending on their needs.

And we have to keep in mind that we serve clients with chronic and severe mental illness.

Uh, they face schizophrenia schizophrenia, bipolar disorder, major depressive disorder, trauma, substance use disorder, and their recovery is a lifelong process.

So these conditions are chronic.

The clients are never cured and never recovered, so to speak.

And what happens is that clients who are discharged or graduate may experience another episode because it's a lifelong condition.

They end up back in the psychiatric hospital.

And from there, they need somewhere to go to stabilize.

So they're referred back to us.

So some clients have been here for a long time, yes, but that's been broken up over the course of their recovery journey.

And the problem is that if we go away, clients will go to John George, but where will they go from there?

With nowhere to go, they'll get discharged and they'll end up back in the psychiatric hospital and end up in this vicious cycle that costs the system much more money and causes immense human suffering.

And Alameda County is behavioral health safety net is already shrinking with wellness centers facing imminent closure.

So their clients are getting referred to us.

And so we urge you to stop the layoffs and help AHS fund our program for the next fiscal year to keep our doors open.

Thank you so much.

Correct, you're on the line.

We're on item two.

Thank you.

Hi, I'm Craig Metz.

I'm the clinical manager of Pheromont Hospital's IOP PHP program.

I want to address AHS's budget for our program and why I believe their numbers cannot be trusted.

And these numbers get kind of thrown around as if they're real, and I don't believe that they are.

The budget for our next fiscal year was created without any input from our program's leadership, and they still refuse to show it to us.

That alone should be a red flag.

At the start of this fiscal year in July of 2025, our budget was approved without issue.

Then in November, we were suddenly told we were running a deficit, but shown nothing.

From what we could see, there was no real deficit.

When the budget was finally presented to the AHS Board of Trustees in February, we understand we understood why they kept it from us.

There was a 4 million overhead added that we'd never seen in over 20 years, was not added to the other programs on this campus.

And without that overhead, our program was nearly budget neutral.

Now we're being told that there's another, well, we were told four million now, just in this meeting, they said 4.6 million.

Mark just said 8 million deficit for our program.

We no one's consulted that with us about that.

There's, but nothing has changed.

The federal health care changes are not affecting IOP PHP programs.

So there should be no budget deficit.

So where is that money coming from?

We don't know, because AHS still won't share the budget or work with us on it.

What we do know is that our numbers, and they show us close to budget neutral this year, and we're on track to being profitable next year.

The closure decision of this magnitude affecting vulnerable patients should not be based on numbers that have been hidden, manipulated, and that no one can adequately explain.

I strongly urge this committee to require an independent audit of AHS's budget figures before any decision about closure is made.

Thank you.

Chelsea, we're on item two.

Hi there.

So can you hear me?

Yes.

So my name is Chelsea DeMardi.

So I'm a clinician at the Fairmont Outpatient IOP.

And I want to talk about the AHS's claim that they are going to refer our clients or transition them out to the county if we close our doors.

This is news to us, and it's extremely shocking as providers because we know that there are no places within the county system that are appropriate for our clients.

Mark Fratsky just mentioned right now something about Medicare partners in the community.

The only thing that I can guess that this is is that they're single therapists who have who see people out in the community and take Medicare.

That would mean that our clients would be expected to travel on their own to these people's offices and possibly at most have one hour of psychotherapy per week.

First of all, that's not enough to stabilize them at all, and that does not count, that does not compare to our wraparound care that we have in our clinic.

Um, with many days a week, many hours a week, different different medical professionals, psychiatrists, psychotherapists monitoring them intensely.

That does not compare.

Secondly, the majority of them will never even make it to those appointments because they're poor and they cannot afford transportation, or they're symptomatic with psychosis or depression or anxiety or paranoia where they cannot even take public transportation.

So it is not true that our clients can easily be transferred out to the county.

Actually, there is nowhere for them to go.

The wellness centers, which are closing, were the closest that closest to our program, but they did not have licensed clinicians treating patients.

And we respectfully ask today if you can supervisors to please fund our program for another year to get us over this hump and to maintain this essential safety net that the community cannot afford to lose.

Thank you.

Parisa, we're on item two.

Yes, hello there.

My name is Parisa Farrohe.

I am the interim admission coordinator for the IOP program.

I have been a PHP therapist, an IOP therapist.

I have been working for 24 years.

And I want to respond to what Mr.

Frasky Fratsky commented on our IOP closing.

That he said that there are programs out there to step down and that our patients have to graduate, quote unquote, and get into outpatient programs and be in quote unquote episodic provided provider care.

This makes me really sad and actually angry.

Sad because if leadership had asked us experts who've been on the front line and learn more about our program, they would know that we serve severely chronic mentally ill patients, not mild to moderate patients who have a month of depression.

They go to their doctor, they get some medication, and they go back to work.

Just like my colleagues said, it's called chronic mental illness.

And our clients do come to us and they cycle out and graduate.

I personally have graduated many clients in the past when I was the PHP IOP therapist and I transferred them to uh to wellness centers when they were stabilized.

And then they would come back to us when they would get destabilized.

So, yes, they it's not a um uh a graph where they graduate and they're fine.

This is not high school, this is not college.

This is chronic mental illness.

We save lives, we keep people out of the hospital.

We are the step that um keeps people out of the hospital.

Peter, you're on the line.

We're on item two.

Peter, unmute your mic.

Peter.

Hello.

Yes.

Can you hear me?

Yes, yes.

Hi.

Yes, this is Dr.

Freed.

I'm the department program manager for outpatient behavioral health.

Just want to respond to some of the things that were mentioned in this meeting and again, to appreciate uh Supervisors Miley's efforts to bring us all together to find a way to avoid layoffs and closures and maintain access for the very uh needy patients that we take care of.

First, uh the staff already alluded to the our budget.

The budget numbers presented by AHS are wrong, inaccurate, and they don't take into consideration our efforts to uh develop um um financial enhancements and and cost cutting that brings our budget to almost neutral aside from the 4.5 million dollar overhead as Teresa had mentioned.

We've never had that in 30 years up until this year, and we and and it didn't, it wasn't not in our budget last June when our budget was approved.

It just showed up um in February when the um they presented that information to the um Board of Trustees.

Second, as Drew mentioned, our program does graduate patients, but we also set up our program uh having multiple levels of care that allow patients uh to uh come at the frequency that they need.

Lastly, the comment made about the state Medicail funding PHP is inaccurate.

I'm I'm part of the state board that has developed and worked on that um uh policy.

And the the reimbursement rates for PHP and IOP are comparable to Medicare, three, four, five hundred dollars a day.

I have the rate schedule, and it's been confirmed by the state meeting.

So, and that is going to start this year, which would add several million dollars to our budget.

And we again would like a year to show that that actually is happening the way it's uh designed to.

Thank you.

Sandra, we're on item two.

You have two minutes.

Hello, my name is Sandra Marshall, and I'm a therapist at the outpatient behavioral health program at Fairmont.

As AHS considers closing our program this month, I would like the Board of Supervisors to understand the uniqueness of our program and the value to the people of Alameda County.

As has been said, we serve patients that are diagnosed with moderate to severe mental illness.

By definition, these conditions require intense consistent treatment and support because of the functional limitations of their diagnosis.

So it will the need to have help and treatment will not go away.

I also want to uh say that we have four levels of treatment.

It's not a one-size fit-all.

Um we have step-down programs, as Drew has said, that goes from intensive all the way to one day a week.

Also, I want to point out that program psychiatrists assess each patient and determine if they need our services, and they certify which level of treatment that each patient requires in order to prevent inpatient psychiatric care.

The psychiatrist then meets with each patient monthly or as needed for appropriate recertification.

So this is carefully monitored.

It's not a walk-in program because people have nothing to do.

It is guided by certified psychiatrists.

Um referrals to our program come from a variety of avenues, doctors, community doctors, psychiatrists, actually county case managers, and other programs over the years.

Um, I actually want to point out that Kaiser has referred to us on uh for years.

I currently have Kaiser patient on my caseload.

I've had two in the last month because they need our help and stabilizing patients from their IOP, they do not have the intensive services we have.

So there is a recognized need from other medical programs that we are doing the work that is needed for this county.

Thank you.

Michael, you're on the line, you have two minutes.

Hi, Supervisors.

Uh Miley and Tan, my name is Michael McAdoo.

I am the program manager, missions coordinator and clinical manager at Highland Hospital.

Uh several things I like to address.

Uh one, really thank you for having us come together and collaborate on keeping these programs open.

They're so essential for Alameda County and um uh the patients we serve.

Uh I did want to address um the budget.

Um, I'm not quite sure where $8 million dollar deficit came from, and I'm not sure where 4.5 overhead came from over the last 30 years.

We are a budget neutral facility, both programs.

But if we get into a bind uh where uh somebody is projecting things that are not quite the reality of our situation, we must look at that situation and resolve it.

Umbody has heard our budget or financial enhancements.

Um, nobody is talking about how AHS has projected us as having an 8.9% collection rate on our on our revenue.

Um, and uh when Medicaid or Medicare pays 100%.

Uh we need these programs.

Um for the health of our community here at Alameda Health System in Alameda County.

I um receiving patients from all of these closed programs from Casa Umbutu to HECO.

I have patients in our program.

If our program closes, there's no other place for them to go.

Thank you.

We have no additional speakers for item two.

Okay, so thank you, speakers.

Thank AHS for the presentation today.

And as I said, the ad hoc commit ad hoc uh committee will meet again uh next week uh to kind of get a status report on where things are and see uh what more um the county is able to do to help move this agenda and I think I think that's about it.

No, um I know I have to take public comment on non-agendized items.

Are are we meeting the fourth Monday of the month of June?

Or are we doing budget?

I think that Monday, June 22nd.

We will have a meeting on June 22nd.

I think that might be I think we might be doing budget that day.

I think county budget that Monday and Tuesday and Thursday maybe.

But okay.

So if we don't meet June 22nd, our next meeting will be 2nd Monday in July.

Okay, so do we have any speakers on non-agendized items?

I have no speakers for public comment.

All right, so we stand adjourned.

Thank you.