The Behavioral Health Commission advises on mental health policy implementation and quality service delivery. It reviews and advocates for effective mental health services, ensuring policies meet community needs. It educates stakeholders to integrate mental health considerations into broader health strategies.

Behavioral Health Commission

New SF public health chief was part of notorious McKinsey opioid-marketing operation

Daniel Tsai, Mayor Daniel Lurie’s choice to lead the Department of Public Health, has a blue-chip résumé: After studying at Harvard University, he landed a prestigious consulting gig before jumping into government, leading Medicaid programs in Massachusetts, then federally under former President Joe Biden.&nbsp;



Along the way, Tsai, in his capacity as an employee with McKinsey &amp; Company, helped to market a powerful painkiller called tramadol during the company&#8217;s years-long streak of pushing opioid sales. The company’s actions ultimately led to a criminal probe, more than $1 billion in settlements, and a public mea culpa over its role in fueling an overdose epidemic that has killed more than 500,000 Americans over 25 years.



Tsai’s actions at McKinsey are detailed in a tranche of documents that were released as part of a settlement with the consulting firm in which it was accused of accelerating opioid sales despite growing awareness of the risks.&nbsp;



The records show that Tsai — who worked for McKinsey from 2007 to 2015, according to his LinkedIn page — helped develop a marketing strategy for tramadol sold under the brand name Ultram ER, an effort that involved cultivating relationships with doctors who became prolific prescribers. The records are housed at the <a href="https://www.industrydocuments.ucsf.edu/opioids">UCSF-JHU Opioid Industry Documents Archive</a>.



In a March 2008 PowerPoint presentation, Tsai outlined a marketing strategy for the drug that included guidance on targeting “specific physician segments to grow high-prescriber group (i.e., physicians more sensitive to patient needs)” and an idea to introduce “coupons” for the drug as part of a pilot program.



<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" height="1629" width="2500" src="https://content.sfstandard.com/wp-content/uploads/2025/02/gettyimages-1247557771.jpg?w=2500" alt="A booth with &quot;McKinsey &amp; Company&quot; in bright letters on a wooden panel. Two men stand nearby, one looking at a touchscreen display." class="wp-image-367908" srcset="https://content.sfstandard.com/wp-content/uploads/2025/02/gettyimages-1247557771.jpg 4396w, https://content.sfstandard.com/wp-content/uploads/2025/02/gettyimages-1247557771.jpg?resize=300,196 300w, https://content.sfstandard.com/wp-content/uploads/2025/02/gettyimages-1247557771.jpg?resize=768,501 768w, https://content.sfstandard.com/wp-content/uploads/2025/02/gettyimages-1247557771.jpg?resize=2500,1629 2500w, https://content.sfstandard.com/wp-content/uploads/2025/02/gettyimages-1247557771.jpg?resize=1536,1001 1536w, https://content.sfstandard.com/wp-content/uploads/2025/02/gettyimages-1247557771.jpg?resize=2048,1335 2048w" sizes="auto, (max-width: 2500px) 100vw, 2500px" /><figcaption class="wp-element-caption">McKinsey &amp; Company has paid more than $1 billion in settlements related to its role in the opioid crisis.</figcaption></figure>



“We hope to be interviewing some high-prescriber physicians next week,” Tsai wrote in an email the same month, attaching a list of questions that could be used to screen doctors. 



Lurie’s office defended Tsai’s appointment as Public Health chief. In a statement, the mayor’s office wrote, “Nearly 20 years ago, Dan Tsai was a 23-year-old entry-level staffer assigned to conduct research for a project at work. He has spent nearly his entire two-decade career supporting those struggling with homelessness and addiction and helping tens of millions of our most vulnerable neighbors access critical medical care, and he will continue that work in San Francisco.”



Several drug and homelessness service providers in the city said they were disappointed by a lack of transparency surrounding Tsai’s appointment process. The revelation of his past role at McKinsey intensified those concerns, they said.&nbsp;



“You’d want a public health official of that caliber to articulate what his participation was in that role,” said Laura Guzman, director of the National Harm Reduction Coalition. “This is an important moment to bring in people with federal bureaucracy expertise. But if [Lurie] wants to address the lack of treatment, we need leadership with expertise in evidence-based interventions.”



Others were less diplomatic in their reaction to the news.



“Holy fucking shit,” said Liza Murawski, co-chair of the city’s Behavioral Health Commission, when told of Tsai’s role at McKinsey. “Why would he be the director? Why don&#8217;t you have someone in there who’s a mental health expert?”



It wasn’t immediately clear who Tsai’s client was when he was marketing Ultram ER. The brand, which has been discontinued, was developed by a Canadian company and licensed to a subsidiary of Johnson &amp; Johnson in 2005, <a href="https://pharmatimes.com/news/orthos_ultram_er_reaches_us_market_996469/">according to PharmaTimes</a>.&nbsp;



Experts say tramadol was initially thought to be less harmful than OxyContin, another product McKinsey marketed for Purdue Pharma. But that view has changed.&nbsp;



Tramadol is a Schedule IV drug — in the same category as Xanax, Valium, and Ambien — and has <a href="https://www.voanews.com/a/report-highly-potent-opioids-now-showing-up-in-drug-users-in-africa/7653980.html">more</a> <a href="https://www.bbc.com/news/world-africa-44306086">recently</a> <a href="https://www.occrp.org/en/news/un-report-tramadol-use-in-africa-is-increasing">been</a> linked to addiction in Africa. “It was seen as this alternative,” said Dr. Rachel Sussman, a South Bay-based addiction medicine specialist. “It is just as risky and just as dependency-creating as any other opioid medication.” In fact, the drug carries more complications than some other opioids, including a risk of seizure and negative interactions with antidepressants, said Sussman.



<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" height="1667" width="2500" src="https://content.sfstandard.com/wp-content/uploads/2025/02/w2a5893.jpg?w=2500" alt="Two men in suits stand near a podium. One is holding papers, and the other rests a hand on his shoulder. A calendar and TV are visible in the background." class="wp-image-366616" srcset="https://content.sfstandard.com/wp-content/uploads/2025/02/w2a5893.jpg 7510w, https://content.sfstandard.com/wp-content/uploads/2025/02/w2a5893.jpg?resize=300,200 300w, https://content.sfstandard.com/wp-content/uploads/2025/02/w2a5893.jpg?resize=768,512 768w, https://content.sfstandard.com/wp-content/uploads/2025/02/w2a5893.jpg?resize=2500,1667 2500w, https://content.sfstandard.com/wp-content/uploads/2025/02/w2a5893.jpg?resize=1536,1024 1536w, https://content.sfstandard.com/wp-content/uploads/2025/02/w2a5893.jpg?resize=2048,1366 2048w" sizes="auto, (max-width: 2500px) 100vw, 2500px" /><figcaption class="wp-element-caption">Mayor Daniel Lurie tapped Tsai to lead the city&#8217;s Public Health Department. The sprawling agency has a roughly $3 billion budget.</figcaption></figure>



Dr. David Juurlink, an expert on tramadol, called the drug a “minor player in the opioid crisis, but a player nevertheless.”



He added, “To the extent that McKinsey helped advertise it as a notionally safer opioid, I think they did a disservice in doing so. The main reason I say tramadol is a minor player is because it wasn’t prescribed like candy, like OxyContin was.&#8221;



McKinsey’s method of targeting high-volume prescribers was part of its playbook to juice opioid sales, despite mounting evidence that the drugs could be highly addictive. In other emails uncovered in the McKinsey documents, employees wrote excitedly about finding doctors who were willing to write opioid prescriptions. <a href="https://www.industrydocuments.ucsf.edu/opioids/docs/#id=hlmn0255">In one instance</a> in 2015, a McKinsey partner wrote, “The challenge which we need to start working on is to identify the sweet spot of docs so we can do targeting. … Fun be[g]ins on Monday!”



San Francisco’s fentanyl crisis is part of a broader trend of opioid overdoses <a href="https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html">that traces back to the 1990s,</a> when prescription opioids became popular among doctors for chronic pain management. Companies such as Purdue Pharma, which manufactured OxyContin, brought in consulting firms like McKinsey to help with sales strategies. After a Department of Justice probe and settlement, McKinsey <a href="https://www.justice.gov/usao-ma/media/1380236/dl">acknowledged that it knew</a> the dangers of OxyContin but continued working with Purdue Pharma — even after several of the drugmaker’s executives pled guilty in 2007 to misrepresenting addiction risks.&nbsp;



McKinsey, along with a slew of drug companies and pharmacies, agreed to pay billions in settlement funds over their roles in fueling opioid addiction. California received <a href="https://oag.ca.gov/news/press-releases/attorney-general-becerra-announces-573-million-nationwide-settlement-mckinsey">roughly $60 million</a> from the 2021 McKinsey settlement. San Francisco, <a href="https://www.sfcityattorney.org/2023/05/17/san-francisco-city-attorney-announces-230-million-settlement-with-walgreens-after-victory-in-opioid-litigation/">under the 2023 settlement</a> of an opioid-related lawsuit, was expected to receive about $230 million from Walgreens.



In both instances, the funds were slated to be used for opioid recovery efforts.



In 2019, McKinsey said it would no longer work on opioid-related businesses.&nbsp;Last year, McKinsey formally apologized for its Purdue Pharma work, <a href="https://www.mckinsey.com/about-us/opioidfacts">saying it was “deeply sorry”</a> for its role in selling OxyContin. “This terrible public health crisis and our past work for opioid manufacturers will always be a source of profound regret for our firm,” the company said in a statement.



At the San Francisco Department of Public Health, Tsai replaced Dr. Grant Colfax, who took the reins in 2019 and led the city through the pandemic <a href="https://sfstandard.com/2025/01/16/grant-colfax-resign-san-francisco-public-health/">before stepping down in January</a>. The role paid $546,133 in 2024, one of the highest city salaries.&nbsp;&nbsp;



On Monday, the San Francisco Health Commission unanimously nominated Tsai as director of Public Heath. Dr. Laurie Green, president of the commission, said the governing body conducted a “multi-hour” interview.



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“In the interview with Mr. Tsai, the Health Commissioners focused on his preparedness to address the current public health challenges facing San Franciscans and his ability to sustain the Department through a potential tumultuous time ahead,” Green wrote in a statement. “This includes his unique expertise in Medicaid funding and programs, in addition to healthcare innovations and transformation.”



Tsai is expected to work with <a href="https://sfstandard.com/opinion/2025/01/07/the-fresh-faces-in-luries-cabinet-will-have-vast-power-but-will-they-know-how-to-wield-it/">Kunal Modi</a>, another McKinsey alum, whom Lurie has tapped to lead the city’s response to health and homelessness. In a statement this week, Tsai highlighted&nbsp;the city’s opioid and homelessness crises and said he was looking forward “to partnering with stakeholders and individuals with lived experience to find new, data-driven approaches to tackling this important challenge.”



Representatives of McKinsey did not respond to a request for comment.



Richard Beal, director of recovery services at the Tenderloin Housing Clinic, said he appreciates Lurie’s early focus on the fentanyl crisis and remains optimistic about Tsai’s appointment. “Just like [Tsai] distributed the drugs, maybe he can distribute the solution to the drugs,” Beal said. “Hopefully, he can use the knowledge he has from helping to create the monster to figure out how to solve it.”

San Francisco drug crisis commission doing nothing for lack of members

A commission in charge of holding San Francisco accountable for its response to the drug and mental health crises hasn’t been able to hold a proper meeting for more than seven months as the city’s elected leaders neglect to fill its seats.&nbsp;



There are currently only six active members on the 17-person Behavioral Health Commission, an oversight body with the power to draft policy and conduct reviews of programs run by the city’s Behavioral Health Department. The department has a $592 million annual budget and is responsible for providing mental health and drug treatment services.&nbsp;



Because there are fewer than nine active members, the commission lacks a quorum and hasn’t been able to wield much of its power or hold meetings since February.



The term of the commission&#8217;s co-chair, Balham Vigil, expired 10 months ago, but Vigil continues to serve; the city has failed to appoint a replacement. The commission is required by state law, and 16 of its 17 members are appointed by the Board of Supervisors.&nbsp;



A 17th seat is reserved for a member of the Board of Supervisors. But that seat has sat empty since January 2022. Supervisor Ahsha Safaí, who championed the creation of <a href="https://develop.sfstandard.com/2023/03/28/can-you-fight-bureaucracy-with-bureaucracy-this-new-commission-is-optimistic/">the Homelessness Oversight Commission</a>, was the last Board of Supervisors member to fill the seat before Behavioral Health Commission members said he abruptly stopped attending. Safaí didn’t respond to a request for comment.



<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" width="2350" height="1567" src="https://content-develop.sfstandard.com/wp-content/uploads/2023/07/1SupervisorsChambersPhotos07062023-23.jpg?w=2350" alt="" class="wp-image-185328" srcset="https://content-develop.sfstandard.com/wp-content/uploads/2023/07/1SupervisorsChambersPhotos07062023-23.jpg 2350w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/1SupervisorsChambersPhotos07062023-23.jpg?resize=300,200 300w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/1SupervisorsChambersPhotos07062023-23.jpg?resize=768,512 768w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/1SupervisorsChambersPhotos07062023-23.jpg?resize=1536,1024 1536w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/1SupervisorsChambersPhotos07062023-23.jpg?resize=2048,1366 2048w" sizes="auto, (max-width: 2350px) 100vw, 2350px" /><figcaption class="wp-element-caption">District 11 Supervisor Ahsha Safai during the San Francisco Board of Supervisors Meeting at City Hall in San Francisco on July 11.</figcaption></figure>



“The supervisors are just not appointing people,” said former commission member Geoffrey Grier. “You’ve got a lot of folks who want to be on the commission but they’ve got to wait a year? Nine months?”



Victor Young, a clerk for the Board of Supervisors, told The Standard there are eight people who have pending applications to serve on the commission. However, he said it’s difficult to find qualified members for the commission due to the types of experience needed for each seat.&nbsp;



Each of the 11 supervisors gets one appointee to the commission. The six other seats are appointed by the full Board of Supervisors, including the one seat designated for a member of the Board of Supervisors.



On top of that, there are other complicated rules. At least nine of the 17 commissioners are supposed to be mental health patients or family members of mental health patients. Two commissioners are supposed to be mental health “advocates,” two seats are designated for mental health professionals, and one seat is to be held by a person “serving the public interest.”&nbsp;



The commission currently has three seats occupied by mental health patients or their family members, two mental health professionals and one advocate.



The Behavioral Health Department is part of the Department of Public Health, the largest department in the city with a $3 billion budget. The Department of Public Health has at least four commissions overseeing its work.&nbsp;



Supervisor Matt Dorsey, who is chair of the rules committee, which evaluates commission applicants, said he’s working on legislation that would shrink the commission from 17 members to 11. He told The Standard the commission’s stringent eligibility requirements have imposed barriers for him and other supervisors to appoint commissioners.&nbsp;



<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" width="2560" height="1708" src="https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-scaled.jpg?w=2500" alt="" class="wp-image-178021" srcset="https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-scaled.jpg 2560w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-300x200.jpg 300w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-2500x1668.jpg 2500w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-768x512.jpg 768w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-1536x1025.jpg 1536w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-2048x1366.jpg 2048w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-650x434.jpg 650w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-370x247.jpg 370w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-800x534.jpg 800w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-450x300.jpg 450w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-20x13.jpg 20w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-185x123.jpg 185w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-740x494.jpg 740w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-400x267.jpg 400w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-1600x1067.jpg 1600w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-225x150.jpg 225w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-900x600.jpg 900w, https://content-develop.sfstandard.com/wp-content/uploads/2023/07/BreedPressConf062923_20-72x48.jpg 72w" sizes="auto, (max-width: 2560px) 100vw, 2560px" /><figcaption class="wp-element-caption">Supervisor Matt Dorsey speaks at a press conference in San Francisco on June 29. | Jeremy Chen/The Standard</figcaption></figure>



<h2 class="wp-block-heading" id="h-do-oversight-bodies-work-some-supervisors-are-skeptical-nbsp">Do Oversight Bodies Work? Some Supervisors Are Skeptical&nbsp;</h2>



In July, The Standard reported <a href="https://develop.sfstandard.com/2023/07/06/only-1-person-at-sf-city-hall-knows-the-answer-to-this-simple-question/">only one person working in City Hall</a> was able to figure out how many departments, boards, commissions and advisory bodies the city has. A representative from the City Attorney’s Office eventually counted 53 departments, 56 boards and commissions, and 74 more advisory bodies, bringing the grand total to 183 different entities.&nbsp;



The revelation frustrated many who said the city is plagued by too many overlapping bureaucracies.&nbsp;



Supervisor Rafael Mandelman, who is one of five supervisors with active appointees on the Behavioral Health Commission, said the city should fill the vacant seats but was skeptical whether it would move the needle on solving city issues.



“If oversight bodies led to good government, we would have the best government in the world,” Mandelman said.&nbsp;



<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" width="2560" height="1707" src="https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-scaled.jpg?w=2500" alt="" class="wp-image-161645" srcset="https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-scaled.jpg 2560w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-300x200.jpg 300w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-2500x1667.jpg 2500w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-768x512.jpg 768w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-1536x1024.jpg 1536w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-2048x1365.jpg 2048w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-650x433.jpg 650w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-370x247.jpg 370w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-800x533.jpg 800w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-450x300.jpg 450w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-20x13.jpg 20w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-185x123.jpg 185w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-740x493.jpg 740w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-400x267.jpg 400w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-1600x1067.jpg 1600w, https://content-develop.sfstandard.com/wp-content/uploads/2023/05/05162023BOSRoundup-071-225x150.jpg 225w, https://content-develop.sfstandard.com/wp-conte...

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Nicholas Goldman

Michelle Domingo

The Assessment Appeals Board #3 provides a platform for San Francisco taxpayers to contest property tax assessments. It conducts hearings where evidence from both taxpayers and the Assessor is evaluated. The Board makes binding decisions on property assessments based on presented evidence.

Assessment Appeals Board #3

John Su

James Reynolds

Shawn Ridgell

Marc Dickow

Assessment Appeals Board #3 Commissioner 5

Assessment Appeals Board #3 Commissioner 6

Assessment Appeals Board #3 Commissioner 7

Assessment Appeals Board #3 Commissioner 8

Assesses property, applies exemptions, collects transfer taxes, and records official documents.

Assessor-Recorder

Joaquín Torres

The Ballot Simplification Committee ensures voter materials are clear and understandable. It reviews and revises ballot language to accurately reflect propositions and measures. The committee advises on simplifying complex legal and technical terms for voter comprehension.

Ballot Simplification Committee

The Bayview Hunters Point Citizens Advisory Committee provides policy advice on planning and land use matters in Zone 2 of Bayview Hunter's Point. It offers expertise in land use policies, zoning issues, and urban development. The committee advises the Board of Supervisors, City Boards, and commissions on relevant projects and initiatives.

Bayview Hunters Point Citizens Advisory Committee

The Bicycle Advisory Committee advises on making bicycling safer and more accessible in San Francisco. It provides recommendations to city agencies to address traffic violence and climate change. The committee advocates for cyclists and addresses biking-related complaints.

Bicycle Advisory Committee

The Board of Appeals provides final review for a wide range of City permitting decisions. It ensures an efficient and fair permit issuance process through an impartial panel. The Board exercises authority to make binding decisions on appeals.

Jefferson Robert Eppler

John Trasviña

Jose Lopez

Rick Swig

Board of Appeals Commissioner 5

Board of Appeals conducts final reviews of City permitting decisions through an impartial panel. It ensures an efficient and fair permit issuance process. The department operates under rules established by the City Charter of 1932.

Julie Rosenberg

Board of Appeals, Executive Director

The Board of Examiners provides a final review process for City permitting. It ensures an efficient, fair, and expeditious evaluation of the permit issuance process. The commission operates as an impartial panel with quasi-judicial authority.

Board of Examiners