Shortly, as well as supervisor sandra lee fewer. Thank you to this committees clerk, john carroll, and id like to thank sfgovtv. Mr. Clerk, do you have any announcements . Clerk yes. Please silence your cell phones and electronic devices. Completed speaker cards and copies of any documents should be provided to the clerk. Items acted on today will appear on the march 10 board of supervisors agenda. [agenda item read]. Chair mar supervisor fewer, thank you for joining us this morning as the sponsor of this hearing. The floor is yours. Supervisor fewer thank you, committee. I call this hearing today after discussions with ifpte local 21 because i am concerned about the use of Civil Service exclusions and the impact it has on our Civil Service industry. I realize that discussions have been ongoing between the department of Public Health and local 21 regarding a process of conversion for these positions since the last hearing that we called on this issue in april 2019. Since that time, this agenda at the time that this agenda was posted for todays meeting and this morning, an agreement has been confirmed between d. H. R. And the local 21. Since that i time, weve agree to hear the agreement. With that, id like to bring up steve ponder from the department of Human Resources to present. Good morning, supervisors. City o steve ponder, department of Human Resources. Im pleased to say we have reached an agreement. If you can pull up this screen, you can see the 12 major departments that we will be looking at. I believe this is going to be over the next 12 to 18 months. So again, were going to set up a pretty robust schedule, monthly meetings with them in which we develop a list of c. A. D. 18 appointments for each department, and looking for some similarity among them and if any of them can be cobbled together. If you look at the economy of scale, like d. P. W. , they have lots of sidewalk projects, so instead of having a number of discreet positions, maybe we can convert some of those to p. C. S. , and so thats going to be our goal over the next 12 to 18 months. Supervisor fewer thank you. Any comments or questions from any of my colleagues . No . Thank you very much. I think right now, then, we should take Public Comment if chair mar agrees. Chair mar so yeah, thank you. If theres any members of the public that wishes to speak on this item, please step forward, and you have two minutes, and you can lineup on the righthand side of the chambers. First speaker. Can i can i can i okay. Ill put my identification here. [inaudible] the health and Human Services illegally evicted me out of my government housing. Now, im government, and the thing is that march 20 of this year, the two years is up for Human Service or the mayor to manage my administration. I brought this here because they illegally evicted me out of government housing. The court ruled that its politics, and i have to deal with the committee, so basically, all im saying is on march 20, the two years is up for the managing government money thats in my name. Now as far as what happened, i dont know because ive got to dale with you all, but im deal with you all. But im saying until march 20, theyre still managing my administration, which is the government money youre all speaking of. Chair mar thank you. Next speaker, please. Hi. Im joel kamisher, School Crossing guard, and tried to address some of our problems with the guards, so we can be parttime and not exempt. If they can be fired easily, theyre going to quit easily, and the city might have some savings by being exempt workers, but then, they have to spend more money by recruiting and replacing people. Theres really no savings from exempt employees. And San Francisco regards itself as a progressive uniontown, and they often refer to their employees as part of a union family. But sometimes, i think were run by the absent likes of jeff bezos, mark zuckerberg, and the like. Im just hoping that the city will do everything it can to try to discourage the use of exempt workers or contracting out. Thank you. Chair mar thank you. Next speaker . Good morning, supervisors. My name is kim thompson. Im the local 21 Information Technology chapter president , and i serve on our unions citywide Bargaining Team. Ive worked for the department of technology for over 30 years. The majority of my career at the city, i never paid much attention to exempt appointments. They werent used very much, so most people werent very aware of who was exempt until a few years ago, when three employees on my department on the same team were let go on the same day without explanation or warning. These were not limited duration project staff, these were tenured city employees. There was no way they had expected to be here one day and gone the next. This triggered a culture of fear which stands in the ways of employees doing their best work and stops them from speaking up when they want to and when they should. I see this happening on a daily basis in my department, so i want to thank you for your support on this issue. Local 21 and the city have recently made progress on addressing the except issue. Im looking forward to working together on the process to convert these employees to permanent Civil Service status. We expect the city to continue to meet with us and execute the agreement in good faith. As agreed, the priority will be the departments having the highest percentages of exempt staff which should address the most egregious situations first. Some of the employees are eager to become permanent Civil Service because they want to continue working for government and serving the community. This will build and strengthen the firstclass workforce that San Francisco has and should have. Thank you. Chair mar thank you. Next speaker . Good morning, supervisors. My name is zach goldman with local 21. 11 months ago, we filled this chamber with nearly 100 city workers who came and talked about their concerns about the abuse of exempt positions and the abuse of exempt employees. City workers highlighted how exempt positions were abused to do permanent ongoing work in violation of the city charter. They testified how exempt employees are at will, meaning they can be required at any time. And they connected the dots for us, showing how this leads to a culture of fear and intimidation that makes it hard to speak out about workplace problems, management abuses, and even serious wrongdoing and misconduct. I want to thank this committee, chairman mar, and especially supervisor fewer for really listening to city workers and using your oversight powers to push our city to do better. A year ago at the last hearing, we identified three solutions. One is we needed an audit of all current exempt employees. Two, we needed a fair process for transitioning folks from exempt employees to permanent Civil Service, and three, we need to strengthen workplace protections so that when people speak up, theyre not intimidated, harassed, or retaliated against. Im happy to say that local 21 has an agreement with the city that makes meaningful progress in all three areas but i would remiss not to point out the challenges that remain. Reurge d. H. R. To we urge d. H. R. To reach agreements with employees that have problems in their areas that they deal with. The city and the supervisors must continue to remain vigilant and work with us to ensure that workers rights are now protects and managers do not take advantage of this protection to supervisor fewer excuse me, chair. I have a question, actually, for the public speaker. What is the third . Thank you. The microphone got thank you. Third, we have to have a conversation about what is the root of this problem, and from our view, the root of this problem is that the administration continues to put forward budgets that do not provide enough services to invest in city services. When you make it impossible for departments to post Civil Service positions, departments are going to get the work done by posting exempt positions or by contracting out. We need to get to the heart of this problem by making sure that the budget that we pass accurately reflects the resources that are needed to do the work by a professional Civil Service staff. Supervisor fewer thank you. Chair mar thank you. Next speaker. Good morning to all supervisor on board. My name is antoinette johnson, and i am an exempt employee at sfpuc as a Water Quality tech, and i just decided to come over this home because i wanted to speak regarding me being a 49years native of San Francisco. I decided to go back to college after 24 years to get my waterwastewater Treatment Technology college degree. I came in on board with 20 hours per week. I do have to work several other jobs just to make my ends meet, and i would just love to have some participation in the ongoing process of Civil Service as a fulltime Civil Service. I have been waiting patiently, ive been applying continuously online to look forward to fulltime work, but overall, i work hand in hand with my fulltime employees with no benefits. I would love to do overtime, but unfortunately, as exempt, you can only get 20 hours per week. And i just look forward to well, i honestly can just say ive just been waiting patiently and holding onto serve my community here in San Francisco as a native, and excuse me and im just waiting patiently to be a fulltime exempt in my own city. I do not want to go honestly, i do not want to go to other cities such as davis, solano county. I want to work here continuously in my own city, where i was born and raised and make sure that the city and county of San Francisco has clean Potable Water and safe water for all of us, as unity, as people. And i just believe that that [inaudible] chair mar thank you. Thank you so much for your service. Next speaker. Good morning. My name is osha astrith. Thank you for taking up this very important issue. We just recently about six months ago noticed a pattern at the department of technology where we had about 50 of our members occupying exempt appointments. Many of these exempt appointments have been continued over several years. One, i believe, has been over two decades of multiple exempt appointments that have transpired over the years, so this is a very important issue. Its something that we look forward to working with d. H. R. To try and address. Weve requested to meet, and were hopeful that d. H. R. Will cooperate with us like they will be doing with local 21 and mirror everything that local 21 just said. We have very, very similar issues but i wont bore you with redundancy. Thank you. Chair mar thank you. Next speaker, please. Hi. My name is tono watanabe, a clerk at the Members Services agency, and a member of local 21. There are all ways for individual managers to try to bypass Civil Service rules as well as budget restrictions similar to president ial appointments who are in acting positions without sorry. Without congressional approval. To keep their jobs, their loyalty is to the person who gave them the position and not to the law, their city workers, the government, or residents of the city. Public polls that can be found in any law or policy will be exploited by those who are being asked to do more with less, and so we need to make sure that there are also consequences for the managers who implement these plans without any repercussions on their jobs. Theyll continue to do those things because theyre still going to be employed by the city, and as long as theres pressure to show a budget decrease without actual oversight of the sorry. This is my first time up here, so im a little nervous. Supervisor fewer its okay. All right. Without the actual overtime pay, theres going to be a lot more of this coming. So i appreciate your time on this, and i hope that 1021 will be able to work with you guys to get this kind of thing passed. Thank you. Chair mar thank you. Next speaker, please. Good morning, board of supervisors. I am sandra ng, the acting officer of the Civil Service commission. We have heard from extremely many of our union representatives, our employees, regarding the concern of exempt appointments, and so we clearly understand, and our commissioners have given direction to the department of Human Resources and the Municipal Transportation Agency on the concerns on the high number of exempt appointments. And there are audits and annual reports being presented to the commission. I do want to emphasize that i we keep hearing the word transition and conversion, and i just want to make sure its clear that the positions ourselves are being looked at and how they can be put into permanent Civil Service positions from exempt, but it is not a guarantee that these exempt employees will transition into permanent Civil Service positions because according to the charter and the Civil Service commission rules, people must still meet the minimum qualifications, still compete in an examination process, must still be a reachable eligible before they can be appointed. So i just wanted to clarify for the board of supervisors, there is no guaranteed movement that the employee whos in the exempt position will be guaranteed a permanent Civil Service position because that would be a violation of the charter. Thank you. Chair mar thank you. Thank you so much, acting executive officer ng. Supervisor peskin had a question. Supervisor peskin thank you, chair mar. I apologize for being a few minutes late. Thank you for being the acting director. I knew all of your permanent predecessors. Could you please remind this body and i must confess, i lost track, who the members of the Civil Service commission are today . Yes. Our president is elizabeth selsein. Our Vice President is indicate sevetti, commissioner douglas chan, commissioner essex crowley, and commissioner jack miner. Supervisor peskin and could you remind us who that appointing authority is, and who confirms whether its the board of supervisors, who confirms their appointment railroor rejection . They are actually appointed by the mayor. Supervisor peskin and are they 300 appointments . Are they appointments that the board can affirmatively reject with a twothirds super majority within 30 days of the appointment . That, i cannot answer off the top of my head, but i know at the same time that when a mayor has made the appointment, it has been brought to the board of supervisors attention. Supervisor peskin okay. Well, that would mean its a 3. 100 appointment. And ill ask no more questions, but i do want to thank supervisor fewer. This has been an on and off again perennial issue relative to exempt and nonexempt employees, so i really want to thank the house of labor for holding our feet to the fire. I realize the issue with the crossing guards is a little bit different, and i say that and ill just let you know, i have been communicating both with chima and mr. Mcguire if the City Attorney were here, theyd yell at me because were not allowed to have an ongoing conversation with that. But thank you, supervisor fewer, for bringing up this perennial problem that comes and goes in City Government. Chair mar thank you. Are there any other members of the public that would like to speak on this item . Seeing none, Public Comment is closed. [gavel]. Chair mar supervisor haney . Supervisor haney if we could ask the member from d. H. R. To come up . So i also want to thank supervisor fewer for her work on this, and her leadership. You had mentioned that you were going to be looking at some of these departments that had over 15 of specifically local 21 employees that were exempt . And i guess could you clarify a little bit which departments youre going to be looking at and what exactly that analysis is going to involve in a little more detail . Yes. Its departments with 15 or more of their overall employees. For local 21, theyre about 17. 6 . Thats just for local 21. Osha, who ive spoken with before on this matter, ill commit that im going to following up with her, as well. I have the same concerns with ddas, so ill follow up with her. Our concern was when we looked at this on a macro level, things looked fairly consistent. When we look at this, a lot of these look to be appropriate project hires, so our goal here in these committees is to sit these meetings will have the laborist to provide their list of exempt employees and go over with them a reassessment of how its being done. I think its mentioned earlier theres a lot of redundancy working on sites, working on the streets, and maybe we could cobble it together to be an ongoing position. So instead of having ten different positions where people are rotating through those because theres 1,000 people in local 21 and cat18, and a year later, its down to 500. So were looking at with ongoing work, can we convert that to p. C. S. . Supervisor haney i appreciate local 21 for their leadership, and i would imagine theyll be on us for this. I would say in analysis to these particular employees and how to transition them and how to deal with them, i would suggest we look at maybe some stronger protections and controls and oversight so that this doesnt sort of grow particularly in certain classifications or in areas, so thats something im sure we would like to see and in terms of how we can provide better oversight. The two things that i also just want to flag that this committee will be looking ad is a very high temporary position for nurses, and we are going to be having a hearing later today with department of Public Health. So when theres Something Like that, it stands out 1600 nurses just temporary exempt, just far and away any of the other seiu positions. So it seems like theres a specific particular solution thats needed there in addition to the one by one, oneoff kind of approach to it. So i hope that would be part of the analysis. I also want to flag that im not especially surprised to see that. D. P. W. Is at the top when it comes to the use of exempt employees in local 21. As we look at this broader question of whats happening at d. P. W. Or forms at d. P. W. , and even the work that the controller is doing to see what is happening at d. P. W. , i would hope that would be part of this analysis because folks have said not just what this means for the workers, which is whats most important, but broader questions in the way that a department operates and favoriti favortism. Thats a concern around whats been happening in d. P. W. For obvious reasons. So i just want to be sure that thats a part of the analysis that youre doing, and there are these other efforts including looking closely at d. P. W. , which this is clearly a part of that were having a hearing later today, and also an analysis that were having yesterday that was called for by supervisor peskin. Yeah, absolutely on both of those points. Youll hear from my colleague this afternoon. We are working directly with d. P. H. On an expedited hiring plan with nurses, so were hoping to solve that very quickly. Regarding d. P. W. And the plans, thats kind of my plan with this, to sit down with departments instead of looking at this in discreet matters instead of realizing that most of these are ongoing and most of this is ongoing work. So absolutely. Chair mar supervisor peskin . Supervisor peskin thank you, chair mar. Good to see you, mr. Ponder. Its been at least a decade. You said there was a 15 growth in exempt positions. Overall in the past four years, 15 growth in overall employment, and about a 15 growth in exempt employment. Supervisor peskin okay. So that tracks. Correct. Supervisor peskin and presumably, as a matter of charter law, all of that falls into the 18 exempt categories under the charter . Correct. Supervisor peskin and where were not creating new departments, so theyre not Department Heads actually, we did create a couple new departments, so 53 grew to 55, so there is a couple of new departments. Where is that growth . Attorneys are exempt, doctors are exempt. Where is that growth if its 15 , and ive got two new Department Heads, wheres that growth . Right. Its a good question, and i dont know if i have that offhand. Theres a cap on the 2 limitation. I believe most of it is in the 18 area where there is no cap, which makes sense that were at this peak employment at 37,000, so a lot of discreet projects are being pursued by departments. So its pretty much across the board in the city. Again, i can come back and give you some of those statistics. Supervisor peskin yeah. I would actually, if the chair and supervisor fewer and supervisor haney are willing, i think thats actually worth hearing about in a public hearing, and i would suggest that we continue this to the call of the chair. I think thats very important, and i really want to associate myself with the comments of supervisor haney, which is while theres certainly an absolutely legitimate and appropriate role for exempt employees in City Government we are amongst them, the ability to make those employees heed a wayward Department Heads admonitions, which is now the subject of newspaper reports and yesterdays hearing is precisely why the whole concept of tenure in education and Civil Service in government came to exist, so i would really love to drill down to that because, quite frankly, i think we if were running this government right, need more line workers and dont necessarily need to grow the ranks of exempt management. So i would love and there may be very good reasons for it, mr. Ponder, but i would love to actually drill down on that as a matter of public policy. Thank you. Chair mar thank you. Supervisor fewer . Supervisor fewer yes. So mr. Ponder so i just want to say that i am so glad that you are in agreement with local 21 looking forward, but again, there are many other unions, i think, that have been bringing up these issues. So are you in discussions with other unions about this issue . Yeah, and this came up across last year with a number of bargaining unions. Local 21, they do have the biggest member amount and issues. It came up with osha today, and we are having discussions with oth other unions, as well. Supervisor fewer and are you tracking violations of category 15. Yeah. We go through a fairly elaborate documentation before we approve those, and its actually helpful when we sit down and review the department their assessment of that and then also having the union in their positions so get their take on it. Supervisor fewer since these employees were exempt, and they were basically at the will of the manager of the city and county of San Francisco, or the pleasure, how can we make sure that retaliation is protected against this process of conversion and that retaliation doesnt go on during this conversion, and that job changing to prevent someone from applying to the new permanent Civil Service positions are not happening . Yeah. Well be working with departments and try to disassociate individuals and look at the wonrk itself. I think we spoke about that, so we will be working with departments to ensure that doesnt happen. Again, it could be through this process, as i mentioned, if we cobbled together a few positions, yes, the way you make a few positions is youd have to mold it. We cant make any guarantees that someone will get a job. Although thats ideally, the goal, we have the Civil Service rules that we have to abide by. Supervisor fewer i think that supervisor haney and myself recall when we had many asneeded employees exempt, temporary employees serving breakfasts and lunches to our students every day, and some of these employees worked 30 years as needed, even though by state law and federal law, we must supply breakfast and lunch every day to students, and every day, they came to work as an asneeded employee. And these types of abuses are wrong, i think we can all agree. When it came time to see how we could make them permanent Civil Service employees, again, the question of the test came up, and many of them were very concerned, that even though ive been doing this job for 30 years, and i have been called back every single day to do this job for 30 years, if i dont pass this test, this means that im not qualified to do this job, i think theres a disconnect here, so i just want to mention here, also, to miss ng, from the Civil Service commission, that i understand what our charter says, and it doesnt guarantee them a job, however, i think it is imperative upon to understand these people that have done these jobs many, many years, actually granting them some expertise that could be a qualifying factor to retaining these jobs. I would love to see a recent analysis, also, about those people in temporary and exempt positions by race and wage levels. Because when we took a good preliminary look at this, we saw that many people in management positions that were exempt were actually white individuals, while we see in the temporary positions, very lower positions that were paid much, much less, they were primarily people of color and African Americans and latino. So i think were in agreement, mr. Ponder, that that is absolutely not acceptable. And i would just want to say that i would suggest to you and also to miss ng from the Civil Service commission, that we are putting people into training positions, that we should be also allocating a pathway to permanent Civil Service. That anyone that comes into a training position, that they are quite aware that this is a training position, that there is a pathway to Permanent Employment with us at the city because we have heard many times in this chambers that they have been in this position 25 years, and i think that is unacceptable to all of us. I would like to also add my voice to request this hearing be continued to the call of the chair as we have brought up many issues today that need some data and also some follow up. But, again, mr. Ponder and local 21, i just want to commend you on coming together with an agreement that, in recognition, also, there are many other public union public unions that actually have some of the same complaints and some of the same problems within our system. Thank you very much. Chair mar thank you. So, yeah, i just wanted to also thank supervisor fewer for calling for this hearing on on such an important topic, the misuse and, really, overuse of temporary positions in our city and how in t, in the future, w ensure that our city and temporary workers are treated fairly, and ensure High Quality Services for the public. Thank you so much, mr. Ponder from d. H. R. , and, also, miss ng from the Civil Service commission for sharing your updates and engaging the discussion. I think as my colleagues have highlighted, this is something that we this committee and the board want to continue to oversee and engage and ensure that we move move the particularly the negotiations with the other unions forward. So so thank you, and we colleagues oh, supervisor peskin . Supervisor peskin i do have one question apropos the hearing that supervisor haney referred to at the government audit and Oversight Committee meeting yesterday. And this is not a personnel question per se, mr. Ponder. And you may or may not be able to answer this, but in this committee yesterday, we came to understand that in the higher echelons of public works exactly half of the senior manager actually, more than half, if you count the acting director in public works, which we all understand why we have an acting director of public works, sadly, but that 13 out of 25 positions were acting. Now, this is a form of temporary exempt behavior little bit different. Not covered by the charter, but the same notion of acting also puts those people, albeit, theyre all exempt, at the potential of being unduly influenced or exploited. So the question i wanted to ask, and i did not want to put miss ng on the spot, is when we will have a permanent director of the Civil Service position. Im not familiar with that position, so i dont have that information, but i will follow up. Supervisor peskin if in it a followup email or continuing meeting, we could answer that. I would like to have a permanent Civil Service director sooner rather than later. Thank you, mr. Ponder. Chair mar well, thanks, everyone, again, for this hearing. Colleagues, can we continue this hearing to the call of the chair without objection . Great. [gavel]. Chair mar thank you. So we have a special order item at 1 00 p. M. , so were actually going to be calling a recess right now and reconvening at that time to call that item. Supervisor peskin and, mr. Chairman, i will be at a meeting at the bay im joined by supervisor matt haney and ahsha safai who is filling in for aaron peskin. Mr. Clerk, do you have any announcements . Clerk clerk yes. Please silence all cell phones and electronic devices. Copies of completed speaker cards and documents are to be submitted to the clerk. Items acted upon today will appear on the march 10 board of supervisors agenda. Chair mar thank you. Can we excuse supervisor peskin without objection . [gavel]. Chair mar i think its important that we make an announcement for our first cases of covid19. Mayor breed declared a state of emergency locally, and Governor Newsom has done the same for california. I dont mean to alarm anyone, and i im grateful for the wo by these departments and their staff. The reality of this Public Health crisis makes this subject all the more important. The ability of our staff to be well equipped is vital for a good outcome. I visited San Francisco General Hospital in preparation for this hearing and toured the emergency room. Ive met with nurses and labor leaders. I have immense gratitude for their work, and i have questions i hope to raise during this hearing. Im grateful for the nurses and Public Employees here today. We will be hearing from quite a few presenters today, so in the interests clerk mr. Chair, sorry to interrupt, but at the time, the balance of todays agenda hasnt been called. Should we do so now, before chair mar sorry. So, yeah, mr. Clerk, please call items 2 and 3. Clerk items 2 and 3 are hearings to address concerns raised by zuckerberg San Francisco General Hospital registered nurses standarding staffing, the use of contract registered nurses, hiring time frames, safety, and bilingual support, and requesting the department of Public Health, zuckerberg San Francisco General Hospital, and department of Human Resources to report. Item 3 is a resolution urging the administrative of the department of Public Health to include front line registered nurses and resident physicians in their decisionmaking process to implement, to the extent possible, an expedited hiring process to less than 90 days from receipt of application, to aessupplementing staffing requirements with contract registered nurses by implementing, to the extent possible, a ceiling of 5 or less of total staff, to provide annual violence prevention and Disaster Preparedness training for all staff, and to support its bilingual staff. Thank you, mr. Chair, for allowing me to call the items. Chair mar thank you. Supervisor safai, the floor is yours. Supervisor safai thank you, chair mar, and supervisor haney. We called this hearing not because we have a crystal ball, not because i know more than anyone. I called this hearing because the public nurses came out and spoke out in this chamber. Its not often that nurses will come wearing their garb, standing in line, and willing to wait. What they said was theyre overworked, theres staffing issues. Well probably hear some different opinions, but i want to clarify when i say staff. I mean permanent, fulltime positions. Not temporary positions, not parttime, but fulltime positions that will be there when a crisis is faced. Fast forward to todays announcement we just had our first confirmed coronavirus cases. This is a serious Public Health issue, and in the places in the United States where its being dealt with, we are seeing that front line First Responders are having to selfquarantine themselves. Theyre having asking theyre being asked to quarantine, and theyre being asked in some cases in some cases, theyre the ones that have contracted the virus. So that makes todays hearing even more important. Because if we have a hiring crisis in terms of timeline. We originally asked for terms of 90 days, but im going to push the city and ask them to come up with a hiring plan in 30 days or less. We have to have the appropriate fulltime staffing in our department. So were going to hear a lot from the nurses today. Theyve taken time from their busy schedules themselves. Were going to ask the departments to come up first so we can hear their initial responses. Im going to read the initial order of speakers, and as chair mar said, were only going to have anyone speak for five minutes or less so we can move to Public Comment. I just want to underscore that this is something that has been asked for for years. Not only do we have a crisis on our streets, we have a crisis in the city and county of San Francisco. In the opinion of many people that ive heard from and listened to, it has gotten worse and worse. And because of that, these nurses are at the front line of defense in many cases that are dealing with that. So that if theyre overworked, if im getting messages on christmas eve, theyre being asked to take mandatory overtime. Theyre not going to say no, especially if an emergency room is full. But this isnt just about the Emergency Department, this is about all the different divisions within the entire San Francisco general. It is the only Level One Trauma Center in the bay area, and we need to treat it as such. Lastly, ill say that it is important, as part of this process, that we hope one of the outcomes will be that there will be much clearer lines of communication between management and frontline staff. Because when i went, like supervisor mar, i went and did a tour myself. I just listened to the nurses and the things that they had to say. And the thing that i listened to was morale was very low. Morale was very, very low, and if thats true, theyre not going to feel very enthusiastic on their job. Again, this is not trying to beat up on anybody, we. Were trying to have an open and honest conversation. Currently, it is about 200 days to hire a nurse in this area. If you ask the average person in the bay area, will you wait seven months to get a job, the answer will be no, i have to work to support my family. So i just want to lay the framework for that. I really want to thank my staff for putting this together, working very closely in particular with the leadership of seiu 1021, but the frontline staff, julie, krista, heather, theyre there every day, put transgender on the line, and they have tried to be a put for putting it on the line for every day for the people in the city and county of San Francisco. So i know the situation that were dealing with and the crisis that were dealing with, i dont want to take anymore time. Were going to have a lot of questions, and i know that dr. Colfax and others are going to speak, so the first person im going to call up is dr. Colfax, the head of the department of Public Health. Good afternoon, supervisors, chair mar, supervisor safai. Supervisor safai five minutes, please. Fellow committee members, glen colfax, director of Public Health, San Francisco. I just want to emphasize how much i appreciate the importance of this issue. I trained and worked in the zuckerberg San Francisco general, including in the hiv aids epidemic. I know firsthand that nurses and their care are the foundation of the hospital. Staffing, and the quality of that staff, is paramount, as is and always will be worker safety. This is not only an issue in the emergency room at zuckerberg, but an issue in our health care in San Francisco, our state, as well as nationally. Covid19, or novel coronavirus, has only highlighted these issues and concerns, and i want to be very clear. There is no space between d. P. H. Management and the unions on this on these very important issues. We are taking key steps to address concerns. I have made changes in h. R. Leadership in order to address the long hiring process, which i consider completely unacceptable. You will hear about those steps. With regard to workers safety, we have taken a collective approach to addressing those concerns, and you will hear about some of those data today. But i have ensured that during this challenging time with coronavirus covid19 that the leadership is here to answer your questions, listen to the frontline staff concerns, and take action together. Thank you, and unfortunately for the remainder of the hearing, i do need to turn it over to leadership at the hospital, especially given the recent reporting that we released with the mayor today around the two cases in San Francisco. Thank you. Chair mar supervisor ronen . Supervisor ronen before you go, i know you really have to get out of here. Sorry . Supervisor ronen yeah. I just had a couple of questions. In terms of leadership from d. H. R. , is Mickey Callahan here by chance . Supervisor safai im sorry. I went over the list of leadership here from d. H. R. Supervisor ronen because weve got a crisis, and we have to fix it quickly, but it is happening all over d. P. H. Its not unique, its in every single program. Ive talked to hiring managers in several of your clinics, and every time they hire someone, they embark upon the hiring process, theres new rules and new inconsistencies. And they expect the fill position will be about 18 months. Thats why im asking if Mickey Callahan is here. We have a crisis when it comes to hiring in the city, and so i just wanted to hear from you a little bit more first, i wanted to just share that i got a copy of the workers satisfaction report that shows that 32 of your staff in d. P. H. , you ha d. P. H. You have about 3,000 staff feel that their department is adequately staff. That only about 34 of them feel like management adequately communicates with each other. These are shocking statistics, and so i just wanted to make sure that you hear the level of urgency we have, not only about this particular situation that this hearing addresses today, but about your entire department, number one. The second thing that i want you to know before you leave is i got a copy of the steps in the hiring process. There are 30 steps in the hiring process, 30 steps. I talked to one manager, who told me to get through steps o 1 through 10, its taken nine months, and they havent even taken any information, its just preliminary steps. I couldnt go through the endless information i could go through with you today, because i know you have to run, but this is just the very beginning of this process. Im planning, together with supervisor safai, to hold a number of hearings on this issue, because we not only need to fix hiring at s. F. General, but we need to fix hiring in general. Supervisor safai yes, supervisor. We have the Deputy Director of d. H. R. For Mickey Callahan. Supervisor ronen i think that is great. Supervisor safai we had spoke with them in advance because we knew this was going to be a series of hearings. Supervisor ronen yes, but supervisor safai, i thought it was very important to send this message to dr. Colfax because he is head of the department . And this issue is not limited to nurses in general. It is a sustained problem in the department, and i want him to hear from me on that. And i believe the problem starts at d. H. R. , and i believe that, in the future, mickey calh callahan needs to be here, and i will communicate that to her. Supervisor safai dr. Colfax, did you want to say anything on that . Well, i think Michael Brown is our new director of h. R. Were not only talking about the hiring metrics, which are concerning. But i need to focus on cultural differences, and there also is evident over the years that we were not optimizing our relationship with d. H. R. , and im very pleased to say with director browns help, were identified places where some of those steps arent even necessary. So were clearing out what we dont even need to do in order to focus on what we need to do. And he will go into that detail, but were making clear progress in that work, and i just want to emphasize clearly with the nursing work ive asked michael and the staff to focus on this nursing issue. D. H. R. Has been a wonderful partner in that, and i think thats really going to accelerate progress in this area. Supervisor safai thank you, dr. Colfax. I think before you leave, supervisor walton wanted to ask you a question. Supervisor walton thank you, dr. Colfax, for being here. I understand we are in the middle of a crisis, but i have some questions that i have that i feel you as the head of the department to answer. The first is we have break nurses in a ratio of 1 4, and that 1 4 ratio, which is contractual and probably lawful, we get up to about 1 8. How do you deal with that . So i have the director of zuckerberg general and the director of nursing supervisor walton all of which ive met with and had conversations with, but id love to hear from you. I know they will make presentations later today, and i assume you will get answers to those questions. Supervisor walton second, is it normal [inaudible] supervisor walton versus hiring permanent, fulltime workers . I have always placed an emphasis on hiring fulltime workers. Supervisor walton i think one thing that is pertinent, and d. P. H. Will correct me if im wrong, it is wrong in hiring temporary staff in general. We are frustrated with that process, which we know is ludicrous. Just the last thing i want to say, because you may have just been getting on board, but over six months ago, i asked the department of Public Health to send me a detailed Public Outreach plan that we can use as a framework that tells me all the additional recruitment strategies, all the recruitment strategies, how youre going to hire faster than six months. I havent received anything from your department. And i dont understand how thats possible. I will speak to the staff and make sure that you get that. Its possible that with the change in leadership, that thats why that didnt happen, but i will ensure that the team gets you something as soon as possible, sir. Supervisor walton thank you, dr. Colfax. Supervisor safai thank you, dr. Colfax. I think thats a good transition because were going to call up Michael Brown, head of d. P. H. So if you can go ahead and present, mr. Brown, and then, well have a series of questions. [please stand by]. Even though there does show that theres some improvement, you will see later on in one of the slides that i present to you. Not sure how fast we can get to that, but we are moving this that direction. So the hiring process overview, just basics, the first part is the position. Making sure the position has funding. Theres different processes that go through from our own finance department, and the hiring process. The next is going to be the referral issuance process, where it is controlled by d. P. H. If you see that we have 27 hiring packets ready to go. It doesnt mean that 27 vacancies from disappeared. It may be 15 because were backfillng because someone was reassigned to one of the vacancies in the special area. And then, there is a candidate selection process, and were looking at ways we can be ready. And then, theres the inboarding process. All of this is making sure that the person has all the information that they put on the application. Sometimes, people falsefy information and succeed in the hiring process, and we would have to stall that process, so theres checks and balances that go on. Those are the four main components of the hiring process. As i said earlier, this is the graph to show from last year. In 2018, it was 297 days for nonnursing positions. Thats from the point of a vacancy to a letter of tentative employment. So although there are some 117 attributed to h. R. , h. R. Has more than just processing individuals. I want to make sure that you understand even for just San Francisco General Hospital or zuckerberg, it is only about 25 people that are assigned to actually doing the process. So im asking for more staff, and im going to try to make this more quick because we have another person coming up, and i heard the bell. Im not sure how much more time i have, and you will have more questions, but supervisor safai just go ahead and get through your slide. Im going to go through this slide. This is our slide for h. R. , and we have our lead who is for staff all of staffing. The slide on the left side is only the side thats doing the hiring process for San Francisco zuckerberg. We are going to change that so that we have a focus group for doing that. We are also working with h. R. To identify ways that we can improve the process in the long range. But we have a specific team thats going to be hiring for not only San Francisco zuckerberg, but for all hiring. The other teams will be hiring for nonstaffing nurses going forward. We looked for bottlenecks in the beginning. We are looking at having startized questions to standardized questions for the interview process. Were going to have staff trained and ready to go, and then, were also engaged and working with d. H. R. , and youll hear a little bit about our interaction and process that were doing working with d. H. R. Moving forward. Supervisor safai great. Thank you. Supervisor ronen, before you ask questions, i would like ana, whos deputy supervisor is of h. R. To speak, and then, we can ask questions specifically. Okay. Good afternoon, supervisors, my name is ana, and i am the Deputy Director of services for Human Resources. On a side note, i also wanted to let you know that i also worked for d. P. H. For about 12 years earlier in my career. As Michael Brown mentioned in his presentation just now, the department of Public Health thats partnered with the department of Human Resources on what we now call r. N. Hiring project. The goal of the project is basically to reduce registered nurse hiring from its currently state right now of 195 days to 90 days or less from vacancy to approved letter of employment. To give you an idea of what that entails is basically d. H. R. , in collaboration with d. P. H. Human resources and nursing, will be going will be overseeing an intensive full job analysis process of the registered nurses for 20 specialty areas to determine the requirements in order to be successful in the job. D. H. R. Will also be conducting an audit of d. P. H. Current hiring process to find bottle necks and delays in order to find why currently hiring for nursing currently takes the 165. 5 days. D. H. R. Is planning to revise the Continuous Testing Program for nurses so that the eligible lists are refreshed more frequently. For example, every two weeks, depending on the vacancy rate of nurses. And depending on what we find in the audit, d. H. R. , in collaboration with the the department of Public Health, will implement efficiencies in hiring. With the help of the nursing directors and managers, we are also planning to develop and approve a bank of interview questions, approximately 25 for each specialty areas, so that they dont have to get approval of their questions prior to each interview, and theyll be ready to go. Lastly, we also plan to train a large pool on dher policies. Once a vacancy pops, nursing will be ready with a pull ool raiders to pull in for interview without going through the process right now because everythings going to be preapproved. Essentially our goal to complete this project because of the 20 specialty areas is six months. However, due to the emergency of the covid19, i can tell you that d. P. H. , along wi d. P. H. Along with d. H. R. Staff are being deployed, which will most likely delay this audit. We have people working on it, but as covid19 increases, im just letting you know, depending on how d. P. H. Staff and d. H. R. Staff are deployed, it may difficult in delays. We are starting off the project to decrease the number of days it takes for hiring, but we also plan to look at other classifications after we complete our end hiring. Supervisor safai okay. Im i think you hit a really important point, and it has to do with the convergence in the emergency of our city. I understand you have to shift resources, but if these frontline workers are diagnosed and have to selfquarantine, what are you going to do . I dont think we have time to wait for an identifying of b y bottlenecks and so on. I thought you were going to come today with a very detailed plan of what the hiring process is. I dont think it takes 90 days to do that. Im sure youve seen emergency situations before. We need to work with the leadership and the Union Leadership itself, and we need to figure up staffing aggressively, permanent staffing. This is your area of expertise, but i dont know if we need an audit anymore. Lets put that to the side, and once you do, i was hoping you were going to say that d. P. H. And d. H. R. , because of the covid19, youre going to go into even a more aggressive mode, a plan to hire these nurses. Okay. So i guess i wasnt clear, and michael kind of sped up his presentation, but whats going on right now my presentation is all about the future. Supervisor safai thats the later. Whats the deal for now . For now, Michael Brown has put together an r. N. Focus group for d. P. H. R. N. S, and i will let Michael Brown provide you with the details of it. So unfortunately, i sped through some of my presentation. Supervisor safai we have it in front of us. You may, but i wanted to speak to some of the things that we are doing. Supervisor safai okay. I said we are working on hiring r. N. S expeditiously, period. Thats not in there, so were going to convene a time thats focused on hiring r. N. S. We have barriers where h. R. Staff have to be at every interview process, but thats not part of the current processing. If we need someone to sit in, it would not have to be someone from h. R. Were in the process of reviewing interview questions. H. R. Doesnt need to review them. This is an interview in terms of your job, so you should know the subject matter for the job that youre doing. So were going to have a bank of questions that they can rotate for, versus all of the staff has to do it. We have experts looking at that, and thats one of the things. One of the other obstacles we had, we had to have a diverse Interview Panel, and it had to look a certain way, not necessarily whe necessarily were those People Experts on an Interview Panel, but i need to have people who know what nurses are supposed to be in that particular field. Were also going to have experts looking at the matrix. Thats another issue, but were trying to expedite the process totally so we can do it faster. You may here from some of the people at zuckerberg, some of the things that weve put in place, as they come forward from susan and also terry. Supervisor safai before i call on my colleagues, because theyre going to have some questions, this is one question that i want to clear on. In your presentation, is it true that theres 79 vacancies in your division. And is that in the e. R. Or is that hospital wide . So not here, but in a smaller group, i reported that there were 75 f. T. E. That could still be partial, so it could be. 9s and. 5s. Supervisor safai thats only for zuckerberg, for that hospital. Yes. Supervisor safai so theres 75 nurses that are short from your opinion. But its also 18 specialties, so its not all from one place. Supervisor safai and are you including and do you count, in your total for staffing, do you count per diem and contract nurses, as well. No, these are permanent. Supervisor safai these are permanent. So if you were to shift the focus away from cause again, this is some of the focus that were thinking about moving away from and again, everything we thought about yesterday is yesterday. Today is today, and per diem and contract nurses are not as permanent, not as well trained, not as, you know, familiar with the goings on of San Francisco general and our environment. Whats the ratio that you have for per diem and contract nurses versus nursing staff . Im not sure that i have that figure in front of me nor do my staff today. Supervisor safai okay. Im asking you in front of supervisor ronen, i asked you in my office that this was the start of the conversation in general, we are starting a conversation around nurses. But that is an important piece of information to get back to us. I want to know, and supervisor it sounds like supervisor walton asked for it a while ago, as well. What is the total staffing of nurses, what percentage are per diem, what percentage are contract nurses, and then, how are we getting toward them being more permanent . So if were not able to give that information to you today, id be glad to come back and give you that. I presume well have a series of meetings to make this work. Supervisor safai and in your presentation, you said 90 days. Im hearing less now. Supervisor safai well, yesterday is yesterday. Weve got to hearing also what your emergency hiring plan will be, as well. Supervisor ronen . Supervisor ronen yes, thank you. My first question is for ana. Thank you. I totally agree that were moving forward, but i have to ask one question and make one question about the past. Mr. Brown wasnt there, and so i want to ask you this question. Going back to 2014, where nurses came to the Health Commission and told you the same stories that theyre telling you today. This has been a crisis that has existed and only gotten worse for at least five years. Why is it that youre only now starting to take this seriously . How did this not pla [applause] supervisor safai folks, just so you understand the rules of the chamber, if you want to express your please use your happy hands. Not trying to silence anyone, this is a decorum that we have across the board for anyone. Supervisor ronen th supervisor ronen this is why i hope you can bring this message back, that its extremely important that director Mickey Callahan can be at these meetings. We have a systemic hiring problem across this city. Were seeing it in ways weve never imagined because of the coronavirus. The relevancy today is just right in our faces in a way that it wasnt previously. But this is not a new problem. And these safety complaints have been brought to the citys attention time and time again. What have we been doing the last five years . I have to be honest, i was not at the department of Public Health in the last five years. Supervisor ronen exactly. Which is why im sorry. Supervisor safai supervisor ronen, i spoke with director callahan. She was not able to make it today because of the current circumstances. She asked her deputy to be here. Im not making excuses for anyone. Supervisor ronen i just want to go on the record and say what is the point of having a hearing if the people that are coming and presenting before us were not there and cannot answer our questions . Its insulting, and its outrageous quite frankly. This is about the coronavirus today. We have a potential pandemic coming, and we have a hospital, a frontline defense that is understaffed and dangerous. And we dont have the respect of the directors of the department at least dr. Colfax came here and said something to us before he had to leave. It is unacceptable to me that miss callahan is not here, and that she sent you and its not your fault that she sent someone who hasnt been at the d. P. H. And cant answer our questions. Its truly unbelievable, not your fault, so i will move on. But i want to send this message loud and clear to miss callahan, this is unacceptable. Ill move on. How do you clearly, our nursing you know, the nursing staff is understaffed, but right now, you have over 1100 vacancies in d. P. H. , 1100 vacancies. I cant even begin to wrap my head around that. Clearly, you are very understaffed in d. P. H. And d. H. R. Just wait. Just to give you all because im studying this issue inside and out, day in and day out. Just to give you an example of how severely understaffed d. H. R. Is and d. P. H. I want to make sure i get these numbers right. The airport, the airport, which has about 1600 employees, and Pretty Simple job classifications. They have 60 people working in d. H. R. By contrast, d. P. H. , which has 8,000 employees, probably more, and were not even counting ucsf employees, were not counting all the subcontracts we have with Community Clinics that work with d. P. H. But basically do. D. P. H. S staff has about 120. That is nuts. I understand that you were not going to fix this problem unless we have a properly staffed d. H. R. I understand that dr. Colfax is asking for 20 additional staffers. Im asking supervisor ronen you are asking, dr. Brown, for 20. Because if you compare it to the airport, youre not going to get close to what you need to fix this problem. So what standards are you looking for to have a properly staffed department so that you can fix these these crisis level problems . And im sorry. I understood you said r. N. , but i think you meant h. R. Staff. Supervisor ronen correct, because you cannot fix the endemic r. N. Staffing problem until you fix the endemic h. R. Problem. I am totally in agreement that we dont have enough staff, and i need to have more, but i dont know how this budget is going to support it in terms of when it goes before the mayor and the board of supervisors. Supervisor ronen so what how did you make the decision of asking for 20 . Looking at whats happening now and whats missing, there are some key positions in term does of manager had a gun a terms of manager key positions there, laguna, we dont have a manager there. Now i dont have a manager for the labor section thats going to be managing the additional staff thats coming on. Theres just a lot of holes that i see. Im not going to get 100 people, but i could ask. Supervisor ronen im a believer in ask for what you actually need, not pretending that theres not a problem. And the and then, we go from there. So you have 1100 vacancies, and im not sure how many of those are budgeted vacancies. Supervisor safai supervisor ronen, can he confirm that . I cant confirm that. Supervisor ronen well, you are the director of d. P. H. Can you confirm that . Id have to ucome back to yu with that. If youre saying all the vacant positions, there could be 1,000. I dont know. I have to be able to report accurate numbers to you. Supervisor safai whats the answer to the first question, then . Supervisor ronen mr. Brown, i find that unacceptable. You are the director of d. P. H. , and you dont know how many vacancies there are in the department . Well, i have to give you information, and i cant have that information right off the top of my head. Supervisor ronen well, how are you going to fix the problem if you dont know the scope of it . Today, i came regarding the scope of the process. If you give me time to respond, i will do that. Im hoping im not getting attacked. Im trying to get to where we are and where we need to be in the focus of the hiring. Coming supervisor ronen mr. Brown could you please let me finish. Supervisor ronen yes. I believe in what you are saying, and we do need to have the staffing and appropriate staffing, and we do have to have it in h. R. I was there in the contract negotiations when we talked about staffing, many times, and im going to say yes, they are right. I dont know what happened in the meantime. Supervisor ronen how long have you been in your position now . Three months. Supervisor ronen okay. Do you think its an attack to ask you no, i dont. I dont. Supervisor ronen do you think thats something i should expect the director of h. R. And d. P. H. To know . Yes, and you should give me adequate enough time to ask me. Supervisor ronen i dont know a more basic question to ask that. I didnt know we have im sorry. Im flabbergasted. I will move on. So given that you did prepare to come here to give a stepbystep explanation of the hiring process, what we what you actually gave us in the presentation was extremely vague. Could you actually go step by step and tell us what the hiring process is for these nurses in this expedited manner for general. I can bring back that step by step flow. I do have it on my desk. I dont have it with me, but its a flow. Its a long page, and it would take a long process to tell you th that jere that. Supervisor ronen wait a minute. You just said you had that information. I had five minutes to give you a general presentation. Supervisor safai mr. Brown, can you give us the steps in the hiring process . So its very close. The only difference is the terms of the announcement, and you can apply at any time. Its basically the same in terms of the budget process, the the four things that i listed there. Even one of those four areaed that i had listed in there has four areas that i had listed in there has areas supervisor ronen ill walk you through it. You receive, from a hiring manager, a form 3. The form 3 . Theyre going to be reviewed with h. R. Theyre going to make sure its appropriately filled out. Theyre going to check with budget to make sure it is a funded position. Then, theres going to be once theres that information, they go to a request to fill for d. H. R. D. H. R. Checks to see if it will be appropriate. Then, they check to see if the Mayors Office, Controllers Office are going to approve it. Then, they come back to h. R. , and they start the next process. Supervisor ronen okay. And whats the next process . Supervisor safai sorry. Can i just ask a question. When it goes over to the Mayors Office or budget office, how long do you wait for it to come back . It depends. For management, it may take longer, but for r. N. S, i dont know what the time frame is. Supervisor safai i guess if i was going to make some recommendations on top of what supervisor ronen was saying, if we have a follow up, whatever the flow is in terms of hiring a nurse in this particular situation, we have to look at and i understand that you wanted to go through there was an audit process. But we need to figure out a way to cut out as much as we can. I would assume that you can get a blanket, if its a nurse, and you all agree with it, why does it need to be sent over and get an additional signoff if you know the money is there. Supervisor ronen but my understanding of this process is just the very beginning. Thats just the very beginning. Supervisor ronen thats why i said eight months. No, no, ive talked to hiring managers. Theyve described that same process, and that takes about eight months. So then, after that, you get a list if theres an existing list for the job classification that you want, then, they will give you that existing list. But sometimes, theres not an existing list, and if theres not an existing list, the hiring manager has to go back and forth with h. R. And ask if we can create a new list supervisor safai supervisor ronen, i know you want to get it on the record from him. Supervisor ronen perfect. Perfect. Keep going. What happens with the list . As were talking about u nurses, nurses have a continuous listing, so there should be a continuous list. Supervisor ronen okay, y. You send it to the hiring manager and then what happens . We have to see if theres a contract that is signed. And if theres a p103 thats on the list. If we dont have an assignment, we select a p103 to be selected off that list before it goes out, and then, managers have that permission in part of that selection. Then, if theres interviews that need to be done, we schedule those interviews. But in the process that you described, it used to be they had to talk to h. R. , send in their interview questions, have someone review the interview questions, and then have a conversation back and forth about maybe changing the interview questions. Then they have to schedule an appointment and have somebody from h. R. Sit in the interview process just as observers and then make sure that you had an Interview Panel that is the rainbow color, basically, sitting in there that not necessarily have any expertise about nursing in terms of asking the questions. There would be no followup questions, and so you dont need to know or find out more information when you find out or ask questions in an interview process. This is the placement, and i believe you need to find out more information. Supervisor ronen okay. Thats really helpful. That was really helpful. And then, i understand theres this rule of three, so the hiring manager has a choice after the reassignment, lets say theres nobody that wants the reassignment, so they have the list. They can either pick the number one person on the list, because the names are redacted, without knowing anything about that person. Some of these people have been on the list for years or i dont know how long, and letting them know about the specific position and interesting, and getting them from a smaller pool of applicants, or they can pick from the whole list. Its partially right. Everyone on the list is eligible. There is an n. O. I. , notice of interest letter that goes out to those people on the list before you do the interviews to find out whos interested. Supervisor ronen isnt it true the manager has to choose one of those three ways to conduct that hiring process. They have to choose anyone whos on the referral, and its rule of the list, not tree. Supervisor ronen no, no, but my understanding is they can hire from the list in one of three ways. They can choose from one name on the list not knowing them and interviewing them, or they can send out a letter of interest to everyone on the list, and only those that respond they can interview, or they have to hire everyone on the list and get information from everyone on the list. Not hire, interview. Supervisor ronen yes, hire. I think ana was going to explain. Okay. Let me just explain, registered nurses are rule of the list, so everyone is reachable. The Civil Service rules when a vacancy pops requires us to send out a notice of certification basically sending all eligible, hey, theres this vacant position, etc. And you are correct. If there are only five people on the list, theres a manageable thats a manageable pool of people to interview. So thats a scenario. The managers can say, hey, lets pull in all five people to interview. However, if you have two positions and 100 people on the list, the managers will want to screen down. There are different methods of screening down. Keep in mind, the Civil Service rules recently amended its rules to make sure that lists are confidential and to reduce potential implicit bias. So yes, they are d. I. D. ed is what we call them, where you dont get the personal information, and the hiring manager can then say heres my job related criteria. So i need someone who has experience or this certain license thats special that they have in one of their specialty areas. Yes, its the hiring managers get to review all 100 d. I. D. ed and look at that criteria in hopes of getting a more manageable pool to interview, and thats when the list will be released, when the interviews occur. Another method that weve provided is rankon list. Y yes, if there was only one person on that list, you could interview right away. But theres situations where, okay, could i interview the top ten ranks or the top 50 people . You could do that, as well. So there are different methods of screening down. It either needs to be job related or it is by the rank on the list. Does that help explain . Supervisor ronen yes, yes it does. Thank you. So after the interviews happen and the hiring manager has chosen the person that theyd like to hire, is there any step in between making the offer . Yes. The background information, fingerprinting, the medical exam clearance, those kind of things pending that. Supervisor ronen so that doesnt happen to everyone on the list . So if its an outside employee, we need to find a conditional offer of outside employment if were going to talk about registered nurses right now, during the continuous process, the only way to get the nurses on the list right away is we dont check we dont require them to provide verification that they have this experience. We just get them on the list, get them interviewed. Prior to the interview, the department is responsible to make sure that they have the minimum qualifications. So the first step is can you provide me with verification of experience. Weve expedited that process sometimes by saying, you know, prior to you going to the interview, i need you to provide this document. Another thing is we have the conviction history program, so because youre working at a hospital, Everybody Needs to take this. I think its a twoweek t. B. Test, everything, so thats a process within itself. And there are ways so for the emergency process that were referring to, michael has put together a focus group to just focusing on nursing. D. H. R. , although were looking at projected planned, we have also offered what we call mass arriving. So for example, you know, we have offered d. P. H. , because d. H. R. Is responsible for the conviction history program. If they had a mass hire, we can go ahead and go to, for example, General Hospital and bring our fingerprint machines to help fingerprint them versus an appointment each time. So weve offered that and were prepared to assist the Public Health with mass hiring of nurses. Supervisor ronen last question, and then ill cede to my colleague. So that was the general hiring process, and theres a million other steps in there, but i will let all of that go. And i will say so what of those processes you just mentioned one, the fingerprinting. But what else have you cut out to make it faster to hire nurses for general . I okay. So prior to michael becoming the h. R. Director for the department of Public Health, we looked to get an outline of whats going on. What he had mentioned earlier was the Previous Administration, prior to Michael Brown and prior to grant colfax, had different processes in place that significantly delayed just being interviewed. One example he gave you was there was a requirement that all h. R. Staff be present before an interview can go forward. Well, hes correct. We dont have that much staff, and we dont find it necessary to have that requirement, so that was removed. Another requirement that was removed was, like michael said, the Previous Administration had a composite group of people unless you have your raiders. Weve changed it to be a good faith effort to diversefy the panel of raiders versus a formula, so thats two things. The other thing was there was a requirement for a nursing director to be in every interview prior to be for it to go on. Im not a nursing director, im a Deputy Director, and its hard for me to be at every interview. So thats been removed. Like like i said in my presentation, we did an overview of the process, and we took out what we could to alleviate some of the time. I do believe, for future purposes, we can identify every single process that is unnecessary. But without understanding the process every step of the way i cant or michael cant just immediately remove some processes because, again, part of our hiring process, especially with permanent nursing or permanent positioned is governed by the Civil Service commission rules, and we need to abide by those rules. Some of those are the notice of certification or the process where we can have the ability to respond back. It has to be five business days. Thats in the Civil Service rules. Theres also a lot of rules within the examination process, for example, that dictates a period of time that you need to have candidates wait to look at, you know, their scores in the section. Weve tried to ask for Civil Service rule change, and it took us two years to do. Supervisor ronen sorry, mr. Brown. Werent you the director of the Civil Service director prior to changing in this role . Yes. Supervisor ronen so why do we need a long audit . You know the Civil Service rules better than anyone. I know the Civil Service rules. Supervisor ronen so why dont you take this 30 steps to hiring and say this is unnecessary . Just like the three you just took off, why do you need an outside audit . It just feels like outside bureaucracy for fixing problems that arent needed. We have an outside crisis. We are now faced with coronavirus, and you tell me three months into your job, you are faced with an audit to improve your hiring process . I truly understand your frustration, but i want to make sure that we all understand that anas describing and the audit that were talking about is to fix the systemic things that are in the process itself. We are currently working on changing some of the things that are in the way right now that we can do to expedite the harrington process. But, for instance, not having a job analysis done since 1998 or something, whatever the date is, is not acceptable. You should be updated every five years. Thats part of the audit that were trying to do as well as making sure that we have updated information in all the specialties. Thats part of what were doing in d. H. R. And making sure my staff is able to do that. Not only do we have staff missing and not enough staff, the staff have not been trained in order to do their job efficiently. Z so thats something that im doing in the d. H. R. , even in the labor section, as well as the operations and whatever else i have thats under me. So there are other things other than just hiring that im working on, but as you said that for the first three months and i did report that i had to see what was going on before i could make changes. I knew there were some things in the way. Some of the things i could remove right away, some of the things i was still working on. Right now, were in the middle of covid19 thats taking all of our staff. Not just the clinical staff, but we are working seven days a week right now. There is a juggling act, and i understand the frustration, but we are going to make sure that the hiring is done quicker for the nurses especially. Supervisor ronen okay. I could be here all day, but im just going to stop. Im just going to say that i think this byzantine hiring process is to be able to hide behind excuses and make it so complicated, that we have to ask so many questions, that we have to stop asking questions just so we dont have a hearing thats too long. It is ridiculous, it needs to be changed, and we will be changing it. Thank you. Supervisor safai so thank you. I want to allow some of my other colleagues to ask some questions. I held back on a tremendous amount. Just please bear with us. We really appreciate this process because as supervisor ronen says and ive said all along, this is the beginning of a conversation. We did not know that we would be sitting here on the date that we would announce covid19 cases in the city. So what i said yesterday was yesterday. It was not to sweep under the rugs comments by the department to listen and hear these issues. I think youre hearing it, and youll hear more of it when we get to Public Comment. One of the things that im going to say before i hand it over to supervisor walton, is we need a plan. There needs to be a crisis plan, and we are at a crisis situation when it comes to the staffing and many other issues at s. F. General. Supervisor walton . Supervisor walton thank you, supervisor safai. I do want to start off by saying its very problematic for you all to be sitting here without information that i know that was requested. Theres a purpose of this hearing, theres a reason for it, and im not necessarily putting it on the two of you, but the fact that we dont have people here, representing both departments that can give us that information, particularly since dr. Colfax said we have the folks in the room that will be able to answer your questions, is a problem. The first question is for ana. Thank you for your presentation. As i look at the r. N. Hiring project, and i see the goal is to reduce registered nurse hiring to 90 days from approved vacancy, how long does it take to get that approved vacancy list or from that my understanding and, you know, i dont know the exact dates, but my understanding is when the department of Public Health submits their position approval because nursing is labelled as, you know, a safety or credible position, it actually bypasses my teams approval process, and its automatic. Im not sure if it goes through the Controllers Office or the Mayors Office, but i do know the d. H. R. Portion of it is one its submitted, nursing is one of those positions that weve made automatic approvals for. Supervisor walton mr. Brown, do you know how long it takes to get to that approval list . I cant tell you, either. Supervisor walton anybody with you that might have a ballpark of how long it gets to that approved vacancy list . That is important for us to know so we know that whats being proposed will get us to 90 days. May i make a comment . The reason i put approved vacancy is we have eligible lists already ready, and so if the vacancy isnt approved, its not like we can fill it. Im just letting you know thats how i put the language. Supervisor walton i understand that part very clearly, and i know theres a timeline for something to get to that approved havevacancy l. So as i see this list, i dont know that were going to be hiring by 5. 5 months that were looking today. I was just informed that it might be five months. Supervisor walton there we go. Were back up to five months. This means nothing. These are slides put in front of us for us to believe that were going to do something different, but it takes us three months to get to the approved vacancy list plus another three months, which is a little longer than you provided on the graph. That sounds like six months to me. To answer your question a little more thoroughly, terry ann tony is here from zuckerberg to answer your question. What michael is saying, in his presentation, the lists are going to be refreshed every two weeks. Now the lists are refreshed every two months. People get on the list, we refresh the list, we exhaust that. Supervisor walton so well be going from three months to around two weeks . Thats our hope. Thats what we in terms of refreshing the eligible. In terms of updated people that want to work there that werent on that supervisor ronen said, for a long time. Supervisor walton and whats the specific timeline for achieving this goal . That would be h. R. Yesterday when we were talking about this and trying to get this done within six months, it needs to be put on a faster track. So now that we have a dedicated team, well be working on that team on how we can do the refresh sooner. Supervisor walton so you made the statements, mr. Brown, that you want 20 staff that will help you be able to process faster and get this done quicker. Yes. Supervisor walton but you provided a slide that says it takes you 9. 9 months to hire nonnursing classification sector, so you wouldnt even have that staff till next year. Im sorry. Whats the question . Once again, all 20 staff are not for processing. Theyre across the board. Supervisor walton whatever the reason you need 20 staff for. Im not disputing that. Im saying you show me a chart that says it takes 9. 9 months to hire classification staff. So youre basically saying youd hire that staff the next fiscal year. I cannot hear the last words youre saying. Supervisor walton youre basically saying you would hire the 20 staff the next fiscal year. Thats the ask in the budget. The employees that are in those positions, the expertise, whatever theyve learned, they are going to be going out the door. I need stablized staff to work, at least right now. If i have projects going on, at least i can still do projects. But currently, the staff i have are exhausted. Theyre leaving, theyre dissatisfied. Longterm employees that i know are going to other departments. And we have, even with a list, people saying not to accept a position here because its just unattainable. Supervisor walton thats the point that were trying to make, and thats what we need to fix, and were counting on you to be the person. And i know you dont have to be here. Youve made that clear. I am excited to be here to represent the people of this city. And by the way, none of us have to be here. Im hoping that you do support me in that effort in terms of getting additional staff. Supervisor walton as i look at slide five, not all staff are involved in the hiring. You put that on there. Yes. Supervisor walton is there any thought about how to reprioritize since the issue is hiring . We are trying to reprioritize the needs we have and the needs on hand right now. In terms reprioritizing staff, they are in different specialty areas, and theyre not all h. R. That works in processing. Occupational health and safety is under h. R. The labor team that is dealing with the grievances and the discipline, they dont have the processing skills. Those are different areas. The mayor team is confined to doing the examinations and the process. Supervisor walton so i asked some specific questions to dr. Colfax, and he couldnt answer, and he said the team could. We have break nurses that provide our nurses to get the breaks and lunches that they need. Oftentimes, we dont have nurse break nurses on staff, and what happens is, the ratio becomes 1 8. How is this allowable . How does this even happen when we know that the ratio is 1 4 . By contract, by law, how is 1 8 even possible . So im assuming that youre talking about specifically in the hospitals where they have the braeak ratios. Is there someone from zuckerberg that can talk about the breaks . So we do have breaks as mandated by state. Due to sick calls or unforeseen things, break nurses break nurses get pulled to do staff nursing. Its not what we want them to do. We want to have our nurses get breaks and, you know, they work long, 12hour shifts. Supervisor walton so let me ask a question. How do we get to a 1 8 question. I know everybody gets sick, i know Everybody Needs breaks. How do we have 1 8 scenarios . We should not have 1 8 scenarios. Supervisor walton but we do. Can we agree on that . If a break nurse calls in, and they that if somebody goes on break, they dont have a break nurse to cover that . Not 100 . I have data to look at. I meet with the union monthly. Supervisor walton that never happens . Im not saying it never happe happens. Supervisor walton im just trying to get us on the same page. It doesnt happen every day. It is something that we supervisor walton but it does happen, right . In unforeseen circumstances, yes, it does. Supervisor walton how are we going to fix that . We are going to hiring people to work. We have vacancies when dr. Ehrlich does her presentation, i could answer questions a little bit better so you can better understand where were coming from. Supervisor walton i know i asked dr. Colfax a question about it, but i didnt ask it this way. There seems to be a budgetary practice to make sure that were hiring Practice Nurses ive seen budget line items on this. When are we going to instead of prioritizing resources to have travel nurses, prioritizing staff so that we have a more stable system. Were doing that now. Thats what i want. Every nurse, staff nurse, we have about 22 backfill, and that backfill is utilized by per diem staff or by travelers. When we have a large vacancy, we have to fill in those, and those percentages are higher. What i want is permanent staff with 22 for backfill. Thats what i want. Supervisor walton and pursuant to administration and labor, we all want the same thing, and that is to be able to hire adequate amount of staff quick as possible so that we can provide quality patient care. Thats exactly correct. Supervisor walton mr. Brown, i asked the department over six months ago, and i know you werent here, but i was promised this, somebody would send me a detailed recruitment plan so that we could see all the recruitment strategies, all the detailed recruitment. I havent received anything from your department. When are we going to get that . So im not sure when our next meeting will be, but i can try to have something for you. That was not related to me coming on board. Supervisor walton even before our next meeting because i dont know when that is, either. Whats your timeline to put Something Like that together . Right now, my priority is the covid19. Supervisor walton i have to deal with the covid19, too. Ive still got a job to do. I hope thats not going to be the response of everybody that comes up here, that we have a crisis and were not going to do our job. I said we had a crisis, not that i couldnt do it. I asked the date of the next meeting so that i could better manage my time before the next meeting. If i could have a date, id love to make that happen. Supervisor walton i dont know when thats going to be, but id love to get a timeline of when you can get that to me in the next meeting. I dont want to be held to that timeline, but i can try to get you something within the next month. Supervisor walton thats the response . Thats the response. Supervisor walton if you dont see the frustration we have, its obvious, the frustration we have. Theres so many reasons were at this place. We want our staff to have the ability to provide quality patient care by our staffs and by our hospitals. A lot of employees within the department have a hard job. If we know the one thing that is common is we have a lack of staff and a hiring issue in terms of how fast we are hiring people which has existed for years, by the way. It didnt just start with you in your role as deputy. There has to be a quicker way to solve these problems, and we are relying on you all to do that and counting on you to do that. Dr. Colfax is not here, but what i was going to say to him, because of his statements about having a commitment to make sure we do that or to provide quality patient care, is i would rather see a sermon than hear one any day. I dont need to keep having warm, fuzzy conversations about how were dedicated to doing thing things when we dont have the plans in place to do things, and these are the plans that weve had in place for a long time. And now we do have a crisis, and going back to supervisor safais point, if it does go back to a point where we start having the people that we rely on for patient care, and we cant adequately respond to this crisis, then were really going to be in trouble, and i dont know what were going to do in that case, which tells me the reason that dr. Colfax had to leave so fast is to get those types of answers because we do need answers to those questions like yesterday. Supervisor safai thank you, supervisor walton. Supervisor haney . Supervisor haney well, first of all, thank you for being here and for your work. I just many of the things were covered, so i wont go on too much about it. First thing i just want to clarify completely is we all agree that the hiring process that we have right now is far too slow and is not working. Who created that process that we have now . How is it created . Who created it . I cannot point a finger to a point. Supervisor haney not a single person. Theres Different Levels that were added over a period of time, which is its now making it ridiculous in terms of the timelines. Supervisor haney and if you were to say that theres somebody whos sort of above it all who has the power to influence it most, who would that be . Would that be the director of h. R. . It could have been the director of h. R. , it could have been in tandem with the director of the department, whatever the processes were at that time and the decisions that were made. Could have been both. Supervisor haney i just wanted to establish that this is something that weve created, that the city has created, that we are looking around saying that this process that is so slow, that is burdensome, that is making it difficult for folks to do their jobs is outside of our control. Thats what makes it so maddening. Weve imposed certain processes and inefficiencies that now were saying are getting in the way of us to do our work. So if we get to the point to say that if we created it, we can fix it, that is within our power. I do think we are talking about a Health Emergency or a potential Health Emergency that are here, but people are running outside the door and taking up all their time to focus on that when this has clearly been an emergency for a long time. And we had a declaration of emergency around the coronavirus. Does that give you any special hiring powers . Because we have a declaration of emergency and if you needed hundreds more staff immediately, which i think, probably, we need it to happen before, what have you been told in terms of what special authority you have to hire immediately now that we are actually in a state of emergency . So at this point, that is something we need to definitely engage in a conversation with the rest of the city leaders, d. H. R. , the Controllers Office, to see if there is something we can do expeditiously around this process, as well, but i will bring that back. Supervisor haney so i know there are all these meetings going on thats taking people from being here. I hope thats something that theyre talking about as part of that, and that those types of special powers as they relate to hiring are put front and center not just as it relates to the coronavirus, which is most urgent and taking a lot of peoples time, and its incredible to me, with all the attention of the coronavirus, that there have been no special directives around hiring. I will take that back. Supervisor haney one of the things that, obviously, people need to wash hands and not shake hands, apparently, anymore, but we also need to know how we can get people in to help. And, you know, im not putting this on you, but if the director were here, that is something that i think we need to take very seriously. We are currently hiring some nurses and other staff as subcontractors. Is that correct . As category 18 or p103s . Is that what you mean . Supervisor haney are there nurses coming in as subcontractors, sort of contracted out i guess thats what you were kind of referring to as travel nurses . Do you know what i mean or would that be part of the presentation . One thing, when we get to that, is when those folks are hired in comparison to the process that we have. Last thing i wanted to say, one of the things that would be really helpful as we think about the process and supervisors ronen and walton touched on this, really get a sense of how long each part of this process takes, and how we can see almost like on a map, by eliminating certain pieces of it or shortening certain pieces of it, how that will shorten the overall process. Because if we see that it takes really long, as supervisor walton said, it doesnt show us how each of these things are shortening if one thing is taking the large majority of that, and youre doing a bunch of things that arent actually a huge part of it then thats not going to allow us to reduce the time. The last thing i want to say is there are a lot of people who are expertes in this because they work in the system. How are you working with them . How are you listening to them . Do you have our labor and frontline workers as part of an Advisory Group . How are you consulting from them, learning from their expertise to how we can do this better . So we have the labor meetings with the doctors and nurses, and my labor team is participating in those meetings and working with the management in the different areas that we have, one at laguna, and i think they have one at zuckerberg, as well, and they are working on issues that are brought to their attention. So some things are brought to my attention, like specifically in hiring, and thats where i am involved in trying to do that. But i am not necessarily at every one of those meetings. I have staff that are going to them. In our contract, there is a side letter that said we will be working with d. H. R. In trying to stream line the hiring process. Thats why weve been working, trying to stream line the process. It is not something that just came out of the nebulus, its something that we are required to do. Supervisor haney i would just say, im sure in Public Comment, were going to hear a lot of good ideas, and hopefully well get to that soon. I hope theres a way to more formally take that and work on a collaborative basis. These folks want to see it solved, as well. Theyre seeing a lot of it, and so i hope as youre coming up with a more detailed timeline of the changes that are going to be made, that its done in close collaboration with the front line workers and their representatives. Thank you. Supervisor safai thank you. Supervisor mar chair mar. Supervisor mar thank you. Ill keep it brief, and i wont repeat the good points and the general frustrations and points that my colleagues have made, which i totally agree with. I do want to thank both of you for the presentations and sharing the updates on what the department and d. H. R. Are doing to try to to really accelerate the hiring processes for for nurses and other important critical staff and d. P. H. And i do share the concerns of my colleagues about the references that have been made to the escalation of the coronavirus situation here in the city today. You know, many of us joined mayor breed for the press Conference Announcing the escalation earlier today. In fact, i just got an email during the meeting that my Daughters High School was just closed today because of the coronavirus situation, so we all are very aware of that. But, you know, clearly, the situation, whats the timeline to complete that and achieve that goal . So we are completing like michael said, there hasnt been an update completed in 20 years, so were projecting approximately six months. The difficulty im having is right now, were still on schedule, but some of the staff is being deployed to e. O. C. , for example. A job analysis requires that we have nurses there who are the experts to help us with the nurses that do not get deployed, so roughly six mon s months. Chair mar and after six months, what is the expectation . Get, if everything again, if everything goes according to schedule, the goal is reducing it to 90 days or even less . Chair mar okay. So for me, the aggressive goal is to have it before the 90 days from the hiring process, to 90 days or less. May take six months in terms of the job analysis and making sure that its everyone knows what the process is, but in terms of the hiring and getting the numbers down, i think we can get that down within the 90 days in six months or before that. Chair mar great. Thank you for that. Maybe ill leave it at that. Supervisor safai okay. Thank you, chair mar. Just before we move onto dr. Ehrlich, what were trying to underscore, before the announcement of this Public Health crisis thats going to continue to accelerate, i think one of the goals of this hearing was to come up with an aggressive plan. I think that there needs to be a real consideration given, and thats similar so what supervisor haney was saying, and that is what is the plan before we get to crisis . Even though many of the people that youre going to hear from Public Comment, theyre going to say it is a crisis, and youve just not been hearing it from the hospital. I think we need to have a plan, an aggressive plan, so im glad that we proceeded with the hearing today, even though many, like director colfax and Mickey Callahan director callahan were not able to be here, i think you need to go back and convey to them. So i think we will have a follow up hearing in 90 days to get back to us, maybe even in 60 days. But in the interim, there needs to be information transmitted to us that would talk about how were going to move aggressively in this emergency situation. The next person were going to call up is dr. Ehrlich, and if you all can stay around, we might have different questions. Chair mar dr. Ehrlich, before you started, i just wanted to say that supervisor stefani is now present, who will be filling in for supervisor haney. Clerk thats correct. I just wanted to announce that the house has changed, so its now chair mar, supervisor safai, and supervisor stefani. Thank you, chair. I want to say, as always, your support for our workers, our patients, is there, and its not to be taken lightly, and i appreciate that. I know youve heard some compelling stories at the hospital that are concerning to you, theyre concerning to me, and i know theyre concerning to dr. Colfax and our whole leadership team. Just to reemphasize the point that we all have the same goals. We want to make sure that our patients are taken care of, we want to make sure that our staff are taken care of and safe, and were doing a lot to focus on that at the hospital right now. I know you had some specific questions, so because my time is so belief, im going to focus on those very specific questions, but happy to take happy to take questions on any other areas as you would like. So these the concerns that youve heard about generally fall into these areas. Im mostly going to talk about staffing. I have some information also about what were doing to improve safety at the hospital and i can go into that if theres time or what questions you have. So first of all, i want to say that nurses are at the core of the service we have at the hospital. They makeup about 30 of our d. P. H. Staff at the hospital, and we have 900 f. T. E. Budgeted nurses hospital wide. That being said, leaves, modified vacancies affect our staffing. About 10 of our nursing workforce is vacant due to vacancies. In addition, one of ways that we ensure we have qualified nursing staff at the hospital is we have Training Programs. This is a great way of bringing in nurses that are qualified and have the credentials that we need in the more skilled areas, like the Emergency Department, the perioperative area and critical needs. When we have nurses in the Training Program, we couple them with nurses that we have on staff, so that means it limits our ability to provide direct patient care with those nurses. And so we have patients at the hospital. The vast majority of patients we have at the hospital come in through the Emergency Department, so we have to make sure we take care of patients no matter what. And in order to ensure that, we take up the leaves and vacancies with temporary staff and overtime. Now what im going to do is go into specific areas of the hospital and what the staff is there. Since january 2018, the e. D. Visit volume has been relatively flat. Were seeing about 200 or so patients a day. That does vary about 15, plus or minus, on any given day. Before that time, the volume went out a fair amount, about 25 between 2014 and 2018. And so since 2014, weve budgeted about 23 additional nursing positions in order to accommodate that volume. Right now in this gives you a sense of that. Its been relatively stable since january 2018, and this shows you in more detail what the current state is in the Emergency Department. For example, we have 2320 r. N. S, we have 144. 41 f. T. E. About 24. 1 of them are on modified duty vacant, on leave, or modified duty. And we have about 47. 1 that are either p103 thats the temporary nurses, registry, or overtime. In spsychiatry, we have a highr percentage of our staff right now that are on vacancies, leave, or modified supervisor safai thats okay. Continue. 3 of the total staffing. Heres the volume data in psych Emergency Service and in inpatient psychiatry. You can see it goes up and down but more or less stable since 2018. And here in psychiatry, we have the budgeted f. T. E. S. The positions that are either vacant, on leave, or modified duty, and how we have made up with that with the temporary registry or overtime. Medicalsurgical. So our medsurge census is quite a bit higher on a daily basis than weve planned for. Weve budgeted 164 positions, but were running at 179 or even more on some days. To accommodate this volume, we opened up a unit that we had planned to be closed. Thats h58, its been open intermittently and mostly since 2017, and on any given day, we have 8 to 15 patients there. The good news is for this coming year, weve submitted a Budget Initiative to fund that unit permanently. That will start in july, and thats about 30 additional f. T. E. S. In med surge, again, vacancies and leave account for about 20 of staffing. And in medsurge, we have nurses that supervisor ronen dr. Ehrlich, im so sorry, but i have to go to another meeting. I apologize for not being able to stay until the end of the hearing. I wanted to thank, particularly the workers for your incredible work and staying power, and let you know im going to watch the rest of the hearing tonight on sfgovtv so i can watch the worker testimony. Im sorry. No, not at all. Thats fine. Supervisor safai please continue, dr. Ehrlich. Thank you, supervisor ronen. And then, heres the rest of the data on the med surgical unit. 54 vacancies, leaves, or modified duty, and then, the p103 registry that we use to fill those is 77. 25. I think ill stop there on the because this is a lot of detailed data that you requested. Ill stop and see what questions you have about that, and then, if you have additional time, i have a couple of slides about what were doing to address the issue of Workplace Violence. Supervisor safai actually, can you talk about cause i know about some of the nurses today and that ive heard from directly are going to talk about Workplace Violence, so can you speak about that, as well . Yes. Thank you for asking. So first of all, this issue is very much on our minds, and it is a national issue. According to this study from the American College of emergency physicians, 70 of emergency room nurses and 47 of Emergency Room Physicians have been physically assaulted at work, and this situation is unacceptable. At zsfg, we know that batteries and assault account for 85 of reported crime, and theres a high concentration in emergency and psych emergency. So in 2018, we put together a Workplace Violence committee that was geared towards preventing and improving our response towards incidents of violence, and the priorities are, as you can see, to ensure that we have better data and reporting so we know how to best address the problem. We wanted to assess and improve the effectiveness of our crisis institute prevention training. This is training that we are mandated to do by state law. We have done it, and we know we can do better at it, and we have a plan for that that i can talk about in a minute. [please stand by] highest risk for episodes of violence. In those areas, we have planned a 6. 5 hour training. That is different from the lower risk areas where we have just a couple of hours, which is what weve been doing so far. In march, well be sending out a frequently asked questions based on the town hall feedback we got. And were planning, at this time, an improvement event focused on how we respond to episodes of Workplace Violence. That is planned for the week of march 30. And then you can see well be updating staff quarterly in april. Thats one of the quarterly times. We have a really nice quarterly equity news letter where we convey information and answer that were updating the Health Commission every quarter. So thats the information i have about Workplace Violence. Im happy to respond to questions you have. Thank you. Supervisor stefani thank you, supervisor safai, im really happy to be joining this hearing today. I want to thank the nurses for bringing it to our attention and the testimony. Thank you for your presentation on Workplace Violence. Its something im glad youre collecting data on. My mom was a psychiatric nurse and had an incident. My sister is also a labor and delivery nurse, not in San Francisco, but im wondering what happens when there is Workplace Violence in terms of who is i mean i know youre directing the data, but are the Police Called . What does it look like when a nurse is injured, what happens . Right, so the first thing to be mindful of is were doing everything we can first to try to prevent episodes of violence. So all of the training were talking about hearing from staff, getting their ideas, this is the most important thing is to prevent the episodes to begin with. When an episode happens, and this can be it doesnt have to be a physical assault, it can be a battery, meaning a verbal assault. In fact, we know in the first two months of this year that about twothirds of the episodes that are reported are verbal assaults. What we do, we encourage the staff to report the incidents. One of the things we want to try to encourage is what we call a culture of safety, where everybody feels comfortable reporting everything all of the time so that we have the ability to respond to it. Then what we do we have this detailed questionnaire and tool kit where we do a long series of questions. I think its 54 questions in total, that is developed by cal osha, so we respond we figure out all the details about why that happened so we can address those. And then we provide whatever support that employee needs, whether its emotional support, whether they need attention in the Emergency Department or any kind of physical or behavioral support they need. So its quite a lot that we do to respond. Supervisor stefani i just want to make sure, too, because if a violent incident is occurring, like say someone is under meth induced psychosis and in that moment a nurses life is threatened, how quickly i know there is the deputy sheriff. I just want to make sure the Response Time is quick and thats what im trying to get at. Its not just verbal assault from what i heard, especially with p. S. And what were experiencing on the street with methamphetamine and what that can do to people and what that can do to the nurses. I didnt mention the sheriffs department. We have a multimillion dollar contract with the sheriffs department. We have posted positions. We have roefg positions. Our Security Director oversees that contract. We have a captain and many others throughout the health department. I meet with basil and the captain every single week. We hear the data about what happened the week before, what things were concerned about in the weeks upcoming and what were trying to do to prevent violent episodes on campus. Thank you. Before we open actually were going to go to were going to ask the union to come up and speak. Before we do that, just going back to the question while youre up here, doctor, of the emergency situation that were in. And emergency situation that we have been in. When i add up all just from the presentation itself, when i add up the shortfalls that you have and the way youre saying modified duty, when i add that up, it comes out to over 100 positions that are not filled. So that that has to be a cause for concern when you have a fulltime staff of 877 when i add it up, it comes up to 158. 7 based on what youve presented here today. Your ftes are 877ful thats just nurses. Supervisor safai thats just nurses . So going back to that question, that has to be a cause for concern in terms of where we are, in terms of the overtime, overuse, morale, all the things youre going to hear today. Even without the coronavirus, it seems like this is a crisis for our frontline Trauma Center. What are we going to do i understand r. H. Wants to audit and come up with a hiring plan, but shouldnt we be moving aggressively as possible . I couldnt agree more. This has been an issue that is very challenging for us. We have the same goals as you do, as our nurses do, as other staff do. We want to fill the positions as quickly as possible supervisor safai is there anything we havent asked. I want to hear from the nurses themselves, but is there anything we havent asked for . What is it that we can do to remove the bottle neck so you can get well qualified trained staff in the positions and not rely on contract and per diem nurses . I think the best thing we can do is partner with the h. R. Team to understand what the most important bottlenecks, getting lists for example and taking those off the table. We want to hire permanent nurses. There is no doubt about that. And we stand ready to work with h. R. And to get them hired as quickly as possible. Supervisor safai one of the things ive heard from the nurses after working with them, they just dont feel as though theyre listened to. When theyre in the Labor Management meetings and they bring the issues up thats why they ended up coming to Public Comment and why theyre crying out for help. How can you as a leader of the department, at that hospital, help to push and encourage a more conducive environment for Labor Management relations . Thats a great question. And there is nothing more deeply concerning to me than to believe that our staff doesnt feel that i personally, or management teams dont care about our workers and dont want to take care of them and dont want to hire folks when we have vacancies. Im in the areas myself. We have our labor monitoring meetings. We have various groups of all types, Workplace Violence, to try to hear. Today i was in the Emergency Department this morning talking to staff about the covid19 situation. We had a town hall this morning, we had 100 people packing the auditorium to listen to staff, to listen to concerns so we can address them, so were trying. Supervisor safai do you attend the Labor Management meetings . Do you ever go to them . And if you havent, i think it would be a good idea to check in going forward. Its one of the things we heard. The Labor Management sometimes, if they dont see the top leader, then theyre feeling as though sometimes theyre not listened to in general and kind of the suggestions are going out into the universe. So if havent attended those, i would strongly suggest it would be helpful to the environment. Absolutely. Supervisor safai for you to attend. Thank you for the suggestion. Supervisor safai do you have any other questions i think were going to move on to the other part before we get to Public Comment. Thank you for your support. Supervisor safai one last thing, i want to underscore, the know the director h. R. And d. P. H. Along with you have the power and authority to adjust this situation in terms of hiring. I would say lets move aggressively to do that. Thats what the purpose of the hearings are, to work with you, help you. If you feel youre receiving pushback in City Government, its our role to help you in that process. Thank you, i appreciate that. Supervisor safai next is Vice President of local 1021. Good afternoon, supervisors. And good afternoon guests in the audience. And my fellow coworkers and union members. My name is teresa rutherford. Im a nurse assistant at laguna honda hospital and dedicated member of employee of the city and county of San Francisco. Ive worked for the city for 17 years. Im also the regional Vice President for sciu1021, the San Francisco region and i represent over 17,000 workers, including nurses, including nurse assistants, including janitors. We all form the team that takes care of the city and county of San Francisco. Today were here to focus specifically on our rns who give Superlative Service every time, but the issues were dealing with are systemic as has been already raised by several speakers from the board of supervisors. We also want to point out the fact that the issues that were raising were raised in 2018 at bargaining. They were raised in 2016. They have always been raised. And so this is not new. And its a shame that we have to come all this way in front of the board of supervisors to talk about an issue that should have been addressed years before. It should not take 17 years to have a job analysis. When weve been talking about this problem, when patients have been harmed because of the short staffing. We should not have to come here to talk about staff being harmed, staff having to work overtime, multiple times, putting their family at risk and themselves because of short staffing. The managers and people who run the city of San Francisco know better and should have done better. Were taking no more excuses so were here today for solution. No more studies. No more trying to figure it out. You know what the problem is. Fix it. Were thankful to supervisor safai for calling for this resolution and hearing to help bring to light the issues our members, the Health Care Workers at the department of Public Health are facing every day on the front lines. In order to have this conversation in a thoughtful and honest way we must acknowledge we are here to serve the patient. All of us became Health Care Workers to take care of people and put patients first. We love this city and we are committed to take care of this community. As nurses and Health Care Workers, we are also we also have an obligation to call out concerns of Patient Safety and the lack of readiness for disasters. For years the San Francisco department of Public Health has mismanaged San Francisco general and created unsafe conditions for hospital patients and staff. This has gone on for too long. Nurses and Health Care Workers are standing up for our patients and each other and are demanding accountability from the department of health so we can take care of our patients in a safe working environment. As you can take a look at the slide and you will see some of the problems were facing, the neglect, the mismanage am, the lack of accountability. The result on safe conditions for patients, staff, lack of preparedness for disaster, systemic failure to serve the public. Today were highlighting the issues at s. F. General, but we could have easily spent more days raising concerns about staffing and preparedness at laguna honda hospital, the Community Clinic, Public Health, Mental Health. I will share for you at laguna honda, for example, they are so woefully understaffed that it has now become a safety risk for both patient and staff. The problem also is that when a staff member is hurt by a patient or hurt in the facility, it is treated with scant regard and there is no outcome no good outbreaking for that staff member. In fact, usually the blame is placed on the employee as opposed to the employer. D. P. H. Management has known for years about inadequate staffing and its effect on patient care and workplace safety, yet the problem continues. We will now pass ask sasha, one of our d. P. H. Nurses to speak. Thank you, supervisors. Im a registered nurse and i was at San Francisco General Hospital until i was i was my position was eliminated because they werent happy with me speaking about some of the issues were talking about right here. Im now working at the call center that is located up at laguna honda and ive also volunteered for being a field Public Health nurse for the coronavirus so im jumping in the queue because ive been called to go out and test some of these terrified people who are being tested to see if they also are infected with the coronavirus. And the thing that i need to get up and tell you is that we heard from dr. Octor about the public safety. What is in department of Public Health is a culture of silence and fear. That is what is going on. Its very courageous from everybody to be speaking out about this. I want you to know that during negotiations we asked for there to be nurses in the emergency room to help with to help with the problem of severe sepsis, which is killing many of our patients. We have to and we were told, oh, no, we cant do that, that is not possible. Mr. Cutler, i need you to wrap up. Im going to be stepping out, but what i wanted to tell you, this Public Health nurses recommendation is that you address the fact that there is toxic bullying that takes place from administration and they dont listen to the nurses and that is something that has to stop because silence equals death. We have this epidemic going on now and there is only a few of us that are trained and have the proper equipment. We want to be partners with the department of Public Health because weve done it before, why cant we do it again . And the mayor calling for budget cuts at the beginning of a pandemic is madness. So im going to be on my way into the field now, so i encourage you keep going, keep asking. Supervisor safai thank you so much. The next speakers were going to call up are stewards heather and martha. Its part of the presentation. Good afternoon. I would like to thank the supervisors for giving us an opportunity today. I think that the staff at San Francisco general has been working so hard on this issue. Many of us for as long as 10 years trying to advocate for our patients. So to see you in your elected positions being willing to advocate for us, makes a big difference. So id like to thank you for the opportunity. My name is heather bollinger. Im one of the e. R. Staff nurses and been there for 12 years. For many years i was a night shift charge nurse. I want to start by saying, i feel your pain. I understand how confusing and frustrating it can be to ask questions and be presented with the answer of, i dont have that information for you, or im going to have to get back to you, or im not sure who handles that, or i forgot, could you remind me in an email . Youre feeling our pain and im sorry. Its been a very frustrating situation. The presentation im going to speed talk through is edie heavy because thats where i work, but this be considered d. P. H. Wide in terms of the extension. First, i want to point out this is not the first time weve been here. We were here in 2014, 2016. Weve signed petitions in 2018. I provided the supervisors with a detailed list of the number of things that we have done trying to draw attention to this issue. I want to make it very clear, its very nice for administration to say they care and theyve heard us and theyre here and with us. This is why theyre here. This is why theyre with us, because weve spent 10 years trying to get them here. These the assignment objection forms that supervisor walton was speaking about. I just have a few examples here. I was hoping to give him an idea of how often that occurs. Becauses its pretty often. That is just the stack i was able to obtain in the last week. So that is not something that is new. These have been submitted to management for well over 10 years and each one of them dictates an unsafe patient care situation for the nurse. This slide indicates the progress weve made in staffing since 2016. This was data taken in 2016 indicating that the Emergency Department was understaffed 53 of the time, oddly enough november 2019, were understaffed 52 of the time. One would think the sick calls at that point could be predicted. I want to give you a snapshot of what it looks like to be in the Emergency Department at night, not a theoretical, but actual. One of the things that is very frustrating, is our new facility was advertised to the public as a 58bed Emergency Department. Thats what the city taxpayers thought they were getting. Now you subtract the 16 beds closed because of the staffing deficit, subtract the 17 beds with admissions, now youve got a functionsal 25bed Emergency Department which is smaller than your last one. Add to the 28 active patients that are in the 25 beds, and youre at full capacity. Now add the 20 patients that are sitting in the waiting room. That is the picture almost every day. And its untenable. And what youre doing is putting nurses in the situation where they know theyre going to fail these people every day. Im not going to go too much into this. We know the budget doesnt meet the current census and it doesnt staff to the current census. If you look at the green line this isnt our data, this is their data. The green line is what were budgeted for. The blue line is the patient load. This is the gap. Were not seen staffing to budget because all of the vacancies. That gap between the red line and the blue line, the bigger it gets, the more negative the patient outcomes. That is a discrepancy in care. The hiring process clearly we dont need to talk about that anymore. But what i would like the supervisors to be aware of, all of those days, 30, 60, 90 days from offer letter to hire, application to hire, you need to add six12 weeks of training. It takes 12 weeks to train a nurse to work in the stable areas of the Emergency Department. Just those areas. So you have to add three months, 90 days becomes 180 days. So from the time they post that, 180 days later, maybe you get a pair of boots on the ground. So where does this leave us . Reactionary staffing has been the only source. Theyre using travelers for three plus years. Thats not a temporary employee, thats just an employee with no protection, no retirement and no contract covering their work. That is what that employee is. We have 25 of them since 2020 at the ede. They dont get disaster training, violence prevention training and dont get employee protection. Overtime. Mysteriously overtime stopped getting paid at time and a half. That 12 hour shift, if you leave and go home, there is not going to be anybody to care for the patients, you stay the extra four hours, thats what you signed up for and your paycheck doesnt show time and a half. They created a new designation called straight overtime. We cant figure it out either. Been going on a year. Theyre mandating overtime in 2019. How do you how do you work how do you not be completely distracted by the fact that you dont know if youre going to be allowed to go home to your family until the last couple hours of your shift . Reactionary programs are installed. They change patients billing categories, but they dont improve care. Our care Start Program ran out of the waiting room for two years. Staff objected to it daily, meeting. There is traffic, emails. So many concerns. No policies. No ratios. They didnt listen to us. The state was called in to evaluate it and immediately shut it down. We know what were talking about and we know our jobs and apparently we know the law better than the people that run our institutions. You can see that all these reactionary programs have not helped our diversion status at all. So what are they for . P. E. S. , yeah, theyre seeing less people because theyre on condition 58 of the time. So their census numbers are going down because those patients are in the Emergency Department. They dont have anywhere else to go. Thats the preparation. Like what disaster preparation . I would draw your attention. I provided you with the disaster and mass Casualty Program stipulated by title 22. This is state law. This is not a union contract, a request, something we would like. This is a law. It clearly states, disaster plans should be rehearsed at least with twice a year. There should be a written report and evaluation of all drills. Ive been in that institution for 12 years. Ive participated in one disaster drill in the old hospital. I havent put on the ppe that is supposed to protect me in a decon situation in three years. I havent been trained on how to manage what the chain of command was. I was a night shift charge nurse for many years. I alerted my management multiple times that we were concerned about what would happen on a saturday night at 2 00 in the morning when the earthquake hits. Because the staff are frightened. So thats where we are. And my colleague martha bear is going to let you know what this means for our patients. Thank you can, heather. I hope that was as powerful to the supervisors as it was me listening to it. The struggle so many nurses have been in so long to get an ear is very moving to me. Its also moving to me that our patients suffer from all the things that youre hearing. Were very dedicated people. Nurses are good people, were short on ego, were long on competence, we do our jobs because we care about people and we dont like suffering. What we see because of these problems is more suffering that could be fixed. So Patient Experience, im not going to spend time on this. Heather really gave you the story, but the Patient Experience due to these problems with staffing is obviously negative. I work in primary care. The worst the worst day of my week is when i have a patient who is decompensating, running out of breath, turning blue, sweating and i have to say, we got to get you to the emergency room. And the patient says, no way. [please stand by] [please stand by] to make my point, i would just suggest going on to yelp, and look at some of the reviews of the San Francisco general emergency room. So that brings us to where does that leave our employees . Youve heard a loft data about this already. 23 assaults in the emergency room in one month. Okay. We know these are not all being reported to the state. We have we have suddenly a new violence workforce, taskforce. There are 14 people on that taskforce to address violence problems. There is one nurse. I just want to mention this is another slide about mandated overtime. I just want to clarify. So what this means is, if im a nurse and i have planned out my eighthour shift coming up, and i know i have my child care set up for 10 hours later, and ive organized with my family that were going to do x, y, and z, and i go to work in the psych emergency room, which is probably one of the more highstress jobs in the city of San Francisco, when i get to hour searching they can say to me, you need to stay another seven hours. The employee has no choice. The city likes to go to very expensive consultant fees to get help when there are a lot of us here who would like to help. They Consultant Group do a survey of Employee Satisfaction at San Francisco general. Im not going to read through the whole slide. [buzzer] it took us a year to get the data from that. I would argue if youre struggling getting information from a group of people and they keep deliberately obfuscating with run around, there is something that is not right. I dont know where the money is going to the m. T. S that are empty year after year. I hope theyre not going to car repair. [laughter] and last, i just want to point out that as youve heard, a number of attempts are being made. I find that to be convincing that, there are attempts being made now to fix some of these problems. But whats wrong with that is that there are 10 years, at least, before any of those things starter. And these people are angry. Nurses are very angry. And now im going to hand it over to jennifer. Before jennifer jennifer, before you speak, supervisor stefani needs to make a comment. I want to thank you for your presentation. And let everyone know i do have to go. Supervisor haney asked me to fil fill in for him, and i could only do so until 3 30. I look forward to watching the hearing and hearing all of your comments. It is very important to me. I have called previously a hearing, in terms of the rate at which were filling vacancies on for responders and nurses it is a hearing i will have again to discuss this issue. I wanted to let you know im only leaving because i have to, and i will be watching the rest of this hearing. There are a few of you that have come to Public Comment and i wanted to speak to you further. Thank you very much for being here today. It its a tough crowd today. Mrs. Secretary, is it possible to indescernable . So what weve talked about a bit has certain origins, and it may not be car repairs, but that are mayoral priorities. The mayor has stated very clearly in her budget plan she wants to reprioritize funding. She says she wants to be responsive to residents and support city workers who are out there trying to make a difference. And yet 3. 5 budget cuts have been suggested. 3. 5 budget cuts across the war board in every city department. Even though right now we have this eraf. For eraf, in 2019, there was an additional 250 million. The city is projecting a budget shortfall of 420 million, but if we use eraf funds, that completely covers the shortfall. You guys have heard all about the dereliction of duty coming from the city of San Francisco, the department of Public Health. Can we switch to the slide. Im sorry, guys. I dont have the ability to go back and forth. So we have a lack of accountability. We have a lack of transparency, and we have a lack of resources. All of this is unacceptable. The steps to a solution are that we request an immediate formal, independent budget audit and performance audit of the department of Public Health. We demand that the budget be immediately revised so that people can be hired, so that this budget cut that the mayor is proposing goes away. Because the reason that were focused on temporary staff, registry nurses, is mainly because the mayor continues to say that eraf funds have to be yufused for untime onetime spending. Can you switch back to this one for me . You kind of have to. The mayor says onetime spending. Can we go back to the slide show . We want to fix the hiring process immediately and expedite frontline staff vacancies right now. We want to make employment rational so we can support executive leadership staff that have failed to address these issues by having a rational process. It is no longer dependent on leadership. We want to have comprehensive training for Disaster Preparedness, pursuant to state law. We want protection for every employee in the hospitals, not just nurses, but everyone. We want to keep the department of Public Health management accountable believers and we want t. We want frontline care represented on the Health Commission and the joint commission, so that we can be hui sure that executive leadership is held accountable, and we can be sure that people who provide care on a daily basis to our community are the ones who give the feedback and the input to the mayor, not just special appointees. Can we switch back to this one now . So. I just want to share with everyone the mission of the San Francisco department of Public Health. I dont know if this is big enough for everyone to read. Basically to quote directly the mission of the San Francisco department of Public Health is to protect and promote the health of all san franciscans. San franciscans. Not san franciscans with money, no some, but all. The ultimate goal is to ensure that san franciscans have optimum health and wellness at every stage of life. Thats hard to do with 3. 5 budget quotes. One last quote comes from the Health Commissioner executive secretary. In 1983, and in 1984, General Hospitals accreditation by the joint commission was in jeopardy. The hospital did not have an affective governing body and had antiquated Management Systems and staffing shortages. We heard from Hillary Ronen today, and she called it bizantine, antiquated, it sounds the same. Weve heard about staffing shortages. Weve asked questions of our management that they are unable to answer. It seems similar. In addition to these accreditation issues, there were issues with ambulance Response Times. Thats First Responder issues. Were talking to e. R. Staff who are on diversion 60 of the time. Even then, many people in the Community Felt that the City Mental Health is not responsive to the needs. Remember Mental Health s. F. . Sounds similar. So the joint commission was created so that the city could make budget and policy decisions more transparent because the business would be conducted i in public meetings. When the joint commission was created, after this 1983 and 84 crisis, the aids epidemic was under way. And it was the frontline staff then that brought ideas, that created 5b and 5a, which became our aids ward in San Francisco General Hospital. The nurses themselves physically erected the ward. It had previously been sleeping quarters, and instead became a lifesaving unit. Right now today we have nurses and frontline staff speaking out and bringing forward the problems in the department of Public Health. Were very appreciative of having this moment so we can bring these issues to the forefront again. We hope just like then, right now we can also help to lead the creation of something new and better. Thank you very much. Thank you. I think were at the end of the presentations. Right, jason . I think were going to open it up for Public Comment. Each person you can do it by the speaker cards . Would you like to do it that way . Okay. So ill call your name, and you can line up on the side there. If i havent called your name and you would like to speak,please also line up. Sonya reyes, derrick richardson, diane no yenez. Debra i cant read it waniski. Amelia aire. Naomi shonfield. Each people will have two minutes. If you would like to state your name, please do so. The first speaker, please. Good afternoon, my name is wendy. Im a member of the public. I came here because i saw you guys on tv talking about this, and i was going to be at city hall anyway. I have been a family caregiver. Caregiver of three of my family members. And im about to be a caregiver again, an unpaid caregiver, for someone who has throat cancer, and will be at San Francisco general. I am appalled to here what has been transpiring. I know firsthand, as a family caregiver, that nurses do everything. And, um. And as a former retail worker, being the face of any organization, restaurant, or whatever, we had always been required to, you know, smile and be nice and so on and so forth, while taking care of peoples needs. And i cannot imagine a bigger disconnect between nurses, who have always been great to me, my family, and my community, while hiding behind the things that i have heard today. So, um. Another part that i want to speak to [buzzer] is the fact that, um, the city of San Francisco spends 7 million per Police Academy class, with graduates of about 35. And people come out and they make 100,000 with no student loan debt. I dont think it is the equivalent of nursing. Thank you. Next speaker. [buzzer] hello. Im derrick richardson. Ive been an emergency room doctor at the general since 20 is 13. 2013. And im here to support and advocate for my nursing colleagues. I would like to share a video from one of my nursing colleagues who couldnt be here today about her experience in e. R. Make sure we keep it in the timeframe. Can we just pause the time for a bit . Okay. So hang on one moment while i get your audio. [applause] it should work for you now. I was violently. [no audio] by a patient on october 3, 2. We see these types of patients that are often dangerous and agitated often. The patient punched me, pulled me down by my hair, slammed my head against the floor and clawed at my face. And there was difficulty getting the patient off of me. This assault was handled poorly by the hospital administration. Some saw me shortly after the assault and asked what they could do. I knew this violence in the workplace was a very serious event, so i made a point to return to the e. R. Four days later and talk to the e. R. Staff and management about my safety concerns and the concern that this will happen again and someone might get killed one day. [buzzer] i even spoke to this at the Management Meeting in person at the e. R. , and was heard by e. R. Management, the e. R. Director and physicians, and they assured me they would follow up. I have not heard anything back from anyone at the hospital since then. I asked in writing to know if this had been reported to cal osha, and to clarify safety issues in the e. R. , and no one has returned my emails or phone calls. I was not even paid for the shift after that. [buzzer] i think your time has concluded. Thank you. Next speaker, please. Hello. Im debra wineki, and im a registered nurse at San Francisco General Hospital. And ive been working there for almost 35 years. And i have heard the same responses from management for decades. And i feel like it is just paying lip service to the labor force that works at the hospital. I work in the o. B. Department, and youll see one of my coworkers back there with a stack of requests for staffing over the last year. We had over 350 requests for extra staff in one year, and many of those requests were for two or three nurses. I feel that o. B. , labor and delivery, gets staffed better than many other units because were a very high liability we work in a highlie detectorliability setting. So, you know, trying to find out how to fix this and i think that over the years the mantra has been Human Resources, Human Resources, Human Resources. [buzzer] so i think maybe there is something to that, and Human Resources needs to be, you know Human Resources needs to be focused on. We have a very high turnover rate. I dont think that the recruitment of nurses is nationwide. I think it is very small. The recruitment and retention [buzzer] thank you, maam. Thank you. Next speaker. Hi, good afternoon. My name is diana anis, and i work at the birth center at San Francisco General Hospital. We often dont hear about the birth center because were supposed to be the happy place. But were not very nursefriendly. These are the 359 emails that debbie was talking about, asking for nurses, and they say things like, it is 2 00 in the morning, if you cant sleep, please come to work. If you dont come to work, your coworkers cant go home. If you dont come to work, no one is going to get a meal break. The nurses last year missed a thousand plus meal breaks. Thats a thousand times a patient had to have a nurse that didnt rest, that didnt eat, and it is possibly even mandatory overtime. We know that Maternal Death is real. Babies are born that need resuscitation. It used to be an exciting experience to be at a moms birth, and now it is a scary experience because we decent know if were dont io get that second nurse to help with that newborn resuscitation. Ive been here for more than 30 years, and the story doesnt seem to change. Were going to hire. Dont worry. Its going to be better. It hasnt gotten better for 30 years. And working at the birth center, the babyfriendly hospital is not nursefriendly, and it is getting tiresome, and the nurses are burned out. [buzzer] thank you. You still have 30 seconds, but thank you. Next speaker. Good afternoon. Thank you for listening to all of us. My name is suzanna kylie, and im a registered nurse. I would first like to start by emphasizing that as a nurse, and all of us as nurses, were accountable for our actions or nonactions. And im expected to show up every day at work prepared. I cannot ignore or otherwise not answer questions and get back to you later. I dont think it is an unreasonable expectation that others perform their jobs with that same level of accountability. I currently work in behavioral health. And in three weeks i will begin working with the whole persons integrated health, also known as street medicine. I began my nursing career 36 years ago here at d. P. H. I worked on 5a in the 80s and continued working in h. I. V. Care in the 90s. All of my career choices have been informed by my commitment for caring for underserved communities. I believe this kind of commitment is what drives all of the nurses in d. P. H. To continue working, shortstaffed. S. F. D. P. H. Has been propped up for too long by these hardworking, committed nurses. And the chronic understaffing has tested the resolve of great nurses and broken the resolve of many who have left. With currently chronically understaffed system, the ability to care for our clients has fallen short, which is unacceptable. [buzzer] it puts in the question of this gasping systems ability to affectively respond to the coronavirus. The time for corrective action is long overdue, and this is certainly no time for budget cuts. I thank you for your time. [please stand by] my name is herbert weiner. With Patient Safety this resembles the schoolyard and the bully victim and bystander. Were faced with the coro coronavirus and its an a question of one disaster preparing for another. I have a masters degree in social work and ph. D. In clinic psychology. I applied for medical and psychiatric social workers countless of times and turned down based on the one of three rule. I hope this doesnt happen to other people. But basically the hiring had to be streamlined and we need it now more than of. This is a National Emergency and even a question of homeland security. Thank you, next speaker. Im a nurse at San Francisco general. I have a lot to say but going to tell you what happened sunday morning when i was the team lead and we have six rooms and that day we were short one recessed nurse and got to the point where we had 12 critical patients in the resuscitation. I dont know how you can wrap that around your head but the reason why we couldnt move any of the patients is because we couldnt staff the rooms in pod a. There ways cpr in progress that came early in the morning. My coworker was working on it. The patient passed away and after she walked out i did not have time to let her decompress or think about it. I said i need you to hop in because theres another cpr in progress. Cpr in progress means you need at least three nurses in the room depending on the cause. And we only had four trauma nurses assigned. This is not isolated either. I was put into a position where christen went into the room and had a patient with a bone stick out of his leg broken obviously. And she said chris tan can you come in and help me with medications. I said i cant because yefr every one of my trauma rooms is full and i needed help and she said im sorry i dont have anybody to send you. Triage called me and said they needed to give me another patient. This patient was ill as well and i said all right put a gurney next to the storage unit and well try to figure it out. Thank you, next speaker. Hi, ive been at the general 15 years in the Emergency Department for three. Ive stoken at these things spoken at these things quite a bit and my generalized statement si dont want you to fix the problems alone i want to film them with you. After the incident with corina you saw in the video i joined the emergency room violence protecti Protection Task force and never missed a meeting and will be there march 30th to try to fix the problem in the Emergency Department. Unfortunately many requests have been made for the Workplace Violence Prevention Task force for me to attend and be a part of that and every time we heard no. So if you dont mind im going to take this opportunity to say dr. Urlich do you mind if you join the hospitalwide Prevention Task force. Id like to stand by you with you and help this problem. I really would like to help and put my name. Put me in. Please direct your comments to the panel here. The committee. Thank you very much. Thank you, next speaker. So folks understand theres rules of decorum in the chamber. You have to address Public Comment to the members of the board of supervisors. Im Rebecca Grant a Nurse Practitioner in the Emergency Department. Ive worked as an rn and Nurse Practitioner. Most of my job is performing in the triage area after the illegal care program was dismantled. What that means is i greet each and every patient who comes into the doors as much as i can. Sometimes theres 25 an hour and i analyze them and screen them and see if i can refer them to their primary care to the urgent care clinic to p. E. S. And the urge urgent care is closed and the patients are telling me it takes months to get appointment to their clinics. If the refer them to a primary care provider it takes at least six months to get a call because the list is over 1300 patients long. Thats terrible. Basically weve all been working very hard to get our leadership in the department in the hospital level and now were here and we appreciate you guys listening to us to hopefully urge the department of Public Health and the h. R. Department to hire more nurses and staff and the Community Clinic and micky callahan i was told is responsible for blanket firing and all dual rec questions for the requisitions for the temporary exempt positions and were waiting on nurses and i was let know via email anyway i think wed like to know how many people are affected because the patient loads were immediately dismantled and its a big deal. Im bob ivory a retired nurse and ive been on the Bargaining Team for 25 years so i want to give you historical background. Everything these young nurses say has been going on for 25 years. Its not the hospital is under staffed but under budgeted. The union was in bargaining and we asked how many new positions are you going to put in. The answer is we dont know because we dont know the right size until a study and we dont know. Its not hard no figure out how many nurses it takes to run the department. I wish all the temporary nurses under the charter were doing relief work. However, in violation of the charter, they have opened whole new floors, departments with no budget for registered nurses. Theyve had to rely on creative staffing through ftes for travellers and did i per diem. If you look at the budget youll look at 500ftes a year. Ill address this to you maybe mr. Brown when he comes back next continue how many nurses are participating on his task force. What their names are and have they actually been released to got to the meetings. Thank you very much. Thank you, next speaker. I work in the Emergency Department. Thank you guys for having this hearing and many more that might follow. Im reading comments from a colleague of mine and the poor resources on the guaranteed coronavirus outbreak and we have a lack of preparation for managing the patients in other hospital the patients are going to other units and often bypassing the e. D. Were losing quickly without replacement and have no one in our disaster position. They have one person persist . I worked the past two shifts but theres no space. One without the other is useful in either direction. The lack of leadership and transparency by the nursing director is a big problem and the engage. The survey after a year or more. I find it insulting the only i time we see the ceo is when regulatory supervisor visits is happening. And sarcastically im glad theyre working on violence in the e. D. The whole hospital went to [bleep] when they went to the lean model even when they identified the needs they dont act on it. Why even do it then . Its a waste of time, resources and money. We need a strong leader that can identify the problems and have the inside experience to make the changes needed to accomplish this not another work group. Thats what i have for now. Nothing was changed. Thank you, next speaker. Hello. Im also one Emergency Department nurses and also a steward. I have a portion of our petition that we submitted to the Health Commission back in october. The one thing i do want to talk about in administration is administration including chief Officers Ceos and chief nursing officer failed to provide consistent experience and Ethical Leadership for our department. As a level 1 Trauma Center it serves over 1 Million People and consistent organization has been overlooked since e. D. Has been functioning since a Revolving Panel in the last 10 years. The current nursing director was hired in february of 2018. Since may of to 19, 50 of our managers or people in our leadership positions have resigned. Theyre reasons include but no not limited to the development of new programs that affect be patient care, implementations of new programs against the objections of nursing staff and leadership and intimidation by management to remain silent on issues that affect safety and exclusion of the frontline nurses in programs and procedures and intimidation in regards to procedures of policies and the leadership style at San Francisco General Hospital has created a culture of intimidation and fear the employees fear advocating for their patients and avoid interactions with management whenever hospital. The hostile Work Environment is having detrimental effects on the Mental Health of staff and theres no chance for the members of the Health Care Team to collaborate in a way that must be to provide comprehensive and Compassionate Care to our most vulnerable patient populations. I did submit something for the record for you guys to see. Thank you. Next speaker. My names and ive been an e. D. Nurse three decade and i hung up my scrubs and retired but the subjects still dear to my heart and one thing i think of is the culture of austerity that seems to take root in Public Services in general and you get used to doing work arounds or figuring out how to glue things together. And i think the publics starting to wake up so this theres no excuse in a city as wealthy as this there should be no reason to not bring in enough people you can staff adequately. One thing i look at is the culture of wishful filaments and wills never have babies or go on leave or get sick. Thats never going to happen. I think 20 with us cited. Thats always going to be there and if we had per diems co cover that youre covered but instead theyre covering all the wrecks and all the positions that are unfilled so theres nobody around when you need a Training Program youre cutting down to muscle. Nobodys left. Were not getting to a world where everything goes away. Its always there and you need toan toance to anticipate that. Thank you for hearing this. Thank you, next speaker. Good afternoon. Id like to thank the board and everyone here for their time and attention for listening to this important issue. My name is cheryl randolph. Ive been a registered nurse at San Francisco general for the past 22 years. I take care of the Overdose Patients and make sure they continue to breathe. I take care of the trauma patient who thought this was just another day and now clinging to life. I take care of you, your friends and your family. Ive always been proud of our dedicated and professional e. D. Staff but im not proud now. Now im afraid on a daily basis. Im afraid this is going to be the shift when a patients going to assault me more severely than every other time this has happened. Im afraid this is the shift when i make a fatal mistake because im trying to do more work than a single nurse can safely accomplish. Im afraid this is the shift my nursing license is in jeopardy and not conforming to the required standing of care and when my experience and training dont matter because people have needlessly died. E. D. Nurses have always been willing to suck it up and go without breaks because its always short staffed and take care of more patients and we try to do right by fellow nurses. Here in california nursing is protected by ratios. Meaning a particular number of patients to nurse. While that protects us both it limits how many patients may be treated in a timely manner. On a daily basis my e. D. Is impacted by patients taking 50 to 75 of the available beds and wait hours and sometimes days. That means the e. D. Nurse takes care of floor patients in the waiting room swells with patients who wait for hours and hours. We need to refocus on Patient Safety by ensuring safe nursing staffing. I respectfully ask the board to approve funding or any other measures to help staff. Thank you, next speaker. Im a registered nurse. For nearly 10 years i worked at San Francisco Hospital Trauma Department as an e. R. Nurse while i left sfgh after my first child the mafg amazing nurses and doctors are still near to my heart id like to ride a statement for someone who wants to remain anonymous for fear of retaliation. The staff has been one of the more poorly run hospitals ive worked in but has gotten so much worse. This administration is known to offer false promises to anyone who comes to them for assistance only to appease them and then do nothing. I find it extremely upsetting now that our strong union folks have called the administrations out those same administrators come running to our department when board of supervisors visit to buffer and present a misleading view to you of our department. In all my years at sfgh and when ive seen my chief nursing officer in our department. What are they trying to hide . When nurse were threatened they shut the door. The budget sin surplus yet administrations have not been paying staff nurses and clerks for overtime. Im going skip the letter and when came from new york as a trauma nurse from the time i was interviewed and on to the floor it only took three weeks sow i know so i know the problem can be fixed. Thank you, next speaker. I work in Emergency Department as a nurse r. N. And been there 28 years. Ive been there a while and its been good to me and ive seen a lot of changes and different situations but i feel were not properly equipped to manage and take care of the behavior and psychiatric patients which is ef departmentally increasing because of the homelessness and meth use and were in the Emergency Department and we have four rooms for them which are monitored but the rooms are doubled. This is not right. Its very difficult to look the highly difficult stressful patients and unfair to the other patients and unsafe for the staff and ive seen many situations, violence has escalated. Im one of the nurses recently violated against and was there the day the other nurse who reported was assaulted. So i just feel its difficult. I know theyre having a hard time and on red alert. Since we moved to the hospital i feel theyve not been great because of the geographical distance. The psychiatrists rarely come to the Emergency Department and we become the p. D. S. Thank you. I retired in 2018 from 12 years on the lift team or safe patient handling service and its not just nurses in solidarity but cnas also have the same problems. I was on the lift team and the team should have two. If either of anyone called in sick or was on vacation you worked by your several and thats the way they rolled. I submitted to my superiors some ideas for creating a safe patient handling department including an educational component for bedside safety for the nurses but basically ignored. I love the people and love the work but i couldnt stand it and bailed, i have to say. There is a moralee morale problem there and it would be a great morale shift if you staffed sufficiently and its come to my attention it takes four supervisor to put a motion on the ballot asking the people if they would like to return the name of the hospital to San Francisco General Hospital. I think that would do wonders for morale. Next speaker. Im mike hill a nurse in the e. R. Since 20134. 2014. Thank you for letting us speak. I was going to raise doubts in your mind in handling disasters and preparedness and i think its abundantly clear and we have two confirmed cases. We cant even staff for a regular patient load. We joke how many people are in the waiting room, 40, 46. How many people are we holding that cant go upstairs . 20, 30 . How many hours have they been here, 26 hours . 36 hours . This is day to day. How are we going to ever handle a crisis like were going to be faced with pandemically . S i havent had disaster training since 2017 and we have a facilitator that retired six months ago. Unfilled position. Its crazy, right . Were in the midst of crisis and we dont fill the positions. Its attrition. Shes gone. I have nothing more to say but its historic to feel this closeness with my coworkers and respect and admire all of you so much. Thank you, next speaker. Im megan green a nurse in the oncology and Palliative Care unit and also the same floor 58 is on. Its unbudgeted and has been the default overflow for the e. D. The e. D. Has been bombarded with patients as mike said. If theres admitted patients downstairs and no bed upstairs theres nowhere for them to. Before the most recent contract negotiations we were frequently being asked to come in for overtime and still havent been paid and later we were told we were never under staffed. After public pressure we were told wed get a float pool and dont have one and theres 50 beds in 58 accounting for 38 bedside nurses not including a chart and break nurse and were pulling nurses from other units. I worked last friday, saturday and sunday and for two of the 12hour shifts i got one 30minute break and one 15minute break for a 12hour shift. This happens quite a bit. Im not sure you want to be taken care of by a nurse with a 15minute and 30minute break. My coworker was covered one nurse per break the other had a decompensating patient that needed to be brought down to cat scan when she left to go to cat scan she had seven patients. We wish we could say its infrequent but it happens all the time. Nurses who are burnt out call out sick. Theres been multiple studies and were told not to come in sick when were sick and then blamed for short staffing when sick. Next speaker. Im a registered nurse in the med surge unit and in supervisor heaneys district 6. Mike dingal brought up about not just being a registered nurse understaffing but very much to do with our support staff not being at the bedside to help us. Registered nurses have a defined scope of practice and have things we have to address and many things that fall outside of that. However, at San Francisco general in the med surge floors if youre a danger to others or of falling you dont have the attention of a nurses aid to make sure youre safe to address the issues a registered nurse doesnt have time to address because were fulfilling our legal duties. It has led to patients who are already angry feeling as though theyre being avoided. Theyve become more agitated. This becomes a direct danger to the nurse. We know in hospitals all over the country assault is a big deal and many nurses every year are hurt and taken out of work for that reason. Just a quick example i had a patient who was quickly running out of steam and unable to breathe on her own and addressing her and called for assist. My work phone kept blowing up. It was going and going and nobody could help address it until finally i was able to go to the other room and see what it was. A patient spilled their urine and the floor and needed help cleaning it up. Its not a reason to leave an unstable persons bedside. We need help and to be addressed. I appreciate your taking the time and i yield the Small Business of my time back. Thank you, next speaker. Good afternoon, supervisors. Im aaron kramer a registered nurse at San Francisco General Hospital 12 years and work in the cardiac lab. I would like again to thank you and all my colleagues that came with me today to speak and share a taste of the reality of what he Public Health care is today as we speak. Its shortstaffed and stressful and dangerous. These are peoples lives we deal with. We came here today because we need someone to listen to us. Its the feeling of the nurses at General Hospital that we as the frontline staff we try and voice our concerns. We try and speak out and speak up and were met with this wall and many nurses speak to me as their union delegate they dont want to get involved or want to do anything more at General Hospital because they feel a feeling of fear and intimidation and a culture of that and its the scope of Public Health for San Francisco general. I want to speak quickly on behalf of some of my colleagues. The meat and potatoes of the hospital as reported last week to the Health Commission 25 vacancies. Again, my other colleagues spoke to a contractual obligation negotiated last year to help support med surge with a lift team. Still unable to hire and staff that. I have petitions that are trauma med surge unit. The whole staff submitted asking for help. Really quickly for the record, for labor monitoring who i serve as a delegate for we had to file a grievance last year. Next speaker. Good afternoon supervisors safai and supervisor mar thank you for having this hearing. Im with local 87. We represent the janitors and private sector and you may be asking what does the Janitors Union have to do with this. We had 86 janitors here this afternoon. We had to pull them off their job today because of the fear of coronavirus. All those janitors were here because they wanted to be able to have somebody speak to them. These shortages in the department are affecting everybody and nurses are the First Responders when theyre in a situation and nurses hold us literally physically up when were at our most vulnerable. Supervisor ronin and walter and supervisor heaney, theyve all spoken but i wish they would have stayed for the remainder to hear the stories and witness tm of testimony. You cant give us the big words and then leave. Im here because i understand the department has had its setbacks but this has been going on a while now and last year i happen to hear terry anne speak and how successful being able to fly in nurses and contract out nursing was working for the city. I find shame in that because these are workers being replaced and nurses deserve to have anything knit on the job. Dignity on the job. Janitors are here because we want to make sure were heard and an understand dr. Brown you started three months ago but youre inheriting a ses pool of problems we hope you can guide and lead us to what needs to be fixed. I understand decorum but what you dont understand and everybody else in the back is my family and everybodys families [bell] thank you. Next speaker. Supervisors, its incredible you did this. Its what should happen but it doesnt happen and it hasnt happened and so its a profound thing that has happened. I say this as a nurse whos worked for the dph32 years and i cant imagine life without janitors. Nurses and janitors are working most closely with body substances. Lets put it that way. I want to tell you how i got introduced to the culture of silence. There was a budget cut slated to cut our interpreters three years in a row until chris daily said if this happens one more time i knew the nurse manager of the interpreters office had important statistics and i was at a hearing the Health Commission or here and had the naivete to slide over to the chief nursing over and say why are nay not up here they not up here giving the data and she looked at me like i had four heads. She said he cant talk. Hes the boss of all of us. I learned we can go to our head nurses and manager and go to the cno and theyll put a whole different spin on it for the people above them. For a whole host of reasons. The whole culture of silence. Culture of safety. We go in the loop weve been going to the Health Commission for months and months. Finally, we speak nothing back. We have to listen to the presentations that really if theyre not live they put a nice bow on things and so we chanted a meeting down. What happened . They called the sheriff. They come marching in and came from the e. R. Walked away from the e. R. Thank you. Next speaker. Supervisors, my name is josie mooney im a proud member for many many years here on behalf of Joseph Bryant who couldnt be here today because hes on strike with Health Care Workers in san joaquin county. This is an emergency. It is not a time for focus groups or more studies or reviewing whats already been done or taking a look at the Civil Service rules. Its an emergency. What that requires is people act together. So i want to say on behalf of our union that we are prepared to sit down and confront this emergency with all of our beautiful amazing fierce warriors and their colleagues who are back at the hospital now. We have to treat this like its an emergency and that means emergency measures which you on your own cant do and they on their own better not do. So its up to all of us. So i pledge we will be at a meeting tomorrow, tonight, the day after tomorrow, on the weekend, this cannot stand as is. We so appreciate so very much appreciate the hearing and the opportunity for you to hear from the frontline workers what they face every day and were looking forward to being at a meeting this week to resolve the crisis. Thank you. Thank you, next speaker. Thank you. I want to followup with what she stated. I want to add first we want to thank you for holding the hearing. We would not be here today if it was working. We would not be here today if the Labor Management Committee Meetings were working or if the Health Commission was listening to the r. N. S wen they go and speak and other Health Care Workers and told the same stories you heard today. These stories represent a small fraction of all the stories across d. P. H. Whether theyre workers at s. F. General in the Community Clinics or laguna honda. The staffing needs to be fixed and fixed now and we do need oversight and we do need accountability and thats why we are hear in front of the board of supervisors and asking, yes, more hearings, more oversight, more accountability. Please stay on this process and please stay on d. P. H. Until we get this solved and we thank you for raising these issues and having us all here today. Thank you. Thank you, any other members of the public wish to comment on this item . Seeing none, Public Comment is closed. Dr. Urlich can you have can i have you back up and it may be for your team but i want to direct them to you. One thing i heard about and i know you rushed through your presentation and others did swell as well but the thing not budgeting to your census. When we moved in the new hospital there was uncertainty to what the level of volume would be and quickly starting seeing the number of beds, medical, surgical beds was too low. We have a budget for 164 med surge beds and i think i mentioned to you in my presentation its typically running well beyond that. So for the past two years weve had what has been called a project budget that has given us Budget Authority but not physician to staff that unit and thats what some nurses were talking about. We filled the beds with temporary staff. The good news is as i also mentioned this year the Budget Proposal to the mayor includes per permanent staffing about 30r. N. S sto to staff over the course of the year as well as a 24 7 practice nurse to give us provider capacity as well. We feel very fortunate to have that in our Budget Proposal and hope it addresses some of the issues weve talked about today. So my next question would be in terms of the list and theres a list and people that have gone through and interviewed and once theyre on the list, are there 1,000 people . Are there hundreds if not 1,000 people on the list ready to be hired and were not hiring them and im sure she list is not up to date but is there an active list youre working from in terms of hiring nurse. We have an active list and theres a list based on nursing specialty. I dont know the number right offhand. Wed be happy to get that for you. As i said before, were devoted to hiring nurses and other team members as quickly as we can so we can best take care of our patients. The other thing that disturbed me that i heard in the presentation is this idea of straight overtime and time and a half and can you talk about that, please . I would have to defer to my h. R. Colleagues about that. Okay. Mr. Brown. You have a ph. D. By one of the presenters. I have an advanced degree today. So it depends on the contract and looking at the hours the person is working. If theyre working because nurses are exempt employees if theyre working less than 40 or 80 hours or working overhours its overtime straight until the meet the threshold. Youre talking too fast. Explain slowly. You spoke about overtime and i understand the concept much time and a half. They have the ability to earn time and a half under certain conditions. If theres a parttime nurse not working full times the extra hours would be overtime straight and theres forced overtime under the contract. Theres different provisions under the contract where payroll is looking to see when the time and a half kicks in. One of the things i heard in the e. R. Listening directly to the nurses and i could be conveying this incorrectly, one thing they tried to do and ends up happening from management is the nurses are asked to stay. Will you stay late, were understaffed. Its a way to get them to say yes voluntarily without having to pay them the extra time. Can you talk about that . In light of the conversation . No, it seems to be a practice outside of the contract and seems to be one that should not be encouraged and in fact discouraged because if youre putting someone on the spot in that moment when theyre short staffed from things we heard youre asking them to voluntarily stay extra and then you dont compensate them additional time and a half that seems to be a couple of different bad management practices. There may be and i cant speak to what actually has been said in those cases. I do believe in the nursing contract there if there was forced mandatory overtime theyd be paid time and a half versus volunteer. I dont know what the conversation is going on at this point and i dont know if theres anything they can add because use have to be in the trenches to know. I get it. I want to put it out there. I dont think well revolve it today. I want it on the record as an area of concern. I think theres areas that are longer term that need to best adjusted and the immediate need with the crisis at hand in terms of hiring in an expedited man perp and the last thing as the head of h. R. Because it sounds like a lot of people we heard and its one i asked for in the resolution was the disaster training. Are people getting the appropriate training, if not, whats the plan to ensure theyre getting that training. For me its the first time ive heard about the disaster training and im sure its been brought up at the hospital where the training is provided. Im not sure if susan has information on when or how thats being administered and i can come back and report if were not able to today. The last thing id like to say to close out one of the things i want to highlight si appreciate all the time and effort and energy the nurses put into this today. I know this took away from a lot of the different things. This is their time off and their free time. Sounds like theyre already over worked and stressed as it is so i appreciate that and appreciate the union coming out and giving their input and thank management and h. R. I know youre new on the job whether you lift or left or came back at least you came back with the perspective you understand where the problems are in the process. Im glad the Deputy Director of Human Resources is here as well. I think that this situation n s necessitates a working group and need dph in the room and maybe the mayors budget office. Im going reach out personally to the mayor and her staff on this because we have to make this a number one priority. We just grot got an announcement today that a high school was shut down and they clerd the school. These things may be happening more. People were asked to leave to deal with people that have been exposed. These are our first line responders and we can get ourselves in a serious crisis more than it is now. I think we need to commit to putting together an aggressive plan to hire people in an expedited manner. I know we can do it. If we create the bureaucracy and i understand and respect the Civil Service process and i know the unions have been involved in that as well in ensuring its fair and equitable but at the same time we have to put our Heads Together and figure out how to get people hired in 30 days or less into these positions. And this is years in the making. This is years in the making and sometimes it takes a crisis and a more exacerbated crisis like the one were facing now to force us to put our Heads Together and get a solution. Id like the commitment from dr. Urlich and ill talk to dr. Koufax and followup with the mayor and her team and put together a plan to Work Together to come up with an immediate action plan to staff up in an appropriate way. I see her nodding her head. Ill note that for the record. Also, i left out the union and the union should act the table as well. So much, supervisor issafai r calling the hearing and thank you to the nurses and frontline workers who shared their stories, organized and demanded action by the city to really address the chronic understaffing and related workplace issues at the e. R. Or Emergency Department at sf general and throughout our city and Public Health care system. Clearly this is a crisis that is undermining the welfare of our frontline Health Care Workers as well as the welfare of our patients. And as many have spoken to today, these are issues that have existed for years or even decades. Youve certainly got the attention and support as supervisor safai and myself and our colleagues on the board and i think we appreciate the leadership from d. P. H. And s. F. General and h. R. Updating us to fix the hiring process as soon as possible. Well continue to work with you and to push you on that to make sure that gets addressed as soon as possible. I also wanted to thank the leadership for sharing the Broader Solutions with us and address the broader budgetary and transparency and accountability issues that plague our s. F. General hospital and Public Health care system. Have you our commitment to follow through on the proposals and to address these underlying issues that have led to this crisis in the hiring and for the frontline staff at General Hospital. Thanks again, everyone. Thank you, supervisor is a fa supervisor safai. Can we send the motion. Clerk both items are called right now. I wanted to make a motion to excuse supervisor hany without objection. Can we have a roll call on that . Just kidding. That was a joke. No objection. So can we make id like to make a motion to send item 3 to the full board for positive recommendation and added as a cosponsor as well, correct . And take that without objection. Yeah. And then for item 2 id like to continue this hearing to the call of the chair. Im going to confirm when the appropriate time frame is. Im thinking 90 days to come back and check and the leadership of the hospital and h. R. And others were beginning to work on because i had reached out to them and asked them and highlighted to them the things i needed them to work on. Given the crisis at hand, i am going to ask to put together this working group in the interim and well work to get that to that aggressively. So maybe what well do though well continue this item to the call of the chair we might come back sooner than 90 days but well let everyone know in plenty of time to get back in touch. The leadership of the union has been in constant communication with me and working with shop stewards and the frontline nurse. Theyve been in touch with me. Well be in constant communication with the findings of the working group and how to aggressively begin to staff up the hospital and ill make a motion to continue item 2 to the call of the care. Without objection. Thanks again, everyone. Mr. Clerk, is there any further business . There is no further business. We are adjourned. We are celebrating the glorious grand opening of the chinese rec center. 1951, 60 years ago, our first kids began to play in the chinese wrecks center rec center. I was 10 years old at the time. I spent just about my whole life here. I came here to learn dancing. By we came we had a good time. Made a lot of friends here. Crisises part of the 2008 clean Neighborhood Park fund, and this is so important to our families. For many people who live in chinatown, this is their backyard. This is where many people come to congregate, and we are so happy to be able to deliver this project on time and under budget. A reason we all agreed to name this memorex center is because it is part of the history of i hear to name this rec center, is because it is part of the history of San Francisco. They took off from logan airport, and the call of duty was to alert American Airlines that her plane was hijacked, and she stayed on the phone prior to the crash into the no. 9 world trade center. I would like to claim today the center and the naming of it. [applause] kmer i actually challenged me to a little bit of a ping pong the mayor actually challenge me to a little bit of a ping pong, so i accept your challenge. It is an amazing spot. It is a state of the art center. Is beautiful. Quarkrights i would like to come it had been rain for several days. At 12 30 there was a notice of large amount of input into the reservoir. We opened up the incident command and started working the incident to make sure employees and the public were kept were safe there is what we call Diversion Dam upstream of moccasin. The water floods the Drinking Water reservoir. We couldnt leave work. If the dam fails what is going to happen. We had three objectives. Evacuate and keep the community and employees safe. Second was to monitor the dam. Third objective was to activate Emergency Action plan and call the agencies that needed contacted. The time was implement failure of the dam. We needed to set up for an extended incident. We got people evacuated downstream. They came back to say it is clear downstream, start issuing problems and create work orders as problems come in. Powerhouse was flooded. Water was so high it came through the basement floor plate, mud and debris were there. It was a survey where are we . What are we going to do to get the Drinking Water back in. We have had several emergencies. With each incident we all ways operate withins dent command open. Process works without headache. When we do it right it makes it easier for the next one. We may experience working as a team in the different format. Always the team comes together. They Work Together. Our staff i feel does take a lot of pride of ownership of the projects that they work on for the city. We are a Small Organization that helps to service the water for 2. 7 Million People. The diversity of the group makes us successful. The best description we are a big family. It is an honor to have my team recognized. I consider my team as a small part of what we do here, but it makes you proud to see people come together in a disaster. Safety is number one through the whole city of San Francisco. We want people to go home at the end of the day to see their loved ones. We dont want them hurt. We want them back the next day to do their work. There is a lot of responsibility the team members take on. They word very they work hard. They are proud of what they do. I am proud they are recognized. Id to call to or the meeting of the Public Utilities commission. Today is tuesday, march 10. If we could have the roll call. President Ann Moller Caen is expected shortly. The vietor here. Moran here. Maxwell here. Paulson here