instructor: are there any corrections? if not, all in favor of the minutes instructor: are there any corrections? if not, all in favor of the minutes say aye. student: aye.

student: aye. >> in the area of high impact, hiv prevention. we want to acknowledge this is great work on their behalf. the city and county of san francisco has entered into play lor contract knee negotiations. concerns about position vacancies have been raised at bargaining sessions and the hr director continues to provide

updates on process improvements in hiring. the end of may 2014 is a general har target for approving negotiations. all staff and diverse disciplines tlouts the san francisco health network can take a moment in their fast paced work lives to openly discuss the social issues that arise and emotion that will issues that arise and every second thursday at noon at the wellness center with complimentary lunch for staff to share their experience throughout actual patient cases. we want to acknowledge the flu season is over. the goals were achieved in honda. 95 percent for staff. the resident vaccination rate was 89 percent. total number of laboratory

cases is three type a. there were zero deaths and laguna honda compile wd the health officer the mandatory masking mandates for all healthcare workers who declined vaccinations. we want to make sure they get recognized for their good vaccination work. national volunteer work in the newly opened gerald simon auditorium in laguna honda. i'd like the health officer to come um to talk about some issues in los angeles county regarding invasive disease among men who have sex with men, but before that the mayor did ensure the language access for doug speaking for city residents and announced that

certification in filipino as a third required language in addition to chinese and spanish covered under the language access ordinance and the department is working hard on making sure our documents reflect that. >> good afternoon. so on april 2 is los angeles county department of public health reported that they had eight cases of disease and four of those were among men who had sex with men and four were hiv positive. when you calculate the population rates of the disease for that population it's significantly elevated so they recommended -- msm especially if you're hiv positive to get vaccinated against the disease. a outbreak occurred about a

year ago in new york city and the similar recommendations were made there and what we've been recommending is anybody traveling to those areas or having close intimate contact with people from those areas that they go ahead an get vaccinated. we're recommending for people in san francisco to get vaccinated. one thing i want to point out is that in san francisco the last time we had this disease in msn was in 2011 so we haven't had any outbreaks in san francisco so we've been lucky so far. just wanted to let you know. >> that's the end of my report, sir. can i request questions? >> so thank you for that update. this is the part that baffles me sometimes, you know. like when we talk about msm is not just about gay men, it's

about bisexual men. so why wouldn't a woman who has a bisexual man as a partner needing to get vaccinated. >> that's a good question. right now the outbreak seems to be concentrated in men who have sex with men in los angeles county so that's how we're making that recommendation. certainly if anybody has an individual concern, if they feel they're having contact to the group that may be at higher risk they can diss cuss discuss that with their doctor and get vaccinated. >> any other questions? i was just going to comment that i thought the first item was extremely important that we are taking a capacity and expertise we have and we're able to turn that into a nationwide type of assistance program and with funding and

congratulations again for the people that did that. and certainly within following the flu, most of the flu immunizations in our different department hospitals and that's i think a spectacular vaccination for our staff and even a more important reduction of flu impacting our population at laguna. i want to congratulate the people at laguna myself. were there any other public comments on -- >> public comment on this item? >> should we go on to the next. >> the next is general public comment. for those of you who are going to be speaking, if i could let you know the procedure. there's three minutes on the clock and you will speak -- the

commissioner ciao will announce your name, you're speak and commissions will not responds to you directly. >> first is dan mirror, to be followed by heather, kim, and then melissa pit so those are the four in order that we received. proceed. >> i'm dan mirror and i've been a nurse in the emergency department for 28 years at sf general. i'm here today to tell you that we don't have enough nurses, assistants or clerks to safely care for our patients in our emergency department. i'm scared that the city's level one trauma center has been unable to fill vacancies and we're now down 23

registered insures in nurses in that department. even if we fill all of those we'll remain understaffed because we're not registered for the amount of nurses we need. i'm scared there's no firm acknowledgment of our needs. the emergency department nurses have been sounding the alarm for two years now. we've written two letters, speak up at staff meetings, have filled out patient safety forms and nothing gets any better. i'm scared. i'm scared when an investigation reveals that a coach keeping a patient under

constant observation is pulled to do something else and the patient disappears, but we have no staffing issue that is linked to patient safety. i'm scared a psychiatric patient spent hours in the busy er waiting for medical clearance. he finally become unglued and attacks another patient. we don't have a staffing issue that addresses patient safety. all patients either on our awaiting a 5150 assessment will be provided constant observation, they will always have a sitter, never unattended, but those sitters were never budgeted for and those patients are almost always left unattended. in addition to being unfair to

our patients, this can't be an efficient way to run a hospital. consider that our bare bones nursing staff struggles to do clerical work, mea work, people need to walk, they need to eat, defecate and urinate. this all takes time to help and we have very little help with that. what happens? we fall behind, we go on divert, the ambulances take our patients to other hospitals, which i understand costs us about $1.5 million a month. then we get patients back which then have -- they still back us up, we go back on the road again and it's a vicious circle. >> thank you very much. >> we need a budget that will address the issue. >> heather. >> i'll talk fast. i've been night shift nurse at

the -- >> you want to raise the microphone a little higher so we can all hear you. >> i'd like to outline a recent shift in our department that exemplifies our staffing concerns. my nurses had the following assignments. rob had three patients including one icu patient and an active card act arrest. audrey smith was caring for four patients and michael had a four patient load and screaming patient also on a 51 hold. and my own patient consisted of three patients. at this point three of my fours nurses are already over their title 22 ratio and the remaining two are in capacity. with these patients already in mrasz four stab wounds arrived all at once. i have fur rn's and they're

already well over while all hands were on deck for recently arrived traumas. not two hours into this chaos after two icu patients was medicated dislocated shoulder was still waiting for treatment, a nice young man and said i'm sorry to ask this, but is there any way i can go to the bath roochl. room. that's just sad. sadder still is my only option in the hallway to try to protect his privacy. our rooms are full. icu patients, trauma patients are everywhere, we've done everything we can and we've had insufficient resources. he's been waiting how long and doesn't want to ask if he can go pee. about an hour later a young man punched a hole in the wall. he was angry his girlfriend had been waiting four hours for a ct scan. after he was arrested in this

hallway we got and i would like

to stress that this event should not be viewed as an outlier with the patient population that we see in the er, situations frequently escalate and violence often results. much of this violence which is often physical is often aimed and and falls on nurses. we often see violence in the er at ourselves and other patients so this event was not an outlier. there have been violent assaults on other patients by patients and on ourselves. this fe phenomenon has only

worsened in my five year tenure in the emergency room as staffing has declined. is not solely a security issue, but relates to staffing as well. managing emotionally unstable or clinically agitated patients can be better with adequate staff. working within state mandated ratios nurses have time to recognize signs that patients are having difficulty coping. they can intervene sooner to deescalate a situation that may have escalated in adequate staff including ancillary staff helps get patients to where they need to be so patients on 5150 holds that have been medically cleared have not with waiting around to be transported to psych services. this helps keep things calm in zone one. this is not even close to happening at current staff

levels. what's more concerning is that under the current budget, if we filled all the open positions in the ed, we'd still be short staffed and at risk for more violence towards ourselves and other patients. i've been asked to add that we have reviewed subcommittee minutes that indicate there are no beds closed in the ed due to staffing issues. and this is not what we're seeing in our daily practice. closing down the emergency department in order to support the clinical decision unit has become daily practice. closing additional beds to account for a lack of nursing staff also happens daily. reducing the number of beds in these less acute zones pushes more traveng to our trauma zone, which leads to extended hours and impacts our availability to ensure patient safety. thank you. [applause] >> thank you.

our last speaker is melissa pits. >> my name is melissa pits and i've been a nurse at san francisco general for nine years. i have spent most of my time in the emergency room and one year in the surgical ucu. currently i serve as a charge nurse. i'm here to ask that you patient safety in the emergency department. i'm proud to work at san francisco general. i love what we do in the ed. our job is to care for anyone in the city no matter who they are, what they can afford or what happened to them. a homeless person we walk by on the street, the mom that gets hit by the car, person that is having a heart attack our stroke and when every second counts we are responsible for taking care of all of them and so many others. i take great pride that our hospital is the only level one trauma senter in the city. with tremendous growth in the

city it is not possible to absorb the influx of patients. when fully staffed we should have 22 nurses and a charge nurse. yesterday we had ten. under those circumstances when trauma happens like the who was hit by the bart train last night we have to stop what we're doing and react. the sluks is to pull people with other obligations. because yetd wasn't an exception, it's quickly becoming the nornl. when we're short staffed patients wait while we're dealing with the trauma. the 80-year-old with a broken hip can't go to the bathroom, the little kid with a stress trackture waits for sedation. in the ed team does not shy away from challenges. i was in charge the days the flight crashed. nurses, doctors, aids and

administrative staff all came in to assist without even being asked. we know what it takes to make the emergency department function. when tragedy strikes we deliver. but we need your support to run an effective department on a day-to-day basis and that means more nurses and ancillary staff on every shift. soon i will be moving to the new facility. i have very serious concerns about the staffing ratios. i, like many of you, have had a sick family member and we all want our loved ones to get the best care, to receive pain medication quickly and never have to wait for a bedpan. as nurses, we want all of our patients to feel safe and that they're being tepided to without distraction. i hope we never meet any of you at the hospital, but i would like for you to take a minute to think about the fact that any one of you, any one of us could be a patient in that emergency room. we are dedicated nurses who

want to give every patient the time and care he or she deserves and we ask that you help us work together to make a reality in a safe, efficient environment. thank you. [applause]. a: >> thank you. as was noted by our secretary, we will take these matters into consideration. thank you very much for coming. we appreciate your concern. we appreciate your work at san francisco general. thank you. the next item on the agenda is the report back from the committee. >> commissioner.

>> which goes into effect april 26 so that was the premise for the update. one of the things that's important about this is the e cigarette sort of trend, if you will, is moving very quickly. the marketers and the tobacco industry are pushing it very heavily. one of the things that some people who are spoking them are saying it's changed my life, but we know that there are known carcinogens, heavy metals and things that are not good for us.

there have not been any long term studies on e cigarettes, but one of the dangers right now is teens and there's been sort of limited information, but an neck an anecdotal information. that's an issue. the other thing which i find very interesting is that the marketers of e cigarettes are able to advertise on television, unlike the tobacco industry so i think we'll see quite a bit of that as we move forward. there's been a lot of advocacy. san francisco once again is leading the nation and pushing for a ban to e cigarettes and basically it's a ban that would disallow the smoking of e cigarettes for a tobacco products are also banned. that's an issue. anyway, it was a very interesting update and i think

there's a great deal more to come. >> would you explain to us, or perhaps the director can, that now the ordinance has been signed, what the obligations of the department are. >> i'd like to turn that over to tomas. >> one of the nice things about the ordinance is that it'll treat e cigarettes like all other cigarettes, so where cigarettes can't be smoked they can't use e cigarettes. from our perspective, it won't really change what we do, just expand from regular tobacco cigarettes to include e cigarettes. >> thank you. commissioners, any comments?

>> point of clarification. so are you saying to me that right now because of what commissioner tailor mcgee said, right now the regulations pertaining to tobacco are not applicable to e cigarettes? >> correct. that means in theory right today you could walk into a mcdonald's and the mcdonald's could be full of adults with e cigarettes in their hands and smoking in front of children and other families. that's currently the case. they're advertising on radio, newspapers and television. within san francisco they're going to have to follow the same laws that are followed for tobacco. we're not using the word ban. we're basically regulating them in the same way we're regulated other cigarettes. >> yes, commissioner -- >> i'd like to go off on that too pertaining to the

utilization of e cigarette. i've heard from a couple of old-timers that i guess have lived in these apartments where before they used to smoke and now they no longer smoke and they say that the landlords have said that there's a smoking ordinance they pay to the health department that says they can no longer be smoking in these small units and some of them are saying, well, the new cigarettes will be exempt from that. and my question is, what -- i mean, are we in fact submitting to certain units or all units in the city that we're charging a non smoking compliance fee for the health department? >> i'm going to have to follow up on that one to find out how that a mays applies to that specific area. i had not thought about that one. >> we need to follow up. and just recently in the press,

actually last night, i guess i noted and you probably already know, the world health organization in terms of the smoking regulations in the world are looking at e cigarettes potentially coming under all of the same labeling and bans, almost similar to what you're talking about in terms of the regs for use in different areas, but i thought more interestingly was the addition of the labeling and that's currently being sought out now. >> correct. >> yeah, so i think we should get a report on how this is going to be rolled out and how acceptable it has been to the public as these issues an challenges. i'm also assuming that if we're following the same regs that e cigarettes are not available in our facilities for smoking. >> correct. everything that applies to

regular cigarettes. this went relatively smoothly. we have very little opposition. the major concern was people around medical marijuana, but it went very smooth. the youth were involved and i think we're going to be presenting in the near future, we're going to bring the community organizations and youth groups that participated. >> at that time we can give the updates on the housing issue. >> okay, great. thank you. other commissioner comments? any public comment? >> there's no public comment. >> i just want to -- i want to thank the health commission because you passed a resolution in 2011 on e cigarettes and i belief believe you may have been the first in the country. >> thank you. we will take credit where we can. okay. any other reports? thank you, that was very

important. >> the next item is the consent calendar, which we have no items to consider. we'll move to the next item. if you'll confirm we're going to switch the order of items 7 and 8 and take it road map first. >> with the permission of the commission, because of how we pub lib so i have proposed without objection that we would have the it strategic vision and road map presented first so they would be within the context and we can review the budget initiatives being proposed. do i hear any objections? if not, we'll proceed with mr. kim, please. >> good afternoon commissioners. my name is dale kim, i'm the cio, i've been here about 8 months. it's my pleasure to share with you our health information system vision and strategy.