initial response was, we haven't received your wage proposal. just in case you don't know, our silence cannot be bought and our integrity is not for sale. the city's second response was, you have to work within the budget that was allocated. that they don't have the authority to allocate additional positions. that is why i stand before you today, because you are the reason our patients sit and urine and stool longer. you are the reason patients fall when that call light is not answered. you are the reason why nurses break california ratio laws when and if they get a break. and you will be the reason, the city is not reimbursed when patients from substandard patient satisfaction surveys. but you have the power to change all of that. i am disheart ened that i stand before you today, not asking for the latest innovation or the best technology. i'm asking for safe [speaker not understood]. i urge you to reconsider your

budget for the department of public health and allocate the funding needed to get the delivery of care that is necessary. the current budget does not meet current obligations of the m-o-u and new positions such as the bridge nurse. staffing just doesn't include nurse hees. we're a team. without ancillary staff, [speaker not understood]. if this is not the correct venue, where should we go? lives are at stake. thank you. (applause) >> thank you. before the next speaker, i'd like to see if we can get a response from department of public health. the statement that was made, the current budget does not meet the current needs and, you know, we're told on the one hand this is a staffing issue and we're working through it, but it seems like there is contention that it's a budget issue and that we don't have the proper resources to be able to meet this need. if you can respond, please.

>> well, as you can see from our -- the amount of salary saving that we have, we are -- we did fix the structural issues that we had in the last budget and we do have the money there to spend to be able to hire. and ron outlined the hiring issues we've had at the hospital. as far as the budgeted bed issue, we have a number of patients, pretty high percentage in psychiatry that are not acute patients. i know one speaker spoke about her experience working in the outpatient area and in the inpatient area we just finished having a survey by the state and they disallowed 64% of our inpatient acute psych days because they felt like they did not meet the acute level of care that was needed, but these patients could be adequately cared for in the community. we have the same experience in

med surge where we do have a number of lower level patients there. so, we've been under budget in med surge, under our budgeted bed by 11. in our skilled nursing facilities, we are under budget -- under our budgeted beds there, too. so, being able to reallocate some of the funding from the empty bed that we aren't using can be used for programs in the community and other areas of the department of public health. >> thank you. one more question. it wasn't mentioned that we were breaking title 22 on occasion, especially during break because i've heard when i go to the hospital other times, what are the consequences for that and what does it mean in term of how we're going to try and alleviate that moving forward? >> well, it's something that we really need to address. working a 12-hour shift, the nurses really do need to have the breaks coverage.

and in the last year and a half especially, we haven't been able to provide that on a consistent basis and that's something that we're looking at very closely. and that's why we need to do the hiring that we need to do. >> okay, thank you. thanks for your patience. next speaker, please. my name is mike dingle. i'm a cna at general. [speaker not understood]. i'm a special patient handling, i work on the lift team. that means i cover the whole hospital. and i see and i want to reinforce all the testimony that i've heard. the lift team goes everywhere. we see the results of not only less nurse staffing and all the issues that are presented in people waiting in emergency for over a day to get upstairs that really need it. as well as under staffing on the lower levels where the support for the nurses happens. also, we are in budget contract talks right now to increase the lift team because one of the

other thing that the lift team provides for the nurses and other staff is back relief because we hopefully are preventing many more back injuries in the handling of combative, overweight, and other patients that have other issues that really require special handling. so, i just want to thank all my brothers and sisters for their testimony because it's really true, we do need the people and the personnel that we are trying to get more people on the lift team. if the lift team prevents a couple back injuries, the city saves 50 to $60,000 right there on any injury just in payouts that we do pay for those kind -- one thing i haven't heard is pete nurses talking about people missing from injury related things that could be prevented by increasing the safety structures in the hospital within -- having more lifting support in the units of the icu. i see it all.

i go everywhere. i know what the effects are from under staffing in radiology. i see it everywhere. please do the right thing. thank you. >> thank you very much. next speaker, please. (applause) hi, my name is annette [speaker not understood]. i'm a nurse on the med surge unit at san francisco general. i've been a nurse for 30 years. i've been in the public sector as well as now the private sector. and it's been really an amazing experience to see the difference between the facilities. when i tell people i work at san francisco general, people are really -- they express real surprise, that's a great facility, i've heard so much about it. and it's true. i really feel strongly that the city of san francisco has supported san francisco general and laguna honda and people who have been on the friend of the society now get very good health care. but it's becoming harder and harder every day. med surge is a fast unit. we admit and discharge

patients. many times these are patients that are discharged that have minimum family support. they need to go home. they have dressings to do. they need medications. they can't do it on their own. this has become a trend where people are being discharged early and they're not ready. we don't have support. we do have nurses that come to the homes to help but that area is now being cut. so, the support for some of these people who need additional help is not there. it's dwindling and it's quiling very fast. i think the san francisco residents have shown over the years by supporting the bill and the money to staff these places is there. san francisco residents have been fantastic. i really think something has happened with the budget. the numbers just don't figure. our beds are being closed, but the need is there. four beds we're losing and that's a large number of bed. so, please help us with getting our staffing safe for our patients. >> thank you very much. next speaker, please. and i'll call a few more cards.

rebecca k. morrow. martha hawthorne. melda [speaker not understood]. gina alman. [speaker not understood]. hi, my name is gary kutz, i'm a tech in psych [speaker not understood]. i came today because i feel it's important that people notice -- or people know that the staffing and the assault ratios have been coming up quite a bit in the last couple of years. and we're down to one unit, one acute unit. we used to have four not too many years ago. we have one now, and part of the problem is the other unit that remains [speaker not understood] has been changed to a subacute unit.

what that means is the patients have got 7b, they get transferred to 7c when they get better. we place them in the streets or in a hotel or bed and care. merrily we go along. what's happened is we have such a heavy load of severely troubled psychiatric patients, the acute ward 7b is getting overwhelmed with high acuity patients. and unfortunately that's falling over to 7c now. it's very difficult to explain this whole arrangement and i was kicking myself trying to figure out how best to say it, but we need more helping. i can't tell you how much i love this job and the people i work with. and i just can't say enough about them. i'm just afraid if we don't see

something soon, thassaults are going to cost somebody their life. we had a broken leg in the last year. one coworker got assaulted three times in the same unit by the same patient. without taking off the floor. most of the times it's because we don't have coverage. there is just not enough staff or staff that they can afford to have work over. so, please, take a look at this. (applause) >> thank you. next speaker, please. hi, my name is timothy goldstein, a registered nurse at san francisco general in the late '70s as a nurse and i've worked all around the hospital there. back then with all of our complaints, they were saying they were working under staffing issues, the most staffing issues they were working on, was getting adequate beds back then. so, it's still a problem obviously. currently [speaker not understood] outpatient clinic right across the street here.

its main population has been the tenderloin homeless patients. my main focus has been hiv patients. i'm more concerned -- i want to express my concerns right now about the, about the expectations of us accommodating all of these new patients coming into the system. our current system, outpatient wise we're not able to accommodate the ones we have. they reconfigured many things in the system so consequently our clinic has been separated [speaker not understood] primary urgent care. we lost a lot of patience, primary care patients in the process of separation and reconfiguration. some of the more difficult patients to getting the primary care and to work with. and, so, many times in urgent care we're getting these patients come in influx we're getting new patients on medi-cal coming in. we don't even know that they are on san francisco health plan or blue shield and they don't know how to work the

system. so, we're having to deal with them there. we have to call the new patient appointment system to get them a county appointment. currently we have many of the clinics are 2 to 3 months wait list to get a patient into -- for new primary care provider. and many of the other clinics are putting patients on wait lists beyond the two-month period. so, the infrastructure currently is not even set up to be able to accommodate these patients and they are basically we're trying to direct them into other alternative for care outside our system. so, the infrastructure is not ready to accommodate the patients. thank you. >> thank you. thank you very much. next speaker, please. hi, my name is [speaker not understood]. hi, my name is sony kim. i work at the [speaker not

understood] health center, one of the larger primary care clinics at general. i am a senior clerk. i want to emphasize that when you consider staffing that the clerks provide the main support for the mas and the nurses. we are the worker bees. we are the front line people. at family health center, the amount of patients has grown so much since 2008 and the amount of clerks have decreased. so, apparently we're still short three clerks and every single clerk that i work with, all my colleagues, we are getting burnt out, you know, and we're tired just like the nurses are. and yet we have to, you know, uphold the mission of general hospital to provide excellent, you know, care for the patients. so, when you consider the budget, you know, please keep in mind that the clerks play an important role because we provide the main support for all of the staff. thank you. >> thank you. next speaker, please.

hello. hi, my name is john was worth. i've been with the pharmacy department at the hospital for about 10 years. i work specifically in the inpatient department. my areas of expertise are in the area of chemo and [speaker not understood] mixing and [speaker not understood] compounding. i was asked to speak on matters of safety as it relates to the budget cutbacks. ~ wads worth comprehensive assessment programs required in previous years have been severely cutback and parts of it have been completely abandoned. this has directly -- i believe this has directly affected patient care and resulted in med error. [speaker not understood] training for temp services has also been severely affected. reduced training programs have been implemented for this

specific temp service group because of budget issues according to our administration and pharmacy. even, even equipment that we use for still compounding has had recommended maintenance postponed because of budget cutbacks. and that was, to me is a huge shock because i didn't know that compliance issues were part of budget cutbacks, the required maintenance on equipment. budget cutbackses are hurting services at the sfgh hospital. we need to stop cutting the department of public health. we are being asked to do more with less, less meaningless staff, less training, less attention to detail, less attention to compliance and training. please consider the impact that further cutbacks will impose on the hospital. thank you. >> thank you very much.

next speaker, please. please come forward. ernesto cacho. mike dingle. trina potes. [speaker not understood] palomar. i melda [speaker not understood]. ~ brandon dawkins. [speaker not understood]. thank you for your time, supervisors. my name is laura may alpert. i'm a resident in san francisco and are not rn who work for the city and county across the street at [speaker not understood] urgent care clinic. i have been a nurse 13 years. i am deeply concerned about staffing issues at san francisco general hospital. as i have sat through contract negotiations i have learned that there are 90 rn and 60

other positions that are unfilled. when questioning the human resource he he personnel they point to the bureaucracy at city hall. when nurses are over worked, patient care suffers. [speaker not understood]. i have personally witnessed this at my clinic. i call on the mayor to end unsafe staffing and restore staffing in hospitals, clinics, laguna honda and city-wide. thank you for your attention to this matter. and i have neglected to submit these texts that were from icu. my name is rebecca kimura

i'm a nurse in [speaker not understood] and i live in district 5. when the city went through the downsizing and the blognomic downturn, we were asked to do more with less ~. we have now reached a critical point where we have to admit we are doing less with less. when i started at california children's services in 2000 there were 11 public health nurses in that program. today there are five. the work load has not decreased by 50%. i am no longer with this program because i can no longer make agonizing decisions over which kids to prioritize over other sick kids. the city has systematically reduced staffing not only through cuts but through attrition and [speaker not understood]. if you looked at the proposed reductions that i've got copies for you, you'll see attrition on the back. and i'll go ahead and give you those.

the 2014-2015 budget calls for a decrease of $5,284,383. the 2015-2016 calls for a $5,721,178 reductions. at the same time, they are telling us that they plan to fill 90 positions at san francisco general. they are also telling us they're making an $11 million rejection of 24 full-time positions. the mayor's budget is wrong and this needs to be fixed. the safety net of san francisco remains important to the citizens who live here. it's a quality of life issue. we expect 20,000 new clients and we don't see a plan for new staff to deal with 20,000 new clients. the focus needs to be away from

the [speaker not understood] and business. they're doing okay. but the poorest of the poor who are very sick need our help. (applause) >> thank you very much. next speaker, please. good afternoon. my name is martha hawthorne. i've been a public health nurse for about 30 years. i live in san francisco. i'm here to support my coworkers who work at the hospital at laguna honda, in the clinics and psych, throughout a very wonderful system that suffers from dysfunction because of lack of rn staffing and lack of support staffing. we're here because we care about the mission of the department of public health and we care about our patients. there are ten public health nurses here today. we are home visitors. there were 70 public health nurses when i started 30 years ago and now we are 25 doing home visits. we are here because we are

concerned about a part of the budget submitted called the maternal child health funding restructure. now, it is revenue neutral and the impact is, according to the department, minimal, but we would beg to differ. we're very concerned about a negative impact this restructuring has on our patients. we see mothers and babies from all over san francisco and we would like to explain to you why this program restructuring doesn't make sense. we'd like you to carefully consider that instead of hiring nurses there are two program analysts and a program coordinator and a nursing manager. my coworker will explain more of the specifics but we'd like you to ask the manager of maternal child adolescent health why this decision has been made and if it's possible

to reconsider with us the staff. we are the persons who see these patients and we would like to be involved in this important decision making. thank you. (applause) >> thank you very much. next speaker, please. >> good afternoon. my name is melda [speaker not understood]. i'm a public health nurse for fielding. currently there are two team of public health nurses that conduct home visits. the first is the field team which impart of. it consists of 15 nurses who visit families over one to six-month period. field nurses serve a wide variety of high-risk clients including pregnant women, new moms, new babies and acutely ill children. for example, every family that delivers a baby at san francisco general receives the referral for field nursing. we succeeded visiting

approximately 60% of our clients each month. and the second team is called nurse family partnership. it is consisting of 8 nurses he who visit families over two to three-year period and these nurses serve high-risk pregnant women, but only those who are first-time moms who present to care early in their pregnancy and who can't commit to the three-year program. but the field nursing is reduced, we won't be able to serve those clients that will not qualify for nsb such as pregnant women with other children, babies and children with acute illnesses and developmental delays, women who did not have access to prenatal care until late in their pregnancy, and who did not know they were pregnant or hid their pregnancy out of fear. and some women who just can't commit to a three-year home

visiting program. and linda will continue. thank you. (applause) hi, my name is linda woodland and i'm a public health nurse with the [speaker not understood] as well. so, both types of home visiting, to see a program and nfp program are incredibly valuable. nurses from both teams make a huge difference improving health outcomes. they assess new mothers for postpartum complications, track developmental progress in new babies, teach families about appropriate family care, ensure safe home environment, support breast-feeding and good nutrition, and [speaker not understood]. however, given the field program's more flexible terms to eligibility, field public health nurses are able to serve a larger number of families each year than our nfp nurses

who target a small number of families but with more intensive long-term intervention. this brings us back to the restructure which proposes the standing the nfp program by reassigning field public health nurse staff. our director has informed us that up to eight nurses should be reassigned from the field team to the nfp team. losing eight of our 15 nurses, more than half of the team would greatly reduce the total number of families that have access to public health nurse home visits each year. with only half the current cna nurse hees available to conduct home visits, [speaker not understood] prioritize kara hmong san francisco highest risk families, how can we justify reaching only half of the families that we currently do? these are families who struggle from housing and stability, financial instability, unsafe neighborhood, domestic violence, substance abuse, mental illness and devastating

chronic disease. all of them serve out of support. not only a small number of them who fit into the strict nfp eligibility guidelines. we urge you to analyze the implications of this proposed restructure. we he question if the change truly reflects the priority of our san francisco families. thank you. >> thank you. next speaker, please. (applause) good afternoon. my name is margaret moran. i'm a native of san francisco as well a nurse. i'm the charge nurse for the field public health nurses who are here today to say that we really, really cannot in good conscience not say anything when we're going to see our services disappear. if we only have 7 nurses in the field and i've been doing -- i was a field nurse for over 20 years. i know how it is to make home visits. we get to people where they live. we prevent hospitalizations. we bring people help when they need help. we get the link to services when we can do that.

you know, i have a masters. it doesn't take a masters here to know if you have only 7 public health nurses you're not going to be able to take 2 to 300 requests for health services. you're not going to be able to do that. i'm not a person to say, no health care for you. you don't have enough problems. go away. we take all of san francisco general referrals. we try to follow-up and we do. right now we have a wait list because with 15 nurses we can't get all of them, all of our clients who are referred to. with 7, come on, what are we going to do? with 7 nurses and i'm the charge nurse. i make the calls in terms of keeping the flow going. like any charge nurse in any hospital setting. i honestly am throwing my hands up and begging as someone who was born and raised here, educated at ucsf, bachelor's, masters, i've never seen it like this. are we going to ignore most of

the city, the women, children who need help? i hope not. thank you very much. >> thank you. next speaker, please. (applause) hi, my name is susan yu. i am one of the public health nurse. the reason i'm here today i wanted to [speaker not understood] all my coworkers and [speaker not understood]. i've been a public health nurse 15 years. we've been serving all the high-risk families in san francisco. the family that are like women in domestic violence, we have a mom with premature twin baby, one of the twins pass away in general hospital the second day when it was born. one of the twins had to be hospitalized for three months and then the mom got home, she went into a domestic violence family. the husband abused her, beat her one night, bit her, all bruises all over the body and she's trying to run out the door to save her life and the husband was chasing after her

on the street and grabbed her hair and took her neck and grabbed her back to the home. so happened that there was a pedestrian that saw and called the police. so, we have a 16-year-old boy out of control diabetes, missed all the appointments for renal for diabetics. doctor gave her a referral to find out what's the reason. we find out the mom herself have mental problems and also have end stage renal disease. and she's also a diabetic. she's not capable of helping her son who is also, you know, have renal disease. ~ to get to the appointments. and also we have a mom who got pregnant women got all the tests, she delivered the baby, the baby was down syndrome. she's debating whether to keep the baby. at the same time she was in domestic violent relationship. at the same time she was facing homelessness. and these are the high-risk

families we're serving now. we only have 7 nurses. who do we judge what patient we should take, the 15 year old over the domestic violence mom? how can we justify, you know, to see over 200 -- >> thank you. first time moms over 2000. thank you. >> thank you. (applause) >> supervisor avalos, i wanted to thank the speaker for those really vivid stories. it really hits at right at the heart of what safety is. but thank you so much. >> great. next speaker, please. my name is [speaker not understood]. i'm a public health nurse with field nursing as well. i'm a little shaken up from hearing that story. but i brought some letters from [speaker not understood] who would have liked to be here today but they couldn't make it because they're new moms. one of them said, i need the service for the nurse to come check on me and my baby because the nurse