so we are currently about 15% behind other compatible hospitals with our kind of staffing and high pace. so why would you stay with us if all you could look forward to was a cost of living raise occasionally? we are just an on the job training center. registry and senior students stay with us to use their name, the zuckerberg name on their resume. i can't begin to count how many of these students and residenti registry people rotated through our hospital only to leave and take high paying jobs somewhere else. we are a high level i trauma center. if you can work here you can work anywhere. is that a 2 minute bell? >> 30 seconds. >> one of our competitors called us to thank for the well trained candidate that they were about to hire that was trained at our facility. we ask our new techs that work on the on call discredit and this requires that

you be able to be in the hospital within 10 minutes after your pager goes off. >> [bell ringing] >> thank you.

>> level one trauma center. it's highly respected in the we have the ucsf raidology and they've rin the textbooks in the field. they provide feedback for scans and they're he had skating the stenographer. this is why we're highly-skilled staff as well as students. after receiving the training, people leave here to take better-paying jobs. leaves us short staffed and unlike extra we can't pull from x-ray or ctmr we're left short-staffed. so we hire and retrain. this is frustrating to us the doctors. they expect high level of skills and the bear is an expensive place to live. the s.f.g. need competitive

salaries. i myself is a single person with a mortgage who commutes from oakland. why wouldn't i take a higher-paying jobs closer to home. we're advocating to take care of the employees who take care of the people of san francisco. we like to keep good employees and provide safe patient care. >> thank you. nnext speaker, please. >> hello there. i've been a raidology tech for 15 years and ctmri. san francisco general is a level one trauma center. i've seen patients come, shot, stabbed, in a plane crash, even tiger attacks. you see it all there. working at sfch is like being on the front lines a lot of the time. we sometimes find ourselves in generation situations to help people who need it. unfortunately last year, i was punched in the face by a psyche patient who was violent with

staff members in the past. on top of a stressful working environment, the city pays less than local hospitals. this leads to under staffing which inhir inhibits our abilito take care of patients. steed of the city paying a competitive wage they pay o.t. and out of state registry company to fill our ranks. a lot of these techs have very little experience and many of them are actually graduates from san francisco city college. since we cannot hire externally at san francisco general, we're training techs and spray cat stan and interventional and mammography. this is a very time-consuming and expensive progress. after the techs get this training nothing keeps them from getting a better-paying job and better working environment. it takes a special type of person to work at general. for me and my co-workers behind me, it's not all about the

money. we do it because we feel like we work in a place where we make a difference. we all help the people of san francisco. >> thank you. >> next speaker, please. >> while you are coming up i'll call ramsey omary. alice geese and wilson lee. >> i was wondering if the registry is offering an incentive with greater job flexibility. it sounds like that is what people are looking for and they're receiving it in various ways. it may be detrimental to the operation of the organization, however. also, i wonder if stenographers can meet patients at home if they have preference, otherwise it sounds like the stenographer are loosing jobs 30% job reduction it sounds like. rather than hire near-term, can

you provide greater education opportunity given that we're speaking of the profits center providing high value service, hopefully facility profit in higher incomes and possibly generating general higher tax revenue. would it be feasible to expand the raidology department at city college and yeah, i understand the courses there are personal and the public is paying for this so, i would imagine placement referenced for impacted courses could go to exiting senior medical workers. since only 2% of patients are privately insured, where are the profits coming from? >> next speaker, please.

>> hi, good afternoon. my name is talma and i started working at san francisco general hospital january of 2012. i began working as needed as an employee which allowed me to work for either six months or a thousand 40 hours, which came force. when i was terminated i began working as a registry. so i did this back and fourth for three years until i became a part-time employee. but during this time, i didn't pay into retirement nor did i get vacation pay. i stuck it out because i enjoyed my time working as x-ray tech at sfgh. i loved working with our patient population. i have basic communication skills in spanish that allowed me to help like i was helping the hispanic population. i worked hard to be where i am in my career. today i work at interventional raidology as a technologist we cover vascular surgery, neuro i.r. and also body i.r.

we use light you will extra sound and c.t. for imaging. i have compared earnings from my classmates who graduated at the same time as i and they are making $15 more per hour than i am. i work very hard but i can't even afford to live in the bay area. i commute with my kids from fair field every day to work in san francisco and nearly spent almost two hours driving back home every day. it's unfortunate that i have to do that because i love working where i work and i don't want to look elsewhere. that might be the case eventually, thank you. >> next speaker, please. >> good afternoon. my name is nancy and i've been a technologist at the general for 28 years. currently, i'm the lead tech at the avon breast center where

last year we performed over 8500 exams in our clinic and at 11 community clinics in the street. in our mobile van we detected 68 new cancers. in the last few years, two of our techs have retired. we've been unable to recruit any new experienced technologists and therefore, i have been open to training inexperienced technologists. we've trained three techs, two of which were registry techs. each new tech requires about 40 hours of training just to do the save mammogram. all three techs are no longer working at san francisco general hospital. one left for a higher paying permanent job at stanford and another left to take a job with better pay after she got tired of waiting for us to offer her a permanent position and the third left ultrasound school in hopes of a career with better pay. he was informed a season

technologist makes 12 and a half dollars more than a heck at zfgh. currently, we've been operating on the bar minute yum staffing. if someone is sick or on vacation we're short and both my supervisor and i will fill in to cover our gaps. we often times have to compete with c.t.s who are also very short for the one tech we can use but it's usually available for a few hours here and there. we have one tech that is due to retire this year and we need additional tech positions with better compensation. thank you. >> thank you. i'd also like to call up daniel becker. emma gerard and david cannon.

>> my name is ramsey. i'm a computer tem ography technologist on the graveyard shift. i run the c.t. scanner from 11:30 at night to 7:30 in the morning in the emergency department at san francisco general. our job requires us to be fast and accurate. we provide the images that help diagnose and treat the sickest, most injured patients. last week, we scanned three children who had fallen within 90 minutes. the first one had fallen from his mother's lap after she had fallen asleep. the second one, had been shaken and dropped to the ground which her mother who was suffering from postpartum depression. the third one had fallen on to his head getting out of a parked car. in may of 2016, as you know, we all moved into a new hospital building. with that move, we doubled the number of c.t. scanners and we

did not add a single new c.t. technologist. last year, we offered two outside candidates job in our c.t. department. both declined receiving higher offers at other facilities. from my memory i can remember at least four people from registry or the permanent staff leaving specifically for reasons of steveing another job offer or higher pair. not all of us can work here strictly for our dedication and without considering additional money. >> hi, my name is alice. i live here in san francisco. i'm a diagnostic imaging tech one at sucker burg san francisco general where i have worked since october of 2004.

my point is pride. we work for pride in our trauma center and service to the needy persons of our city. i would encourage you to support us in that to the point that i myself maxed out my step many years ago. there's no further steps for me to go to and because i've worked for a number of years the people who are promoted from training are required to work weekends and i was able to no longer work weekends because i worked for a

long time. you know, despite, colleagues leading for better offers, those of us that stay with the facility is because we love our city and we love the people we serve. and would ask you to continue that we can have great pride in our service to our needy and as the best trauma center that you ever want to come to if you are in need for our services. if you yourself have an accident. thank you. >> thank you. next speaker, please. >> good afternoon, my name is wilson lee. i have been a tech just for three years. i have a c.t. technologist and also the raidology clinical instructor on behalf of city

college of san francisco. i have actually been through the whole loop of going through the program myself. move of us techs at the raidology department have graduated from city college of san francisco and been in partnership for 40 years now. and i just want to bring up that i waited for three years, worked in the registry for three years and we have a permanent position. with the students we train, the time and money we spend training with the students and seeing them leave because we can't hire and retain them. it's a issue and a problem. i know we just ended a discussion about gun violence and i just want to say that sometimes these registry people's that we hire they don't have the qualified skills. if we can be serving your kids, your family, your friends, and if we don't have the qualified people to handle this situation and get the proper diagnosis, you know, we might not be able to have the proper skills and the doctors won't have the

proper information to give the care and heal with your family and friends. basically we really need to is it retain and i know you've heard that we've been training people within and we're taking people from x-ray but, at the same time, x-ray is getting reduced and we take people, we hire people from the registry but again, these registry folks might not have the proper skills to work at a level one trauma center. we hope you can support us with the proper staffing and also the proper raises and wages to keep these people. >> thank you, next speaker, please. >> i'm here to speak in support of the raidology department. the department has suffered from

inadequate staffing and also wages that are not competitive and this is effecting our members greatly. staff members are being hired and they leave for better opportunities after training. this is resulting in more people just coming and getting the training and leaving and even though the members are suffering the people that are really suffering are the patients. for a city that prides itself on quality public services and good jobs this should be alarming. the union has been engaging with the city over this matter for a couple of years but the slow process has produced not a lot more than excuses and reasons why this is impossible for the city to fix so again, this is the patient that are suffering the most and we are asking for your help in fixing this

problem. some of the ways is adding an extra step to the current series and by converting registry hours and overtime hour to permanent civil services for 17f.t.e.s and create an internal classification and for raidology techs and you wil ultrasound te. >> my name is jonas. i was a student in 2009 at sfgh is 2067. we cover going to the patient room to do the x-rays and e.r., we have seven recess rooms and pod a and pod b, pod c, two of them have 20 rooms that we have to go through the patient room to prosecute form the x-rays.

orth owe has out patient facility in the old building and since 2009, i graduated in 2012 and i was working as a tech for six months for 10-40 hours and i had to let go and come back for another six months. i've been doing that for a while. i was hired as category 13. i was became permanent at the hospital. the past week we were just looking at the statistics of how many patients procedures we do per week. 2,332 and we're doing one. this is just x-ray only.

3,149. 807ctnr. my classmates are going to ucsf for better pay and wages so i will ask you to help us to better staffing and better wages for our staffing. >> thank you. >> thank you. >> next speaker, please. >> good afternoon. my name is mondonaa. i've been with city and county of san francisco for 30 years. i currently am a charge shift for the swing shift in raidology. six or seven months after i started working in 1988, in 1989, we got the 50% raise and this is the historical situation that we have in raidology. we've always been below the industry. in 2004, again, you have to take

drastic majors to be heard by the city of we are under raidology workers. the last director came from outside. he brought some new evidence and expertise to do the reclassification for us. we started that six years ago. i've been trying to make people understand what we do as raidology and what is it that we need to have to be compared to other hospitals in the bay area. we got halfway there and they keep saying five, 10, 15%, 15% is only one percent is going to get 15% in ultrasound. the rest of us won't get anything. all those one and twos won't

get a cent raise. this is not fair to the people that they work at a level one trauma center. we're not recognized for what we are doing, we also are not com pennated accordingly. with our new leadership and your help i hope we can fix this issue and put an end to this craziness. thank you so much. >> thank you, next speaker, please. >> good afternoon, emma gerald with 1021. i wanted to go through a couple numbers with you. regarding recruitment and retention from 2013 to 2018, there was 54 dip ones trained from registry. 20 of those 54 were hired.

34 were lost. of the 20 that were hired, 13 were given dit2 training. which is the next level. of those 13, four left and six retired. i want to demonstrate in the turnover and retention rate in this classification is very low and this is one of the classifications we're asking for. for sten ography there was 10 trained and these folks were hired at step 5 or step 6 and five were lost to go to other hospitals because they were offered more money. when you look eight situation when you need, if you can hire experienced folks that step five and step six and the pay scale only goes to seven, people are very dedicated to san francisco. they're dedicated to the patients. they're dedicated to the hospital. they're dedicated.

level one trauma is an exciting place to work but sometimes you have to bring home the bacon and you have to do what you need to do for your family and that's what is happening here so what we're asking for is fair. what we're asking for is an extra step for one, two and three and we calculate this at 17s.f.e.s and create a classification which san industry standard skull find it at any other hospital that does that and public or private that m.r.i. should be. >> can i ask a follow-up question. when you say convert it to 17s.t.e.s do you mean you no longer use the registry? >> yes. >> i wanted to make sure. >> thank you.

>> next speaker, please. >> thank you for scheduling this hearing. like previous speakers, we've been struggling to fix this problem for years. and we feel like there's an opening and there's an opportunity to fix it and we want to fix it during this budget season. you have heard about the patients safety concerns that were raised. the wait times. someone from d.h.r. mentioned these folks are well paid. this is a highly competitive industry. other hospitals know each other. they recruit each other. and they compete with kaiser and ucsf in this city and kaiser and ucsf pay way more money than san francisco general hospital. you just can't ignore that. they have to try to compete with kaiser and ucsf in order to run this department. you can't run a raidology department or hospital with 40% reliance on registry in the

biggest group which is the basic raidology classification. it's unacceptable and shouldn't be happening. and by the way, your questions, the people that are making the money here are the companies, not the employees. they are getting rich off of this problem. management is stalling. they have no plan on how to fix this. yes, steve from the department of human resources who did this survey and analysis, he says there's no crisis. we're just loosing registry people. yeah, buffet constant revolving door registry people and you can't run this hospital that way. the city is proposal is true, they gave us a proposal. of about 86 people, 55 will get zero dollars and that is in the dip one and dip two series where the highest turnover rate is happening. that's where the recruitment and retention problem is happening. actually, you asked what do other hospitals do? what does the industry do? they have a career path in these

classifications. they have m.r.i. 1, 2, 3.

>> so i dwsh -- you know, i think it's good that ron mentioned that, because i think it would be good for you all to see that, that we really don't get paid the same way that we do. >> so medi-cal does point reimburse. >> like i said, right around, this actually shocked me.

it was, like, $24 for an ultrasound of the carotid is $24. and with a commercial payer that we contract with, like, a dignity health, they may get, like, 300 and some dollars for that same exam. so it is just different, and i can't really speak to the intrac intracan -- incidetricacies, bt is complex. >> no, i appreciate that. >> yeah. >> supervisor, we will --

[ inaudible ] >> thank you, david. and maybe if you could just state your name -- unless you have a record -- >> canum, seiu. >> thank you. stephanie, do you have any other comments? >> i just want to thank everyone for coming out today, everybody from the department. and sf general. everybody asks if it makes ai difference if you show up in person, and i think it does. i'd rather learn what you're going through and hear what you're going through rather than just reading it in a briefing. just because you do this because you just want to make a difference, i appreciate that. and some of you mentioned the

gun violence item that was heard before, and i know how hard it is for surgeons and our nurses, and everyone who touches on the level one trauma situations, and we are so lucky to have sf general in everything you do there, so i just want to thank you for that. obviously this is just a hearing, and i've learned a lot today, and i want to thank you again for educating me on this subject. having run a department, i do understand how hard it is sometimes to backfill positions or hire off the list or wait for the list and wait for the test. high -- use k5d 16's, 17's, 18's, to backfill. i understand how hard it can be and how hard it can be to advocate for the resources you need to run the department. obviously this is a hearing, but we will take it into our budget deliberations. thank you for educating me on something i did not know before

this began, but now i feel i have a better understanding, so thank you. >> again, i just want to thank you, everyone for being here, the individuals of the department, and the tremendous work of the folks from sfgh, to take it to heart. so do i have a motion to file this hearing, and this'll be continued to the call of the chair? >> so moved. >> for clairity, are you hopin to file this item or continue it? i'm not sure. >> we'll continue this. yeah. can i get a motion to continue this to the call of the chair? >> i so move. >> okay. >> okay. without objection. and then, clerk, is there any further business before this committee? >> clerk: there is no further business. >> thank you. we're adjourned.

- working for the city and county of san francisco will immerse you in a vibrant and dynamic city that's on the forefront of economic growth, the arts, and social change. our city has always been on the edge of progress and innovation. after all, we're at the meeting of land and sea. - our city is famous for its iconic scenery, historic designs, and world- class style. it's the birthplace of blue jeans,

and where "the rock" holds court over the largest natural harbor on the west coast. - the city's information technology professionals work on revolutionary projects, like providing free wifi to residents and visitors, developing new programs to keep sfo humming, and ensuring patient safety at san francisco general. our it professionals make government accessible through award-winning mobile apps, and support vital infrastructure projects like the hetch hetchy regional water system. - our employees enjoy competitive salaries, as well as generous benefits programs. but most importantly, working for the city and county of san francisco gives employees an opportunity to contribute their ideas, energy, and commitment to shape the city's future. - thank you for considering a career with the city and county of san francisco.

>> san francisco city clinic provides a broad range of sexual health services from stephanie tran medical director at san francisco city clinic. we are here to provide easy access to conference of low-cost culturally sensitive sexual health services and to everyone who walks through our door. so we providestd checkups, diagnosis and treatment. we also provide hiv screening we provide hiv treatment for people living with hiv and are uninsured and then we hope them health benefits and rage into conference of primary care. we also provide both pre-nd post exposure prophylactics for hiv prevention we also provide a range of women's reproductive health services including contraception, emergency contraception. sometimes known as plan b. pap smears and

[inaudible]. we are was entirely [inaudible]people will come as soon as were open even a little before opening. weight buries a lip it could be the first person here at your in and out within a few minutes. there are some days we do have a pretty considerable weight. in general, people can just walk right in and register with her front desk seen that day. >> my name is yvonne piper on the nurse practitioner here at sf city clinic. he was the first time i came to city clinic was a little intimidated. the first time i got treated for [inaudible]. i walked up to the redline and was greeted with a warm welcome i'm chad redden and anna client of city clinic >> even has had an std clinic since all the way back to 1911. at that time, the clinic was founded to provide std diagnosis treatment for sex workers. there's been a big increase in std rates after the earthquake and the fire a lot of people were homeless and

there were more sex work and were homeless sex workers. there were some public health experts who are pretty progressive for their time thought that by providing std diagnosis and treatmentsex workers that we might be able to get a handle on std rates in san francisco. >> when you're at the clinic you're going to wait with whoever else is able to register at the front desk first. after you register your seat in the waiting room and wait to be seen. after you are called you come to the back and meet with a healthcare provider can we determine what kind of testing to do, what samples to collect what medication somebody might need. plus prophylactics is an hiv prevention method highly effective it involves folks taking a daily pill to prevent hiv. recommended both by the cdc, center for disease control and prevention, as well as fight sf dph, two individuals clients were elevated risk for hiv.

>> i actually was in the project here when i first started here it was in trials. i'm currently on prep. i do prep through city clinic. you know i get my tests read here regularly and i highly recommend prep >> a lot of patients inclined to think that there's no way they could afford to pay for prep. we really encourage people to come in and talk to one of our prep navigators. we find that we can help almost everyone find a way to access prep so it's affordable for them. >> if you times we do have opponents would be on thursday morning. we have two different clinics going on at that time. when is women's health services. people can make an appointment either by calling them a dropping in or emailing us for that. we also have an hiv care clinic that happens on that morning as well also by appointment only. he was city clinic has been like home to me. i been coming here since 2011. my name iskim troy, client of city clinic. when i

first learned i was hiv positive i do not know what it was. i felt my life would be just ending there but all the support they gave me and all the information i need to know was very helpful. so i [inaudible] hiv care with their health >> about a quarter of our patients are women. the rest, 75% are men and about half of the men who come here are gay men or other men who have sex with men. a small percent about 1% of our clients, identify as transgender. >> we ask at the front for $25 fee for services but we don't turn anyone away for funds. we also work with outside it's going out so any amount people can pay we will be happy to accept. >> i get casted for a pap smear and i also informed the

contraceptive method. accessibility to the clinic was very easy. you can just walk in and talk to a registration staff. i feel i'm taken care of and i'm been supportive. >> all the information were collecting here is kept confidential. so this means we can't release your information without your explicit permission get a lot of folks are concerned especially come to a sexual health clinic unless you have signed a document that told us exactly who can receive your information, we can give it to anybody outside of our clinic. >> trance men and women face really significant levels of discrimination and stigma in their daily lives. and in healthcare. hiv and std rates in san francisco are particularly and strikingly high were trans women. so we really try to make city clinic a place that strands-friendly trance competent and trans-welcoming >> everyone from the front

desk to behind our amazement there are completely knowledgeable. they are friendly good for me being a sex worker, i've gone through a lot of difficult different different medical practice and sometimes they weren't competent and were not friendly good they kind of made me feel like they slapped me on the hands but living the sex life that i do. i have been coming here for seven years. when i come here i know they my services are going to be met. to be confidential but i don't have to worry about anyone looking at me or making me feel less >> a visit with a clinician come take anywhere from 10 minutes if you have a straightforward concern, to over an hour if something goes on that needs a little bit more help. we have some testing with you on site. so all of our samples we collect here. including blood draws. we sent to the lab from here so people will need to go elsewhere to get their specimens collect. then we have a few test we do run on site. so those would be

pregnancy test, hiv rapid test, and hepatitis b rapid test. people get those results the same day of their visit. >> i think it's important for transgender, gender neutral people to understand this is the most confidence, the most comfortable and the most knowledgeable place that you can come to. >> on-site we have condoms as well as depo-provera which is also known as [inaudible] shot. we can prescribe other forms of contraception. pills, a patch and rain. we provide pap smears to women who are uninsured in san francisco residents or, to women who are enrolled in a state-funded program called family pack. pap smears are the recommendation-recommended screening test for monitoring for early signs of cervical cancer. we do have a fair amount of our own stuff the day of his we can try to get answers for folks while they are here. whenever we have that as an option we like to do that obviously to get some diagnosed and treated on the same day as

we can. >> in terms of how many people were able to see in a day, we say roughly 100 people.if people are very brief and straightforward visits, we can sternly see 100, maybe a little more. we might be understaffed that they would have a little complicated visits we might not see as many folks. so if we reach our target number of 100 patients early in the day we may close our doors early for droppings. to my best advice to be senior is get here early.we do have a website but it's sf city clinic.working there's a wealth of information on the website but our hours and our location. as well as a kind of kind of information about stds, hiv,there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for 15, 40 75500. the phones answered during hours for clients to questions. >>