49 to support businesses make people all the residents and visitors realize had cool things are made and produced in san the meeting will come to order. the meeting will come to order. welcome to the april 18th, 2018, special meeting oh of the public safety and neighborhood services committee. i'm supervisor jeff sheehy. to my left is katherine stefani in for ronan and the

clerk is john carol. i was like to thank leo, ceilna and sf gov tv for staffing this meeting. do we go to your announcements or excuse supervisor peskin. can i beat a motion? >> stefani: i move to excuse him. >> peskin >> sheehy: do you have any announcements? >> silence all phones. items acted upon today will appear on the april 24th, 2018 board of supervisors agenda unless other wise stated. >> sheehy: thank you. read the first item. >> the ordnance to prohibit the police code. >> sheehy: we will hear from supervisor stefani.

>> superwiser stefani: thank you for hearing this today. i would like to recognize everyone in the audience today. my friends, thank you for being here. on february 13th i introduced this ordnance to make it clear that when you are in san francisco you are free to exercise your first amendment rights without intimidation or fear from those carries concealed firearms. last august a proposed demonstration in my district on chrissy field by a far right wing group wreaked havoc throughout this entire city. coming off the hills of charlest charlottesville, virginia there was fear. many officials went on the record at that time expressing thundershoweir conce the potential for violence then mayor lee and now mayor farrell.

the u.s. has a gun homicide rate 25 times higher than other developed nations. other 90 americans are shot dead in this country every day and hundreds more are injured. just one day after i introduced this legislation the tragic events at marjory stoneman douglas high school happened. 17 lost their lives and 17 were wounded changing their lives forever. sadly this isn't the only mass shooting to have happened since its introduction. closer to home we saw the terrible events at the you tube headquarters just a few weeks ago. it's no secret to anyone that public safety is one of my top priorities as supervisor. over many decades san francisco has led the charge on many issues like the right to marry whomever you love. our first amendment right, the freedom of speech and the right to peacefully assemble and protest should not be

infringed, chilled or suppressed. there can be no peace when the threat of concealed weapons are present. to make matters worse, why this is so important, why i'm so concerned about this, the house of representatives approved the concealed carry reciprocity act. the nra's bill to allow people without a state permit to carry a concealed gun in san francisco which could dramatically increase the number of people carrying concealed guns in san francisco at any time. imagine the chilling effect that would have on events like the rally we had in the castro after the pulse nightclub shooting, the women's march or the student-led march for our lives rally and march down market street. not only did they propose patriot prayer rallies send our city into chaos it cost us millions of dollars. it struck the fear of violence in many and that must end. museums were closed,

my son's 7th grade camping trip was canceled and kids sporting leagues had to cancel games. it is time for san francisco to continue to lead the way and protect our represesidents and visitors from the threat of gun violence at public gathering and our first amendment related events in our beautiful city. the legislation before you today, chair sheehy will amend the police code and prohibit concealed weapons at certain public gatherings. i have circulated amendments that highlight one change in the ordnance under section 361, subsection c and i can go through it later. i'm proposing oh change from the minimum number of attendees from 20 to 50. i want to thank john gibner and brad hufney for this and all

those who have come out to speak today. chair sheehy, i'll turn it back over to you at this time. >> sheehy: great. just one thing, could we also have a motion to excuse vice chair ronay as well? >> supervisor stefani: yes. >> sheehy: do you have anyone to call up? >> supervisor stefani: yes and then we can provide to public comment. >> i'm alison andrewman at the law center to prevent gun violence, the gun safety organization led by gun violence and former congresswoman gabby giffords. for 25 years we have been providing legal and policy expertise to legislatures nationwide. on behalf of our organization i urge you to support the ordnance introintdu.

where there's guns there's gun incidents whether intentional or accidental. at rallies, protests and other types of public demonstrations these types of guns incidents are a particular threat to public safety due to the large number of people in attendance. guns discharge accidentally and in a crowd filled with parents, children, elderly attendees and others an accident gun discharge could be deadly. also protests, r rallies and demonstrations are filled with high emotion. they occasional attract counter protesters. the presence of a gun in an intense and emotional situation makes it more likely the gun will be used. research has shown that people tend to perceive their gun perceives a threat whether that's in reality or not. guns in public especially at large events also present grave risks to law enforcement. as noted in the findings to this ordnance the

white supremacist rally in charlottesville was one example. they were out gunned by the participants. that should never be the case. further more, the present of guns at first amendme amendment activities is likely to chill speak and intimidate participants from attending or counter protesting out of gear of -- fear of gun violence. the city will help except the shared expectation that public spaces be free of gun and gun violence. for these reasons i respectfully request you vote in favor of the proposed ordnance. thank you. >> sheehy: so now we'll go to public comment but before we go to public comment -- well, no. sorry. i'm not reading my script right. any members of the public who wish to testify? speakers will have two minutes.

state your first and last name clearly and speak into the microphone. those who have written states are encouraged to leave them with the clerk. no applause or booing is permitted. in the interest of time, reputation of previous statements so not encouraged. so if any of these speakers would like to come up now. any public comment? >> my name is claire sensina. my only child was killed by a stranger's gun in san francisco in 2014. i now advocate for sensible gun laws. this particular law will not stop all shootings but if one person's life is saved in san francisco,

if it is your loved one's life, then it is worth your consideration. thank you. >> sheehy: thank you. is there a next speaker? someone else? that would be great. >> hi, hi name is ellen ginsberg. i'm a san francisco resident and i'm a local group lead for mom's demand action. mom's demand action is a nationwide organization with 4.5 million supporters nationwide and chapters in every state. we support common sense gun laws and we are very honored that supervisor stefini's contribution to our organization over many years. there is no greater person and she's worked tirelessly on this issue for years and we are grateful for all that you've done and all your efforts. it's a great privilege to live in a city that

takes gun violence prevention seriously and doesn't wait to be reactive to gun violence and to respond to tragedy but looks to prevent tragedy from happening. consideration of supervisor steste stefaini's ordnance is that measure. we believe that a public rally is not the time or the place. we thank you supervisor and the board for leading the discussion on this important measure. thank you. >> sheehy: thank you. are there any additional speakers for public comments? please. >> my name is celeste and i'm a member of mom's demand action for gun sense in san francisco. i just wanted to share an experience i had similar to supervisor when the white supremacist rally was happening -- proposed to happen at chrissy

field. i got an e-mail from my son's soccer coach saying due to the rally we have to move our soccer game away from fort scott field to someplace outside the city. i couldn't believe that in san francisco we couldn't do something about it, we couldn't prevent this potentially violent rally from happening in our city. also i just wanted to add that i enjoy taking my children to public free speech events, to the pride ma -- parade, the women's march, the march for science and i would hate to think there's concealed weapons at this event even if people don't intend to use them. fights can escalate and fights can happen. it's something that shouldn't be happening here in san francisco. thank you for introducing this important law. >> sheehy: thank you. next speaker, please. >> hi. my name is amy rosen, i'm a citizen of san francisco and a mother of two children,

therapist and a person who is practicing mental health professional in san francisco. i'm here today because i was actually astonished to learn in august when the patriots prayer act rallies were happening in san francisco that it was actually legal and permissible for people to have open carry weapons in san francisco. one of the reasons i choose to live in this amazing city is because i found it to be a place that honored safety and well being of all people first and foremost. in choosing to raise my family here i was saddened to learn that on that day i wasn't going to be able to safely feel that i could bring them to speak about their first amendment preference to be in a safe community and to share their voices in a forum that honored first amendment rights of public speech. on that day, which actually to be

my birthday, instead decided to avoid at all costs any environment where people were going to potentially be available or permitted to have open carry guns. so i'm definitely very, very grateful for this legislative act or this writing in trying to support not having guns open carry. thank you. >> sheehy: thank you. next speaker, please. >> supervisor max from the san francisco district attorney's office. we are happy to support this and glad we are doing as much as we can to limit the number of guns out there in public and especially at gathering such as these. thank you for bringing this matter. >> sheehy: thank you. yes, please. >> hi. just two items to comment on. i definitely

believe for some of the reasons that people mentioned earlier that the presence of guns at gatherings chills free speech. i also choose -- i attend a lot of gathering and protests but i choose that day to not go to chrissy field because i did feel some threat to my safety just based on what was going to happen there. the other thing is i think it's just widely recognized that there are certain situations where the presence of guns just is inadvisable for safety reasons. you know, we go to baseball games and obviously we are not allowed to bring them there. i would also like to point out that the nra at their national convention didn't allow guns. people were not allowed to bring guns there. i think it should be widely recognized by anybody with a brain that there are certain situations where having weapons present present a security risk to everybody there. so thank you. >> sheehy: thank you. next speaker, please. >> my name is crystal opalado.

i'm a residence -- resident here in san francisco. from the perspective of a new parent to a toddler i'm proud to be raising her in san francisco, the heart of free speech productiotectiop did experience in the last year feeling unsafe with the rally at chrissy field. i left town that weekend. then with the recent student demand action, march for our lives, i did not bring her to that event out of concern that perhaps there might be people carrying concealed weapons and the threat of violence there. so i think this ordnance is a fantastic idea and would certainly make me feel safer in our community. thank you. >> sheehy: thank you. are there additional persons interested in testifying? public comment on this item?

seeing no more public testimony, public comment is now closed. >> supervisor stefani: i would like to move my amendment that changes the number from 50 to 20. that change is reflected on page -- let's see. page number 3, lines 12 through 13 and 14, 17 and 19. so that's the only amendment. >> sheehy: sure. without objection those amendments are accepted. >> supervisor stefani: i want to thank everybody who came out today to express your support for this proposed ordinanance. i've done gun violence

prevention for two decades now and i've been able to do it alongside many of you in the audience and to that it's been one of my greatest pleasures in life and working on something that is so meaningful, especially as a mother to a 13-year-old son and an 8-year-old daughter, i was in my son's classroom the day that sandy hook happened. he was 8 years old. the kids that were killed at sandy hook were in 1st grade, my son was in 2nd grade. it's very real. it's a very real feeling for mothers when we drop off our children at school and don't know sometimes if they are going to come home to us for many reasons. gun violence in this country is absolutely out of control. i've had these conversations with my children. you know, they hear things. we said, you know, it doesn't feel like a free country sometimes when our children and loved ones can be shot dead at a concert, in church, at a movie theater, a nightclub or a rally. it doesn't feel like a free country when we know that our gun homicide rate is 25 times higher than that of developed nations.

it is a uniquely american crisis. it's one of the reasons why i put this forward today. san francisco has led the way on so many issues. we have the chance to lead the way on this today with concealed carry so that people feel safe at first amendment rights. another thing, you know, my daughter said to me, she's 8 years old, it doesn't feel like a free country, mom, because they have lock down drills. when children huddle beneath their desks as they practice lock down drills for mass shootings. she's right. we need to do better by our children. i look forward to moving this to the pull board. i know the amendment has to sit in committee for one more week but i would like to express my complete gratitude for those doing this important work every single day. i will keep going with all of you for as long as i possibly can. so thank you and thank you, chair sheehy, for

hearing this item today. >> sheehy: thank you, supervisor for your leadership on this issue. i think that we are all recognizing really that gun violence has gotten out of control. i have a 13-year-old daughter. i think a lot of us are here as parents. our children are facing a world that we ourselves did not experience. the level of gun violence in our communities across the country and the fact that it's actually coming to our schools, i was at the school of the arts when the -- everyone marched out. i took my daughter who by the way was very unhappy that her school didn't -- her middle school didn't allow them to join the high school kids in the district in march, they did a little action within the school on the school grounds. when i look at my daughter and i talk to her friends and you've had this similar experience and i think other parents have as well, the fear of gun violence is tangible. it's real. they think about this all the time.

they think about it when they go to school. when i went to school i'm sure for you as well, we didn't have to think about it. you know, then you couple that which i'm so grateful that you're trying to address this, i was here when the white supremacist and the neo nazis came last summer. when i took this position i never dreamed that in san francisco that these were the forces that i would immediately be faced with, withstanding in opposition to. i will say for the city we came together and we came together in love and we stood up to these forces and all the city agencies, the way they worked, we didn't have the incidents like in charlottesville and other places and i want to give a shout out to the san francisco police department for their effectiveness and mayor lee for his leadership at the time. this one gap is huge. we were frustrated that it wasn't going to be possible to keep people from bringing weapons to free

speech rallies. again, i want to commend supervisor stefani not just now but over many years and how proud i am to have her as a colleague. i think our next thing is to take a motion to continue to next week. is that right? >> the next scheduled meeting is april 25th, next wednesday. >> sheehy: i thought it was next week. without objection. so mr. clerk, can we call item number 2? >> agenda item number 2, a hearing ohhen the sta -- on the status of radiology and ultrasound staffing at the hospital. >> sheehy: great. i'll wait until everyone kind of clears.

so the purpose of this hearing is really to look at staffing levels in the radiology and ultrasound technical staffing levels at san francisco general. i just note that this is an issue that involves patient safety, this is an issue that frankly as we dig into it we have to recognize that these types of services are profit centers so a lot of times when we start to look at how these services provided they're in the context of net cost. the reality is within the hospital setting these are reimbursed and they the reimbursements should be adequate the cover the cost

of being adequately staffed. so we have three presentations. we have ron from the department of public health. >> good afternoon, supervisors. my name is ron, i'm the human resources director for the health department. i want to stress first that our mission is to provide safe and outstanding medical support to the public. we do that through our staff at zuckerberg at san francisco general in the network. many of the people who came to speak on this are staff members at the hospitals who do this great work. we have over 8,000 staff. we have hundreds of units. of

course they all advocate for themselves for more money and more staffing. everybody wants to do the most they can possibly do. in this particular case in radiology this has been an on going issue for several years which we talked about in negotiations. from 2015 until now we had a 35% physician growth in radiology. that is that we went from 68 permanent positions to 92 permanent positions. we currently have five vacant permanent positions and we are just now publishing the list that people can select off of to hire those five permanent positions. eight months ago we hired a new manager in that university. her name is andrea turner. i'll have her stand for just a moment. so this is andrea. if we have a moment i'll let her speak. she took over eight months ago. some of the things she's done to improve this situation is she's created a new staffing model. that staffing

model makes better use of staff time. she's also worked with karen hill, our personnel manager out there who has developed a leaves team to reduce v reduce vacancies due to leave. we want people to use protected leave but manage leaves so we don't have such a high vacancy rate. this has resulted in less over time use and we continue to work to reduce registry. the hospitals generally can't operate without registry because they are needed to fill in in certain circumstances. we submitted a proposal which susan guard will talk about and which we would encourage the union to accept and adopt but that's another process. with that i'll just say that we have a proposal to increase pay for those modalities that we truly need and that we have reduced vacancies and we've added staffing and reduced over time and we strive to reduce regis r

registries. that will conclude my presentation. thank you. >> sheehy: you have someone else? >> andrea, would you like to come up for a moment? >> good afternoon, board. my name is andrea turner. the reason that i wanted to speak is to speak on behalf of my team as well as the hospital. the team that you'll hear from today are superior. they are one of the greatest teams that i've ever worked with. well, quite frankly we've been working hard to figure things out as a matter of how do we staff correctly and how do we ensure that our patients get the right treatment that they need. we started with staff, a staff grid which when i started that wasn't there. previous to me coming here, the

leader that was in charge at the time, actively worked on reducing registry. we engaged it from a team management approach which others do have a voice. we've been moving that along. so with a staffing grid we can tell how many employees need to be there at what time. there are other things that do play a huge role in how we staff. so i ask that you listen to this team that will speak today and then of course look at the information that is presented. >> sheehy: okay. so i do have a series of questions but i think i might hear from all three department presenters first. do we have someone -- do we have -- we have -- i'm sorry, susan guard from the department of human resources. >> good afternoon, supervisors.

thank you so much for the opportunity to be here today. i want to start out by echoing i'm susan guard with the department of human resources. i'd like to start by echoing the sentiments that both ron and andrea spoke to today. this is vital work that's being done by the team who are here today. we really count on them. it's an important part of the healing process. having experienced being a person who continues to engage in sports that perhaps i might not be the right age to participate in time as my orthopedic would say to me, i know how important it is to get the right images, the right diagnosis so you can get the right treatment and get back to your life. the work they do is really important. we pay them accordingly. these are very well paid positions. the diagnostic imaging tech pays $122,000 at the top end of the

scale. when you go up to 2470 the pay there is $137,000 a year. so we believe that -- we believe in the work they do and we support that with the salaries that we offer. we don't have a problem at the entry level. we are at or above market rate for salaries and we don't have a problem recruiting there. what as ron said we need people with the stills to do the more complex images which we call modalitiemodalities. to d want to encourage the folks already here to develop their careers and advance in their careers to get those additional modalities so we can promote from within. ron mentioned that we do have a contract with if fiu. in the contract it provides for labor management committee where we can address and resolve issues. this is one of the issues that we've talked about for quite some time at that committee. they tend to have something uniquely there,

twice a year they get to take any issues that can't be resolved to the mayor and ask for resolution. this proposal which ron mentioned that would give folks between a 5 and 15% increase in their salaries has been sitting on the table for a year. i'll say the numbers are quite staggering. if there's anyone in the room that's a 2470 there's $20,000 left on the table the last year as the proposal sits there. for radiology technicians it's almost $7,000 sitting on the table. so we really want to -- we don't feel that the offer has any downside for the union. we really want to encourage them to work with us and move forward so that we can implement that and get folks into the new modalities and give them the wage increases they have coming. thank you. >> sheehy: thank you. so i had a number of questions. whoever is appropriate can take it. a question about wait times. are they consistent with industry

standards? >> wait times? >> sheehy: the microphone, please. sorry. >> no, they are not. so, again, there's several issues that play into that. so if we are talking about the third next available appointment we would have to start talking about the different modalities. so in this case say ultrasound. ultra sound has had a cue that ballooned up to about 1,000 and their wait times, their third next available was hovering right around four weeks or more. but, again, there's several issues that play into that. none of which is actual staffing. as far as scheduling, we have worked pretty hard on that. we have two schedulers that are dedicated to ultrasound. we have --

currently we are using two additional schedulers to work on it on the weekends, on saturday. we've seen the cues come down from 1,000 now down to roughly hovering around 600 or so. in between that we had the implementation of a new software that unfortunately added to our problems. so that was another issue. again, not having anything to do with staffing. then in the middle of that we've had issues as far as staffing with physicians, not necessarily staffing from the stenographers. i imagine that that would be looked upon as an issue. where we talk about tnaas, it's the third next available. it's nothing to do with the staffing from the stenographers. >> sheehy: so there's an

adequate number? >> correct. yeah. currently we have nine. previous to that we had 12. so the industry standard is that with -- these are two areas that you can look at. so the advisory board and the arc stipulates and also the armds stipulates that a ste stenographer can do up to 12 patients a day. when we looked at the data that's not the case for us. the charge tech, or the person that functioning in the charge roll, lucy, we looked at the data and we add stenographers doing four or more patients a day. so not necessarily getting up to that 12 patients per stenographer. in that sense if there's nine

techs to do 12 patients per tech that would be 108. well, we roughly do around 50 or so patients a day. so at any given time -- so, again, bringing it back to a staffing model, just to show from the industry standard how much patients we should be able to do a day and not quite frankly not meeting that so that's another standpoint. it's not because the stenographers are not willing to do it, it's mainly because we have a staggering no show rate. so if thors the schs are scheduling 100 patients so so speak for them to show up, we have a 40% or more no show rate. that's patients not showing up. so, again, it's not that they're not willing to do the work, it's a matter of like i mentioned there's several reasons as to what will be factored into that problem.

>> sheehy: is your software issue, the original eehr and now you're moving into a new eehr? >> epic is coming. now epic is coming on august 3rd, 2019. that's not here yet. the software that i'm talking about is the e-consult software from rubicon that was implemented in the january/february time frame. unfortunately the data previous to that did not get migrated over and that caused us a lot of problems. that was a huge issue. we are still working through that. >> sheehy: when you guys move today a new hospital didn't you get more machines and increase staffing? >> we certainly did. we got the beautiful machines, expensive nice machines that you would definitely want to use on you if you needed it. yes, we

did. unfortunately at that time i wasn't here but unfortunately at that time we did not use or ask for additional staffing from what i gather. so we didn't do a performa. instead we went out and we asked for registry and we got registry. my predecessor prior to me gets here, loretta, she actually did a phenomenal job in working with mri and ir and ct where they reduced their registry to zero. how they did that is by going -- so y'all hear radiology technology, the x-ray techs will talk today. what happened there is that we took from that pool of people and we educated them to be able to work into these specific or

specialized modalities. so that was bril -- briliant. she was able to do that prior to me coming here. one of the things that we see now is that we do have more than we would like to see registry in our pool of staffing. quite frankly the reason for some of that also which hopefully someone will speak to that today is that we do have a lot of fmlas. i have 20% of my staff that is on some type of medical leave. so what was happening, we would basically put a registry for staffing. then we were asking

people to work 13 or 14 hour shifts which is not a good thing. ron mentioned working with karen hill and her team. we basically came up with a task force on how to do this and make it better. one of the things we talked about is how we can get a pool of people to be able to draft from when we need them because someone is out on family medical leave or such and we've been moving that along. so that is coming. as you know, because we are in the city and we know it's a little bit brureaucratic we have to go through all the steps to get people in. that's working in our favor. we are making strides. i hope to see it get even better. >> sheehy: i just have one clarification. andrea wasn't here but january 1st, 2015 so now we added positions in that unit. we added positions when we moved into the hospitals. a lot of other rns and other

positions but in this case 68 to 92. >> one of the big drivers of our decrease in frankly our projected budget deficit is an increase in patient census in general than they anticipated when they built the hospital. it's providing more funding to the city than we anticipated from san francisco general. just looking at these staffing dwe -- questionings you've also increased -- because the hospital went from two to four magnets and mris. did we increase people for that? >> so we have a trailer magnet and we have one in building five and we have one in building 25. the second addition to building 25, which is in the or is not operational as we speak. there's no reason to staff it as

of yet. that won't be operational until there's several things before staffing comes to play that will have to be taken care of. as it stands right now we have adequate staffing. >> sheehy: and then what is your policy regarding the staffing of magnet. >> the standard policy is that you have a technologyist -- so it all depends on how your department is designed. so with mri it's designed to have four zones. one where the public is, two where you do your screening, three you're getting closer to the magnet so only people that

will be there for some kind of reason to use the magnet and four where the magnet sits. ideally you would want to have two permanent magnets. it doesn't mean that you have to have two. that's an ideal situation. usually having one technologist as well as an assistant, like a tech assistant would be adequate. >> sheehy: then so they usually have a tech assistant in there with them? >> as long as they are not calling out, on fmla. >> sheehy: so sometimes. >> sometimes they do. i would say most often unless someone wants to contradict they, they do. >> sheehy: have you increased the amount of ct techs as the hospital has increased from two to six machines? >> again, that happened prior to me starting and that's

something that we have been working on and training with the radiology techs that is going well. the charge tech, loretta, did a nice training program where the training is such that they have to pass and do certain things to get there. the other piece of that that i wanted to mention is the fact that we have a -- when it comes to ct it is a modality that is used most in all radiology departments no matter where you go in this country. in fact how we look at it from a director's standpoint is if ct is doing well radiology is doing well. so there are lots of resources that usually move towards ct. in the case here we have several magnets and we are a trauma level i. i say magnets but i meant scanners.

the way that would look and we've done the staffing models for that, is that we would have a tech to each scanner. sometimes we are able to do that. other times we don't. the reason being is practically the way that we staff and the fact that, yes, you will have people out on fmla. i mean, we had an -- i'm sure the charge tech, loretta can correct me if i'm wrong, but we had someone on leave not too long ago, just got back and we had other people that were on vacation and things like that. it's a 24/7 operation. so when you have four or five people out of your department that causes the problem. it's not that we don't have the bodies. it just mean that is the bodies are fmla or vacation or something. they're not present in the department.

so they're non-productive at that point. >> sheehy: hold on. now we are using a category 17 which is a civil service exempt back fill. so when we know someone is going to be out on a long family medical leave we submit a back fill for them to help with staffing. >> may i just say another thing too? the product that we use is called cements. the -- it's a german product. i say that because it's a very, very, very complex system. the recruitment for people with that type of experience is very limited in this area. one of the reasons being is that this area is generally a ge product area. so it only serves as best. i've

taken advice from my team, my leadership team that we do go ahead and train from within. so the training from within is really something that helps us when we're able to take someone from x-ray, train them to be a ct tech. so i say that because with the category 17s while we are getting those positions it's still not going to be helpful to ct right off the bat. you know, that -- we would look to replace the people we are taking out of x-ray, training them to go into ct to make up for that. does that make sense? >> sheehy: yes. and are you -- so you're not able to -- you don't generally hire ct, mri and ultrasound folks from outside? >> we -- well, since i've been here we have hired -- well, we've hired -- i guess we are hiring all -- ultrasound techs

now. but, no, we train from the radiology tech pool and put them in a position in ct and then back fill the radio on tech position. >> sheehy: and then you get people from the registry, are you training those folks as well? >> in ct? >> sheehy: yeah. >> no, truly we want to back fill so the lower level of -- so if you look at the level you're looking at the interim is going to be the x-ray tech. so that's the first position you would come to. then you build on that. so the next level that we look at would be, say, ct. you train for that. you have to take a registry. you have to be board certified for that. so that's an additional amount of expense to those people that are willing to do that. it's also another level of training that they have to go through to get to that. then usually -- we may

have done it a little different here. what i'm used to in my experience is a good mri tech usually has ct technologist experience first to learn their cross section anatomy and so support. those are the steps up. stenographers actually went to school to become an ultrasound technologist. we are not taking from x-ray to make them a stenographer. so we would have to fire -- hire from the outside. >> sheehy: but the other ones are internally generated? >> we've been doing that, yes. >> sheehy: so have you lost radiology techs because the department cannot hire them? >> have we lost? >> sheehy: registry radiology techs because you couldn't hire

them. >> we have a several service merit based system. we go through a job announcement, gather thousands of applicati s applications, screen those down to an eligibility list. if they get on that list they participate in the process to hire. that's the only way we hire them into permanent positions. if they don't apply and compete and get on the list and are reachable then we can't hire them. even if they do get on the list they are still competing with others. they don't get any special reference. >> sheehy: even though because you had -- >> it's a civil service position and it has to be open and competitive. we can't give them a special consideration. when we get to the interview process if they are within reach we want people with the skill set. i would imagine that the hiring manager would look at that. >> sheehy: do you try to recruit them? >> i'm not sure if there's a noncompete with the registry companies or not becausut we ha

couple of recruiters. it would be fine if there's a noncompete. >> sheehy: why would you do a noncompete if you are training them? >> we are bringing them already -- we expect the registry to come in ready to do the work. there may be some orientations and those sorts of things. we are trying to hire the most qualified and experienced people and if they happen to get on the list and we can do that then certainly we look at doing that. because it's merit-based it has to be open and competitive. >> so we don't train. this would be the first i'm hearing of this. >> sheehy: you said you had people that -- >> we don't train the registry people from x-ray to go and do ct. that i would -- i would say that wouldn't be the wise thing to do to train to be x-ray. we are talking about the civil

service employees to train them. the point is here we have the lowest level of the department in the sense of when you come in and you come in as an x-ray tech. if you are registry we encourage that when we do have a position that you do get on the eligibility list, you do take the test if you're so inclined. as ron mentioned, we do have to go through the process of hiring. we look at that eligibility list and we go from there. if they rank in the top 10 or whatever then they're given an opportunity to interview and things like that as long as there's a position. ideally truly you shouldn't be using registry if for a very extended period of time. they're usually supposed to be there for a block of time where we are supposed to justify our use of registry. unfortunately for many years before we've had registry people that were there

for a longer time than they should. those are the things that we are working on cleaning up when i mentioned about the task force that karen hill has put together with myself and budget and all that. it has the full support of my boss which we've been working onto lessen more of that. to reduce it. correct. >> sheehy: what's your retention look like? are you able to retain people? >> so i have people that's been there for over 40 years so, yeah. >> sheehy: how much revenue do you know that the radiology has been generating? there should be a profit center, right? >> it's a revenue-generating center. there's so many things that go into getting paid. we are revenue generating. we should be making money. >> sheehy: but you don't -- >> i don't know the figure

offhand, no. >> sheehy: i mean, do you have a plan -- i mean, is there really a plan to reduce -- it sounds like a pretty large backlog that you have here. now i get the appointments thing. have you looked at best practices across the campus? i know this is san francisco general. i do know that different parts of it use different strategies. i know from being at the hiv out patient clinic that they fairly aagreesively t-- aggressively ty to get people to show up because it's a safety net hospital. doesn't it also impact if you're not -- if you had these large wait times doesn't that impact your ability to get private insurance patients as well? >> so our private insurance i believe is right around 3% of it. let me go back to your

first question. as far as the plan when i started here and we started looking at this whole thing one of the things that we did, we worked to -- well, invited and gauged over providers out there that are working in different clinics. so i worked with 5m and 4m and 1m and we did an a3 which is to basically look at our no show rate and what was causing it going back to the root cause of it. interestingly by working with those clinics we found out that they had a high no show rate as well. so what we've done on their end and they are doing on their end, start -- the root cause would be something like not having the accurate demographic of the patient. so not having the right address, not having the right telephone numbers and things of that nature. so what 1m and 4m has done with us, they started with getting -- at least when they

patients show up to make sure that they're looking at their -- they're asking the question as to, you know, are you still living at 123 whatever and making sure that they're getting the accurate addresses. so that has helped us a great deal. the other pieces to have follow up phone calls which we are doing. so for mri we do have one person that does that. we have another gentleman that we are using now. he just got back but we -- i had a conversation with him yesterday. he was gone for follow up phone calls and things of that nature to try to get in. then in the morning what we are doing is if people haven't shown up for their appointment then we are calling them again to see if they can show up sometime during the day to come to their appointment. so the plan is continuous. it's definitely

flexible to our constituents to their needs. we haven't looked at other people's plans in how they're working at it. quite frankly we are all in the same boat. there are a lot less. so for a ct it hovers right around four or five days. then roughly around the same for the third next available. >> sheehy: yeah. i mean, that's not the same experience i have. >> yeah. >> sheehy: when i go to private hospitals. so i guess another

question is when you're talking about -- this is not necessarily for you. first of all are you planning to recruit more people? just right off the top. do you think that the staffing you have in mind is adequate? >> human resources director of public health. so we have nine vacant positions, five are permanent. 2467, the list, is being created now. so we will be able to hire them quickly. we have four temporary hires coming on, not registries. so there's a total of nine that are coming on that andrea will be able to hire. so we are immediately hiring nine. >> sheehy: your registry use is what percentage of the workload? >> so i'm going to let andrea speak to this because they are not city employees. >> sheehy: like let's say that the number of -- the amount of work that's performed is 10%

done by registry, 5%? >> so back to x-ray where the majority of the -- you'll hear numbers being shot out at you. so 2467s are the ones. those are the x-ray techs. they i would say honestly 40% of that x-ray staff would be registry. we take the city hired employees, train those to go into different modalitiemodalit >> sheehy: they move up the scale. ultrasound that's done by registry is? >> so we had two registry personnel in ultrasound and we are now looking to basically hire permanently. so it won't be any. >> sheehy: so similar in cts

and mris? >> ct doesn't have registry or mr or ir. >> sheehy: so i know that there's discussion about somehow changing the pay structure. where you have the 40% registry is there a plan to change anything there? >> as far as their pay structure? >> i'll address that. what we found is we don't have a recruitment problem at the at the rad tech trelevel. we tend train them. we are looking to give a 5% raise to radiologists if they have different modalities. that allows andrea to use them in different capacities where as if they don't have the modalities their use is limited. 5% for lead radiology technologists, 5% for medical stenographers, 10% for

same the way with three modalities and then medical ste ste stenographers. those classifications that have the additional skills and modalities that we need, we emphasize those. we have a list right now of 25 people on the eligible list for their rad tech. so, again, we don't have a problem recruiting those and we do like to promote from within. so that's the structure that we've proposed. >> sheehy: so at the very bottom you have 40% that are registry, right? what is the cost of a registry person verses the cost of somebody who is on staff? per hour? >> so if you can remember when i started i talked about the fmla and all that. so we do have x-ray techs. unfortunately several of those x-ray techs are actually out on some type of fly