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 family medical leave. last week i got the green light to go ahead because we have a couple that are on ada. so i will be able to fill those positions. it's not -- like i mentioned, it's not that we don't have the bodies, it's what we are bringing in to supplement during that time when we do not have the body at work. so that body comes in the form of registry. so i just want to clarify that. when we think about it we don't have the amount of staffing but

when you look at it collectively, you look at, well, i do have a lot of people on my staffing grid but they're not at work, they're off so 20% of my staff is out on fmla or some type of leave. so how do i get to take care of my patients with 20% of the staff not being there? then i bring in registry. the other pieces that working with ron and karen is how do i get a category to supplement that time. a lot of the times we don't know that people are going to go out on fmla. we have people on intermitten fmla out there. they can call out twice a week and they're not a part of my workforce. so those are the things that i don't think we factor into our discussions but this is the reality of the

department operational needs. we do have people that are on my book so to speak but not present in any department. >> so she's going to answer the specific question on the cost. the advantage of promoting from within is that it gives our staff and the union members opportunities. it does create sort of a continual churn rate at the bottom. susan has the numbers on the registry. >> it actually is less expensive for us to have registry. it comes out to $91 an hour versus $115 and some change for our own employees. of course that's not the direction we want to go. we want permanent civil service positions. it's a little more expensive for us because, you know, of the benefit structure that we have and the costs that are not salary. so it's -- so

it's $115 for a city employee, $91 for a registry. >> sheehy: you pay the register $91 an hour per employee? >> this is ultrasound. >> so that's not for t the tecs that we were talking about? >> the techs only get half of that. the company makes a profit off the top. >> sheehy: i've asked a ton of questions and i have my colleague and we need to hear from loretta johnson. >> supervisor stefani: there is a great presentation. i've learned a lot. i ran the city department for two years so i understand. i had different employees at those levels and i had, you know, situations where people were on fmla and

positions that i can't fill because i have savings in my budget. i know that all city departments have that. i'm wondering too is this something that -- you know, we are in budget season right now, supervisor sheehy and i both sit on the large budget committee. is this something that's being discussed radio it -- right now with the mayor's budget office. >> we are in a no new positions budget. so we have the staffing model to give additional money to those with the modalities to give us more flexibility but we are not adding staffing. >> supervisor stefani: what are the classifications? what are the classifications so i can take a look? >> i don't have those off memory. >> i do. so we have 2467s, 2468s, 2470s, we have 2424 which

are lab aids. >> supervisor stefani: do you have new you couldn't feel? >> no, i would say -- you want to speak? >> we have five permanent vacancies and we have a list so we can hire those. that dollar amount was 102 for a rad tech city employee and $75 for a registry. >> supervisor stefani: if you dent have the limitation of no new ft he saes, we are looking $139 million deficit that we are trying to solve for, what do you think would solve of those staffing issues in terms of the classifications? i know on cat 16, 17, it's not a permanent

position, people don't get the same benefits. in your perfect world what would that solution look like to you and then realistically and everything? >> thank you for that question. my ideal world to be to get my staff on fmla back to work. >> how many? >> i don't know all the numbers off the top. it worked out to be 19.7% of my staff. so if -- to get them back into work and then i would have a good staff as far as numbers are concerned, to continue with training and having that upward mobility in the department which is good because i think that is a wonderful thing as far as workforce development is concerned. then to make sure that our staffing grid is accurate. so one of the things that we weren't operating on when i started was a staffing

grid. understanding at what time are your peak levels and things of that nature. so we've been able to with the input of all the leaders to look at that wholistically from above and below and then -- and to work through that. we have a really phenomenal ehr system, that would be awesome. we are moving to epic. i'm still looking forward to that. a lot of the work that goes on behind the scenes i think epic will definitely be a cure or a remedy for that. so i think when i look at my ideal world that's what it would look like. i would have my team all present and accounted for. i would have upward mobility of training. i would have an ehr system that works really well, you know, from the time that a provider

puts the consult in to the time the patient gets their scheduled appointment and come in for that. right now we have several different systems that don't work together. there's a lot of inefficiencies that are build in. so i would look at it that way. i promise you once you have that and have all that in place it would look like when you call and you get your appointment the next day. you know, you have -- people can look at your labs so i would be able to see it all to know that, you know, this is the way to proceed. so that's how it would work well. then, again, working with finance and the hr team, you know, that when i know that there's an upcoming -- if someone tells me they're pregnant i know 9 or 10 months from now they will be out of my department. i would start to look ahead as to how i'm going

to remedy that during that time. so, yeah, that would be it. >> supervisor stefani: i just have one more question. in the materials i reviewed the city's classification system has not stayed current with the changes in the industry and i'm wondering if you can walk me through that. that's why i asked for the classifications just to understand what that looks like. >> say that again. >> supervisor stefani: the classification has not stayed current with the changes in the industry. >> isn't the industry. -- in the industry. so i came from the mercy industry from the midwest. there's a lot of things that -- how it works in the private sector does not go over into the public health sector. so it's not apples to apples. i had to learn that

quickly. so where i see where there's some comparison, as far as a national standard we need to have a good ehr system. so we start with that. staffing -- a staffing model is what i brought to my team and where i got that from was quite frankly my experience but also the advisory board that i used. the other pieces that we really didn't really pay attention to our data so if i have a staffing model that i have three people coming in at 7:00 or 7:30 but the height of my population is not coming in until later on in the day but now those people are going home so we had to look at our data more diligently. so

that's one of the things that we've done here. go ahead. >> i'm sorry. the proposal that i mentioned that would provide for the 5 to 15% increasing wages that's been sitting on the table for a year does have new class backs. >> supervisor stefani: okay. thanks. >> sheehy: should i hear from loretta johnson first? >> yes, please. >> sheehy: i just want to note that i get the 2.5% cut but these are jobs that make money. this is not the same as if you hired somebody and it comes out of the budget. you hire somebody, more money comes in. loretta, please. we are going to -- thank you. i appreciate your patience and your hard work as well.

>> good afternoon, supervisors. i think we are getting a brief powerpoint presentation pulled up. my name is loretta johnson. i'm currently the lead technologist at san francisco general hospital. today we are going to talk about a little bit about our role at the hospital. you've been hearing some about understaffing, patient wait times and talk about some solutions for recruitment and retention. you will hear today from my coworkers who are ste stenographsten stenographers and x-ray technologis technologists. i myself have been at the hospital since january of 2009. before we jump into the powerpoint i wanted to just talk about what happened to

radiology in may of 2016. when the hospital expanded we greatly expanded our footprint as did many departments in the hospital. the expansion of those departments, particularly the operating room and the emergency department had a big impact on our department. we went from six ultrasound rooms to nine from two ct scanners to four, from two mri scanners to three. the emergency department expanded capacity to 52 beds from 35 and we are now embedded within the emergency department. so 24 hours a day we staff a crew of people, x-ray techs and ct techs who work in the emergency department and the operating room also greatly expanded their capacity. all those areas we work in. one of the good things about the opening of the new hospital is for radiology it finally

separated our out patients who walk in for their general x-rays and their routine mri and ct scans from inpatients who tend to be much sicker and emergency department patients where everybody used to come one place and kind of all wait in line for the same small number of rooms. that's meant that we have to staff those different areas. in order to have out patients come to the old building, building 5 and inpatients and emergency room department patients come to the new equipment in building 25. we also have some out patients coming to building 25. the first slide we are going to look at is just a brief over view of the registry and over time use. just to highlight a couple of things. i know you already heard some statistics and seen some numbers. there

are four classifications in discussion today that 2467, 2468, 2469 and 2470. the registry use for the calendar year 2017/2018 has been about 15.78ftes of registry use. like andrea said that's mostly been in the -- one the general x-ray classification. since we moved our exam count has also gone up and the next slide is basically just an agate sum of all radiology exam counts. we've seen the biggest increases in volume in our department in competed tomography, the operating room, internationally radiology and general x-ray. again, all of those places are now -- all of those areas are

now functioning in multiple places all at the same time. our wait time has been discussed. andrea discussed our tnaas, the third next available appointment. of concern is our scheduliing cue that's reached very high proportions. so for example, right now there's 396 people waiting to have their ct exams scheduled. those are out patients who are coming from the neurology clinic, 1m, the richard fine clinic for mr i332. we have been able to recruit some stenographers.

we've hired four new. they have been hired at step five and six of the ultrasound scale of a 7-step scale. we've held interviews for ct and mri over the last year and a half with either no qualified candidates or the two candidates who were offered positions dekleclining positions at other hospitals with higher pay. the pay scale for ultrasound stenographers just briefly shows that particularly at the entry level we are $3.50 behind the next lower institution. our reliance

on registry is a revolving wheel of technologists coming in and out of our department. from the period of june 16th, 2016, to june 26th, 2017, nearly 20% was on registry because of the expansion into the new building. there has been an effort definitely on the part of the new radiology director to reduce reliance on registry and increase the civil service position. we are still using a great deal of over time and still using registry to meet the

demands in the different places. there's improved patient care for patients. and to meet the needs of our radiology department patients. add an extra step to recruit and retain people. to look into converting registry hours and over time hours into permanent civil service position and to create an internal per diem classification and stop the reliance on outside registry companies. many hospitals have this internal per diem classification.

>> sheehy: we should probably head to public comment. anybody who would like to testify i have cards and i will call out names. on the right i have bob ivory and then talib -- i'm sorry, i'm going to butcher your name, abu. allen ridge cooper. i'm just talking them in the order of my stack. holly johnson and mark rose. i have more but this is to get us started to people don't have to stand up forever. then you have two minutes,

please. >> when he -- when we moved hospitals it's a beautiful unit. with all respect to they did expand the radiology department but when we went from the new hospital. the hospital is running well over 110% capacity for the past 6 months. so somebody has to take care of these patients, both in the emergency department and in the department over staffed and

understaffed. so we are here to take care of the patients of san francisco. we have a new beautiful hospital. we need to get the maximum added to hire the right people and put them in the right jobs. if i have a minute let me just say as a 35 year emergency department nurse i want to echo what andre said, i've seen gun violence and taken care of gun violence and i hate guns. thank you for the service today. >> sheehy: next speaker. >> my name is talib. i'm a tech. the scanner creates a strong and visible magnetic field that's on 24/7. it does not turn off. it's always on. the field that i'm talking about is about 30,000 times stronger than the magnetic field of the

earth. so imagine a magnet of that kind in this room. imagine that. it seems like a hypothetical but it can turn into a tragedy. a 6-year-old boy died after an oxygen tank was brought in the room and it flew in and crushed the skull. this is real. here in the bay area a 17-year-old girl suffered a bun because the tech failed to remove something. in a hospital less than three miles away a doctor was pinned between a magnet and a bed that was brought in. these are all realful according to the american board of mri safety there are almost 7,000mri related accidents here a year in the united states. the sad part is 85% of those are avoidable.

now what do we do? our accre t accrediting bodies created some guidelines that are considered the standard of care how we practice mri. guidelines say two techs per scanner. at the zuckerberg of san francisco general we do not do that. we do not have the staff. we are stretched really thin and we work in a very high stress environment. all you got to do is pick up the phone, call ucsf. i've been to stanford. we are the only hospital -- >> [bell ringing] >> sheehy: thank you. next speaker, please. next speaker. >> hi. hi name is ellen ridgecooper and i've been a stenographer at the general for over 20 years. i would like to clarify that the 15% raise that they said was eligible for

ultrasound is only one person is eligible for that raise on that. i've been a senior tech there for about 20 years. my salary is a step 7 out of 7. i've maxed out my salary ladder many, many years ago. when asked payroll to grant us more steps so we are competitive with other hospitals and the hospitals that were most closely related to were ucsf and keizer, they have 12 steps. we already had preexisting salary ladder for the nurses that had 10 steps. we were declined. we are still on the seven steps. we've actually -- actually our four newest employees were hired at step five and six. we haven't been using one, two, three or four. so this means that within three years they max out on the salary ladder and will be making the same i do after 20 years. 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