francisco, but i'm wondering what happens when there is workplace violence in terms of who is -- i mean i know you're directing the data, but are the police called? what does it look like when a nurse is injured, what happens? >> right, so the first thing to be mindful of is we're doing everything we can first to try to prevent episodes of violence. so all of the training we're talking about hearing from staff, getting their ideas, this is the most important thing is to prevent the episodes to begin with. when an episode happens, and this can be -- it doesn't have to be a physical assault, it can be a battery, meaning a verbal assault. in fact, we know in the first two months of this year that about two-thirds of the episodes that are reported are verbal assaults. what we do, we encourage the staff to report the incidents. one of the things we want to try

to encourage is what we call a culture of safety, where everybody feels comfortable reporting everything all of the time so that we have the ability to respond to it. then what we do we have this detailed questionnaire and tool kit where we do a long series of questions. i think it's 54 questions in total, that is developed by cal osha, so we respond -- we figure out all the details about why that happened so we can address those. and then we provide whatever support that employee needs, whether it's emotional support, whether they need attention in the emergency department or any kind of physical or behavioral support they need. so it's quite a lot that we do to respond. >> supervisor stefani: i just want to make sure, too, because if a violent incident is occurring, like say someone is under meth induced psychosis and

in that moment a nurse's life is threatened, how quickly -- i know there is the deputy sheriff. i just want to make sure the response time is quick and that's what i'm trying to get at. it's not just verbal assault from what i heard, especially with p.s. and what we're experiencing on the street with methamphetamine and what that can do to people and what that can do to the nurses. >> i didn't mention the sheriff's department. we have a multimillion dollar contract with the sheriffs department. we have posted positions. we have roefg positions. our security director oversees that contract. we have a captain and many others throughout the health

department. i meet with basil and the captain every single week. we hear the data about what happened the week before, what things we're concerned about in the weeks upcoming and what we're trying to do to prevent violent episodes on campus. >> thank you. before we open -- actually we're going to go to -- we're going to ask the union to come up and speak. before we do that, just going back to the question while you're up here, doctor, of the emergency situation that we're in. and emergency situation that we have been in. when i add up all -- just from the presentation itself, when i add up the shortfalls that you have and the way you're saying modified duty, when i add that

up, it comes out to over 100 positions that are not filled. so that -- that has to be a cause for concern when you have a full-time staff of 877 -- when i add it up, it comes up to 158.7 based on what you've presented here today. your ftes are 877ful >> that's just nurses. >> supervisor safai: that's just nurses? so going back to that question, that has to be a cause for concern in terms of where we are, in terms of the overtime, overuse, morale, all the things you're going to hear today. even without the coronavirus, it seems like this is a crisis for our front-line trauma center. what are we going to do -- i understand r.h. wants to audit and come up with a hiring plan,

but shouldn't we be moving aggressively as possible? >> i couldn't agree more. this has been an issue that is very challenging for us. we have the same goals as you do, as our nurses do, as other staff do. we want to fill the positions as quickly as possible -- >> supervisor safai: is there anything we haven't asked. i want to hear from the nurses themselves, but is there anything we haven't asked for? what is it that we can do to remove the bottle neck so you can get well qualified trained staff in the positions and not rely on contract and per diem nurses? >> i think the best thing we can do is partner with the h.r. team to understand what the most important bottlenecks, getting

lists for example and taking those off the table. we want to hire permanent nurses. there is no doubt about that. and we stand ready to work with h.r. and to get them hired as quickly as possible. >> supervisor safai: one of the things i've heard from the nurses after working with them, they just don't feel as though they're listened to. when they're in the labor management meetings and they bring the issues up -- that's why they ended up coming to public comment and why they're crying out for help. how can you as a leader of the department, at that hospital, help to push and encourage a more conducive environment for labor management relations? >> that's a great question. and there is nothing more deeply concerning to me than to believe that our staff doesn't feel that i personally, or management

teams don't care about our workers and don't want to take care of them and don't want to hire folks when we have vacancies. i'm in the areas myself. we have our labor monitoring meetings. we have various groups of all types, workplace violence, to try to hear. today i was in the emergency department this morning talking to staff about the covid-19 situation. we had a town hall this morning, we had 100 people packing the auditorium to listen to staff, to listen to concerns so we can address them, so we're trying. >> supervisor safai: do you attend the labor management meetings? do you ever go to them? and if you haven't, i think it would be a good idea to check in going forward. it's one of the things we heard. the labor management sometimes, if they don't see the top leader, then they're feeling as

though sometimes they're not listened to in general and kind of the suggestions are going out into the universe. so if haven't attended those, i would strongly suggest -- it would be helpful to the environment. >> absolutely. >> supervisor safai: for you to attend. >> thank you for the suggestion. >> supervisor safai: do you have any other questions -- i think we're going to move on to the other part before we get to public comment. >> thank you for your support. >> supervisor safai: one last thing, i want to underscore, the know the director h.r. and d.p.h. along with you have the power and authority to adjust this situation in terms of hiring. i would say let's move aggressively to do that. that's what the purpose of the hearings are, to work with you, help you. if you feel you're receiving pushback in city government, it's our role to help you in that process. >> thank you, i appreciate that.

>> supervisor safai: next is vice president of local 1021.

. >> good afternoon, supervisors. and good afternoon guests in the audience. and my fellow coworkers and union members. my name is teresa rutherford. i'm a nurse assistant at laguna honda hospital and dedicated member of employee of the city and county of san francisco. i've worked for the city for 17 years. i'm also the regional vice president for sciu1021, the san francisco region and i represent over 17,000 workers, including

nurses, including nurse assistants, including janitors. we all form the team that takes care of the city and county of san francisco. today we're here to focus specifically on our rns who give superlative service every time, but the issues we're dealing with are systemic as has been already raised by several speakers from the board of supervisors. we also want to point out the fact that the issues that we're raising were raised in 2018 at bargaining. they were raised in 2016. they have always been raised. and so this is not new. and it's a shame that we have to come all this way in front of the board of supervisors to talk about an issue that should have

been addressed years before. it should not take 17 years to have a job analysis. when we've been talking about this problem, when patients have been harmed because of the short staffing. we should not have to come here to talk about staff being harmed, staff having to work overtime, multiple times, putting their family at risk and themselves because of short staffing. the managers and people who run the city of san francisco know better and should have done better. we're taking no more excuses so we're here today for solution. no more studies. no more trying to figure it out. you know what the problem is. fix it. we're thankful to supervisor safai for calling for this resolution and hearing to help bring to light the issues our

members, the health care workers at the department of public health are facing every day on the front lines. in order to have this conversation in a thoughtful and honest way we must acknowledge we are here to serve the patient. all of us became health care workers to take care of people and put patients first. we love this city and we are committed to take care of this community. as nurses and health care workers, we are also -- we also have an obligation to call out concerns of patient safety and the lack of readiness for disasters. for years the san francisco department of public health has mismanaged san francisco general and created unsafe conditions for hospital patients and staff. this has gone on for too long.

nurses and health care workers are standing up for our patients and each other and are demanding accountability from the department of health so we can take care of our patients in a safe working environment. as you can take a look at the slide and you will see some of the problems we're facing, the neglect, the mismanage am, the lack of accountability. the result on safe conditions for patients, staff, lack of preparedness for disaster, systemic failure to serve the public. today we're highlighting the issues at s.f. general, but we could have easily spent more days raising concerns about staffing and preparedness at laguna honda hospital, the community clinic, public health,

mental health. i will share for you at laguna honda, for example, they are so woefully understaffed that it has now become a safety risk for both patient and staff. the problem also is that when a staff member is hurt by a patient or hurt in the facility, it is treated with scant regard and there is no outcome -- no good outbreaking for that staff member. in fact, usually the blame is placed on the employee as opposed to the employer. d.p.h. management has known for years about inadequate staffing and its effect on patient care and workplace safety, yet the problem continues.

we will now pass -- ask sasha, one of our d.p.h. nurses to speak. >> thank you, supervisors. i'm a registered nurse and i was at san francisco general hospital until i was -- i was -- my position was eliminated because they weren't happy with me speaking about some of the issues we're talking about right here. i'm now working at the call center that is located up at laguna honda and i've also volunteered for being a field public health nurse for the coronavirus so i'm jumping in the queue because i've been called to go out and test some of these terrified people who are being tested to see if they also are infected with the coronavirus. and the thing that i need to get

up and tell you is that we heard from dr.octor about the public safety. what is in department of public health is a culture of silence and fear. that is what is going on. it's very courageous from everybody to be speaking out about this. i want you to know that during negotiations we asked for there to be nurses in the emergency room to help with -- to help with the problem of severe sepsis, which is killing many of our patients. we have to -- and we were told, oh, no, we can't do that, that is not possible. >> mr. cutler, i need you to wrap up. >> i'm going to be stepping out, but what i wanted to tell you,

this public health nurse's recommendation is that you address the fact that there is toxic bullying that takes place from administration and they don't listen to the nurses and that is something that has to stop because silence equals death. we have this epidemic going on now and there is only a few of us that are trained and have the proper equipment. we want to be partners with the department of public health because we've done it before, why can't we do it again? and the mayor calling for budget cuts at the beginning of a pandemic is madness. so i'm going to be on my way into the field now, so i encourage you keep going, keep asking. >> supervisor safai: thank you so much. the next speakers we're going to call up are stewards heather and martha. it's part of the presentation.

>> good afternoon. i would like to thank the supervisors for giving us an opportunity today. i think that the staff at san francisco general has been working so hard on this issue. many of us for as long as 10 years trying to advocate for our patients. so to see you in your elected positions being willing to advocate for us, makes a big difference. so i'd like to thank you for the opportunity. my name is heather bollinger. i'm one of the e.r. staff nurses and been there for 12 years. for many years i was a night shift charge nurse. i want to start by saying, i feel your pain. i understand how confusing and frustrating it can be to ask questions and be presented with the answer of, i don't have that information for you, or i'm going to have to get back to

you, or i'm not sure who handles that, or i forgot, could you remind me in an e-mail? you're feeling our pain and i'm sorry. it's been a very frustrating situation. the presentation i'm going to speed talk through is edie heavy because that's where i work, but this be considered d.p.h. wide in terms of the extension. first, i want to point out this is not the first time we've been here. we were here in 2014, 2016. we've signed petitions in 2018. i provided the supervisors with a detailed list of the number of things that we have done trying to draw attention to this issue. i want to make it very clear, it's very nice for administration to say they care and they've heard us and they're here and with us. this is why they're here. this is why they're with us,

because we've spent 10 years trying to get them here. these the assignment objection forms that supervisor walton was speaking about. i just have a few examples here. i was hoping to give him an idea of how often that occurs. becauses it's pretty often. that is just the stack i was able to obtain in the last week. so that is not something that is new. these have been submitted to management for well over 10 years and each one of them dictates an unsafe patient care situation for the nurse. this slide indicates the progress we've made in staffing since 2016. this was data taken in 2016 indicating that the emergency department was understaffed 53% of the time, oddly enough november 2019, we're understaffed 52% of the time. one would think the sick calls at that point could be

predicted. i want to give you a snapshot of what it looks like to be in the emergency department at night, not a theoretical, but actual. one of the things that is very frustrating, is our new facility was advertised to the public as a 58-bed emergency department. that's what the city taxpayers thought they were getting. now you subtract the 16 beds closed because of the staffing deficit, subtract the 17 beds with admissions, now you've got a functionsal 25-bed emergency department which is smaller than your last one. add to the 28 active patients that are in the 25 beds, and you're at full capacity. now add the 20 patients that are sitting in the waiting room. that is the picture almost every day. and it's untenable. and what you're doing is putting nurses in the situation where they know they're going to fail these people every day.

i'm not going to go too much into this. we know the budget doesn't meet the current census and it doesn't staff to the current census. if you look at the green line -- this isn't our data, this is their data. the green line is what we're budgeted for. the blue line is the patient load. this is the gap. we're not seen staffing to budget because all of the vacancies. that gap between the red line and the blue line, the bigger it gets, the more negative the patient outcomes. that is a discrepancy in care. the hiring process clearly we don't need to talk about that anymore. but what i would like the supervisors to be aware of, all of those days, 30, 60, 90 days from offer letter to hire, application to hire, you need to add six-12 weeks of training. it takes 12 weeks to train a

nurse to work in the stable areas of the emergency department. just those areas. so you have to add three months, 90 days becomes 180 days. so from the time they post that, 180 days later, maybe you get a pair of boots on the ground. so where does this leave us? reactionary staffing has been the only source. they're using travelers for three plus years. that's not a temporary employee, that's just an employee with no protection, no retirement and no contract covering their work. that is what that employee is. we have 25% of them since 2020 at the ede. they don't get disaster training, violence prevention training and don't get employee protection. overtime. mysteriously overtime stopped

getting paid at time and a half. that 12 hour shift, if you leave and go home, there is not going to be anybody to care for the patients, you stay the extra four hours, that's what you signed up for and your paycheck doesn't show time and a half. they created a new designation called straight overtime. we can't figure it out either. been going on a year. they're mandating overtime in 2019. how do you -- how do you work -- how do you not be completely distracted by the fact that you don't know if you're going to be allowed to go home to your family until the last couple hours of your shift? reactionary programs are installed. they change patients billing categories, but they don't

improve care. our care start program ran out of the waiting room for two years. staff objected to it daily, meeting. there is traffic, e-mails. so many concerns. no policies. no ratios. they didn't listen to us. the state was called in to evaluate it and immediately shut it down. we know what we're talking about and we know our jobs and apparently we know the law better than the people that run our institutions. you can see that all these reactionary programs have not helped our diversion status at all. so what are they for? p.e.s., yeah, they're seeing less people because they're on condition 58% of the time. so their census numbers are going down because those patients are in the emergency department. they don't have anywhere else to go. that's the preparation. like what disaster preparation? i would draw your attention.

i provided you with the disaster and mass casualty program stipulated by title 22. this is state law. this is not a union contract, a request, something we would like. this is a law. it clearly states, disaster plans should be rehearsed at least with twice a year. there should be a written report and evaluation of all drills. i've been in that institution for 12 years. i've participated in one disaster drill in the old hospital. i haven't put on the ppe that is supposed to protect me in a decon situation in three years. i haven't been trained on how to manage what the chain of command was. i was a night shift charge nurse for many years. i alerted my management multiple times that we were concerned about what would happen on a saturday night at 2:00 in the morning when the earthquake hits.

because the staff are frightened. so that's where we are. and my colleague martha bear is going to let you know what this means for our patients. >> thank you can, heather. i hope that was as powerful to the supervisors as it was me listening to it. the struggle so many nurses have been in so long to get an ear is very moving to me. it's also moving to me that our patients suffer from all the things that you're hearing. we're very dedicated people. nurses are good people, we're short on ego, we're long on competence, we do our jobs because we care about people and we don't like suffering. what we see because of these problems is more suffering that could be fixed. so patie not going to spend time on this.

heather really gave you the story, but the patient experience due to these problems with staffing is obviously negative. i work in primary care. the worst -- the worst day of my week is when i have a patient who is decompensating, running out of breath, turning blue, sweating and i have to say, we got to get you to the emergency room. and the patient says, no way. [please stand by] [please stand by]

>> to make my point, i would just suggest going on to yelp, and look at some of the reviews of the san francisco general emergency room.

so that brings us to -- where does that leave our employees? you've heard a loft data about this already. 23 assaults in the emergency room in one month. okay. we know these are not all being reported to the state. we have -- we have suddenly a new violence workforce, taskforce. there are 14 people on that taskforce to address violence problems. there is one nurse. i just want to mention -- this is another slide about mandated overtime. i just want to clarify. so what this means is, if i'm a nurse and i have planned out my eight-hour shift coming up, and i know i have my child care set up for 10 hours later, and i've organized with my family that we're going to do "x," "y," and "z," and

i go to work in the psych emergency room, which is probably one of the more high-stress jobs in the city of san francisco, when i get to hour searching they can say to me, you need to stay another seven hours. the employee has no choice. the city likes to go to very expensive consultant fees to get help when there are a lot of us here who would like to help. they consultant group do a survey of employee satisfaction at san francisco general. i'm not going to read through the whole slide. [buzzer] >> it took us a year to get the data from that. i would argue if you're struggling getting information from a group of people and they keep

deliberately obfuscating with run around, there is something that is not right. i don't know where the money is going to the m.t.s that are empty year after year. i hope they're not going to car repair. [laughter] >> and last, i just want to point out that as you've heard, a number of attempts are being made. i find that to be convincing that, there are attempts being made now to fix some of these problems. but what's wrong with that is that there are 10 years, at least, before any of those things starter. and these people are angry. nurses are very angry. and now i'm going to hand it over to jennifer. >> before jennifer -- jennifer, before you

speak, supervisor stefani needs to make a comment. >> i want to thank you for your presentation. and let everyone know i do have to go. supervisor haney asked me to fil fill in for him, and i could only do so until 3:30. i look forward to watching the hearing and hearing all of your comments. it is very important to me. i have called previously a hearing, in terms of the rate at which we're filling vacancies on for responders and nurses -- it is a hearing i will have again to discuss this issue. i wanted to let you know i'm only leaving because i have to, and i will be watching the rest of this hearing. there are a few of you that have come to public comment and i wanted to speak to you further. thank you very much for being here today.

it'>> it's a tough crowd today. mrs. secretary, is it possible to (indescernable)? so what we've talked about a bit has certain origins, and it may not be car repairs, but that are mayoral priorities. the mayor has stated very clearly in her budget plan she wants to reprioritize funding. she says she wants to be responsive to residents and support city workers who are out there trying to make a difference. and yet 3.5% budget cuts have been suggested. 3.5% budget cuts across the war board in every city department. even though right now we

have this e-raf. for e-raf, in 2019, there was an additional $250 million. the city is projecting a budget shortfall of $420 million, but if we use e-raf funds, that completely covers the shortfall. you guys have heard all about the dereliction of duty coming from the city of san francisco, the department of public health. can we switch to the slide. i'm sorry, guys. i don't have the ability to go back and forth. so we have a lack of accountability. we have a lack of transparency, and we have a lack of resources. all of this is unacceptable. the steps to a solution are that we request an immediate formal, independent budget audit and performance audit of the department of public health. we demand that the budget

be immediately revised so that people can be hired, so that this budget cut that the mayor is proposing goes away. because the reason that we're focused on temporary staff, registry nurses, is mainly because the mayor continues to say that e-raf funds have to be yufused for un-time one-time spending. can you switch back to this one for me? >> you kind of have to. >> the mayor says one-time spending. can we go back to the slide show? we want to fix the hiring process immediately and expedite frontline staff vacancies right now. we want to make employment rational so we can support executive leadership staff that have failed to

address these issues by having a rational process. it is no longer dependent on leadership. we want to have comprehensive training for disaster preparedness, pursuant to state law. we want protection for every employee in the hospitals, not just nurses, but everyone. we want to keep the department of public health management accountable believers and we want t.we want frontline care represented on the health commission and the joint commission, so that we can be hui sure that executive leadership is held accountable, and we can be sure that people who provide care on a daily basis to our community are the ones who give the feedback and the input to the mayor, not just special appointees. can we switch back to this

one now? so...i just want to share with everyone the mission of the san francisco department of public health. i don't know if this is big enough for everyone to read. basically to quote directly: "the mission of the san francisco department of public health is to protect and promote the health of all san franciscans. san franciscans." not san franciscans with money, no some, but all. the ultimate goal is to ensure that san franciscans have optimum health and wellness at every stage of life. that's hard to do with 3.5% budget quotes. one last quote comes from the health commissioner executive secretary. in 1983, and in 1984, general hospital's accreditation by the joint commission was in jeopardy. the hospital did not have an affective governing body and had antiquated

management systems and staffing shortages. we heard from hillary ronen today, and she called it bizantine, antiquated, it sounds the same. we've heard about staffing shortages. we've asked questions of our management that they are unable to answer. it seems similar. in addition to these accreditation issues, there were issues with ambulance response times. that's first responder issues. we're talking to e.r. staff who are on diversion 60% of the time. even then, many people in the community felt that the city mental health is not responsive to the needs. remember mental health s.f.? sounds similar. so the joint commission was created so that the city could make budget and policy decisions more transparent because the business would be

conducted i in public meetings. when the joint commission was created, after this 1983 and '84 crisis, the aids epidemic was under way. and it was the frontline staff then that brought ideas, that created 5b and 5a, which became our aids ward in san francisco general hospital. the nurses themselves physically erected the ward. it had previously been sleeping quarters, and instead became a life-saving unit. right now today we have nurses and frontline staff speaking out and bringing forward the problems in the department of public health. we're very appreciative of having this moment so we can bring these issues to the forefront again. we hope just like then, right now we can also help to lead the creation of something new and better. thank you very much. >> thank you.

i think we're at the end of the presentations. right, jason? i think we're going to open it up for public comment. each person -- you can do it by the speaker cards? would you like to do it that way? okay. so i'll call your name, and you can line up on the side there. if i haven't called your name and you would like to speak,please also line up. sonya reyes, derrick richardson, diane no yenez. debra -- i can't read it -- waniski. amelia aire. naomi shonfield. each people will have two minutes. if you would like to state your name, please do so. the first speaker, please. >> good afternoon, my name is wendy. i'm a member of the

public. i came here because i saw you guys on tv talking about this, and i was going to be at city hall anyway. i have been a family care-giver. care-giver of three of my family members. and i'm about to be a care-giver again, an unpaid care-giver, for someone who has throat cancer, and will be at san francisco general. i am appalled to here what has been transpiring. i know firsthand, as a family care-giver, that nurses do everything. and, um...and as a former retail worker, being the face of any organization, restaurant, or whatever, we had always been required to, you know, smile and be nice and so

on and so forth, while taking care of people's needs. and i cannot imagine a bigger disconnect between nurses, who have always been great to me, my family, and my community, while hiding behind the things that i have heard today. so, um...another part that i want to speak to -- [buzzer] >> -- is the fact that, um, the city of san francisco spends $7 million per police academy class, with graduates of about 35. and people come out and they make $100,000 with no student loan debt. i don't think it is the equivalent of nursing.

>> thank you. next speaker. [buzzer] >> hello. i'm derrick richardson. i've been an emergency room doctor at the general since 20 is 13. 2013. and i'm here to support and advocate for my nursing colleagues. i would like to share a video from one of my nursing colleagues who couldn't be here today about her experience in e.r. >> make sure we keep it in the timeframe. can we just pause the time for a bit? >> okay. so -- >> hang on one moment while i get your audio. [applause] >> it should work for you now. >> i was violently...

[no audio] >> by a patient on october 3, 2. we see these types of patients that are often dangerous and agitated often. the patient punched me, pulled me down by my hair, slammed my head against the floor and clawed at my face. and there was difficulty getting the patient off of me. this assault was handled poorly by the hospital administration. some saw me shortly after the assault and asked what they could do. i knew this violence in the workplace was a very serious event, so i made a point to return to the e.r. four days later and talk to the e.r. staff and management about my safety concerns and the concern that this will happen again and someone might get killed one day. [buzzer]

>> i even spoke to this at the management meeting in person at the e.r., and was heard by e.r. management, the e.r. director and physicians, and they assured me they would follow up. i have not heard anything back from anyone at the hospital since then. i asked in writing to know if this had been reported to cal osha, and to clarify safety issues in the e.r., and no one has returned my e-mails or phone calls. i was not even paid for the shift after that. [buzzer] >> i think your time has concluded. >> thank you. >> next speaker, please. >> hello. i'm debra wineki, and i'm a registered nurse at san francisco general hospital. and i've been working there for almost 35 years. and i have heard the same

responses from management for decades. and i feel like it is just paying lip service to the labor force that works at the hospital. i work in the o.b. department, and you'll see one of my co-workers back there with a stack of requests for staffing over the last year. we had over 350 requests for extra staff in one year, and many of those requests were for two or three nurses. i feel that o.b., labor and delivery, gets staffed better than many other units because we're a very high liability -- we work in a high-lie detectorliability

setting. so, you know, trying to find out how to fix this -- and i think that over the years the mantra has been: human resources, human resources, human resources. [buzzer] >> so i think maybe there is something to that, and human resources needs to be, you know -- human resources needs to be focused on. we have a very high turnover rate. i don't think that the recruitment of nurses is nationwide. i think it is very small. the recruitment and retention -- [buzzer] >> thank you, ma'am. thank you. next speaker. >> hi, good afternoon. my name is diana anis, and

i work at the birth center at san francisco general hospital. we often don't hear about the birth center because we're supposed to be the happy place. but we're not very nurse-friendly. these are the 359 e-mails that debbie was talking about, asking for nurses, and they say things like, it is 2:00 in the morning, if you can't sleep, please come to work. if you don't come to work, your co-workers can't go home. if you don't come to work, no one is going to get a meal break. the nurses last year missed a thousand plus meal breaks. that's a thousand times a patient had to have a nurse that didn't rest, that didn't eat, and it is possibly even mandatory overtime. we know that maternal death is real. babies are born that need resuscitation. it used to be an exciting experience to be at a mom's birth, and now it is a scary experience because

we decent know if we're don't io get that second nurse to help with that newborn resuscitation. i've been here for more than 30 years, and the story doesn't seem to change. we're going to hire. don't worry. it's going to be better. it hasn't gotten better for 30 years. and working at the birth center, the baby-friendly hospital is not nurse-friendly, and it is getting tiresome, and the nurses are burned out. [buzzer] >> thank you. >> you still have 30 seconds, but thank you. next speaker. >> good afternoon. thank you for listening to all of us. my name is suzanna kylie, and i'm a registered nurse. i would first like to start by emphasizing that as a nurse, and all of us as nurses, we're accountable for our actions or non-actions. and i'm expected to show up every day at work prepared. i cannot ignore or

otherwise not answer questions and get back to you later. i don't think it is an unreasonable expectation that others perform their jobs with that same level of accountability. i currently work in behavioral health. and in three weeks i will begin working with the whole persons integrated health, also known as street medicine. i began my nursing career 36 years ago here at d.p.h. i worked on 5a in the '80s and continued working in h.i.v. care in the '90s. all of my career choices have been informed by my commitment for caring for underserved communities. i believe this kind of commitment is what drives all of the nurses in d.p.h. to continue working, short-staffed. s.f. d.p.h. has been propped up for too long by these hard-working, committed nurses. and the chronic understaffing has tested the resolve of great nurses and broken the

resolve of many who have left. with currently chronically understaffed system, the ability to care for our clients has fallen short, which is unacceptable. [buzzer] >> it puts in the question of this gasping system's ability to affectively respond to the coronavirus. the time for corrective action is long overdue, and this is certainly no time for budget cuts. i thank you for your time. [please stand by]

>> my name is herbert weiner.

with patient safety this resembles the schoolyard and the bully victim and bystander. >> we're faced with the coro coronavirus and it's an a question of one disaster preparing for another. >> i have a master's degree in social work and ph.d. in clinic psychology. i applied for medical and psychiatric social workers countless of times and turned down based on the one of three rule. i hope this doesn't happen to

other people. but basically the hiring had to be streamlined and we need it now more than of. this is a national emergency and even a question of homeland security. >> thank you, next speaker. >> i'm a nurse at san francisco general. i have a lot to say but going to tell you what happened sunday morning when i was the team lead and we have six rooms and that day we were short one recessed nurse and got to the point where we had 12 critical patients in the resuscitation. i don't know how you can wrap that around your head but the reason why we couldn't move any of the patients is because we couldn't staff the rooms in pod

a. there ways cpr in progress that came early in the morning. my co-worker was working on it. the patient passed away and after she walked out i did not have time to let her decompress or think about it. i said i need you to hop in because there's another cpr in progress. cpr in progress means you need at least three nurses in the room depending on the cause. and we only had four trauma nurses assigned. this is not isolated either. i was put into a position where christen went into the room and had a patient with a bone stick out of his leg broken obviously. and she said chris tan can you come in and help me with medications. i said i can't because yefr --

every one of my trauma rooms is full and i needed help and she said i'm sorry i don't have anybody to send you. triage called me and said they needed to give me another patient. this patient was ill as well and i said all right put a gurney next to the storage unit and we'll try to figure it out. >> thank you, next speaker. >> hi, i've been at the general 15 years in the emergency department for three. i've stoken at these things -- spoken at these things quite a bit and my generalized statement si don't want you to fix the problems alone i want to film them with you. after the incident with corina you saw in the video i joined the emergency room violence protecti protection task force and never missed a meeting and will be there march 30th to try to fix

the problem in the emergency department. unfortunately many requests have been made for the workplace violence prevention task force for me to attend and be a part of that and every time we heard no. so if you don't mind i'm going to take this opportunity to say dr. urlich do you mind if you join the hospital-wide prevention task force. i'd like to stand by you with you and help this problem. i really would like to help and put my name. put me in. >> please direct your comments to the panel here. the committee. >> thank you very much. >> thank you, next speaker. >> so folks understand there's rules of decorum in the chamber. you have to address public comment to the members of the board of supervisors. >> i'm rebecca grant a nurse

practitioner in the emergency department. i've worked as an rn and nurse practitioner. most of my job is performing in the triage area after the illegal care program was dismantled. what that means is i greet each and every patient who comes into the doors as much as i can. sometimes there's 25 an hour and i analyze them and screen them and see if i can refer them to their primary care to the urgent care clinic to p.e.s. and the urge urgent care is closed and the patients are telling me it takes months to get appointment to their clinics. if the refer them to a primary care provider it takes at least six months to get a call because

the list is over 1300 patients long. that's terrible. basically we've all been working very hard to get our leadership in the department in the hospital level and now we're here and we appreciate you guys listening to us to hopefully urge the department of public health and the h.r. department to hire more nurses and staff and the community clinic and micky callahan i was told is responsible for blanket firing and all dual rec questions for the -- requisitions for the temporary exempt positions and we're waiting on nurses and i was let know via e-mail anyway i think we'd like to know how many people are affected because the patient loads were immediately dismantled and it's a big deal.

>> i'm bob ivory a retired nurse and i've been on the bargaining team for 25 years so i want to give you historical background. everything these young nurses say has been going on for 25 years. it's not the hospital is under staffed but under budgeted. the union was in bargaining and we asked how many new positions are you going to put in. the answer is we don't know because we don't know the right size until a study and we don't know. it's not hard no figure out how many nurses it takes to run the department. i wish all the temporary nurses under the charter were doing

relief work. however, in violation of the charter, they have opened whole new floors, departments with no budget for registered nurses. they've had to rely on creative staffing through ftes for travellers and did i -- per diem. if you look at the budget you'll look at 500ftes a year. i'll address this to you maybe mr. brown when he comes back next continue how many nurses are participating on his task force. what their names are and have they actually been released to got to the meetings. thank you very much. >> thank you, next speaker. >> i work in the emergency

department. thank you guys for having this hearing and many more that might follow. i'm reading comments from a colleague of mine and the poor resources on the guaranteed coronavirus outbreak and we have a lack of preparation for managing the patients in other hospital the patients are going to other units and often bypassing the e.d. we're losing quickly without replacement and have no one in our disaster position. they have one person persist? i worked the past two shifts but there's no space. one without the other is useful in either direction. the lack of leadership and transparency by the nursing

director is a big problem and the engage. the survey after a year or more. i find it insulting the only i time we see the ceo is when regulatory supervisor visits is happening. and sarcastically i'm glad they're working on violence in the e.d. the whole hospital went to [bleep] when they went to the lean model even when they identified the needs they don't act on it. why even do it then? it's a waste of time, resources and money. we need a strong leader that can identify the problems and have the inside experience to make the changes needed to accomplish this not another work group. that's what i have for now.

nothing was changed. >> thank you, next speaker. >> hello. i'm also one emergency department nurses and also a steward. i have a portion of our petition that we submitted to the health commission back in october. the one thing i do want to talk about in administration is administration including chief officers ceos and chief nursing officer failed to provide consistent experience and ethical leadership for our department. as a level 1 trauma center it serves over 1 million people and consistent organization has been overlooked since e.d. has been functioning since a revolving panel in the last 10 years. the current nursing director was hired in february of 2018.

since may of to 19, 50% of our managers or people in our leadership positions have resigned. they're reasons include but no not limited to the development of new programs that affect be patient care, implementations of new programs against the objections of nursing staff and leadership and intimidation by management to remain silent on issues that affect safety and exclusion of the frontline nurses in programs and procedures and intimidation in regards to procedures of policies and the leadership style at san francisco general hospital has created a culture of intimidation and fear the employees fear advocating for their patients and avoid interactions with management whenever hospital. the hostile work environment is having detrimental effects on the mental health of staff and there's no chance for the

members of the health care team to collaborate in a way that must be to provide comprehensive and compassionate care to our most vulnerable patient populations. i did submit something for the record for you guys to see. >> thank you. next speaker. my name's and i've been an e.d. nurse three decade and i hung up my scrubs and retired but the subject's still dear to my heart and one thing i think of is the culture of austerity that seems to take root in public services in general and you get used to doing work arounds or figuring out how to glue things together. and i think the public's starting to wake up so this there's no excuse in a city as wealthy as this there should be

no reason to not bring in enough people you can staff adequately. one thing i look at is the culture of wishful filaments and wills never have babies or go on leave or get sick. that's never going to happen. i think 20% with us cited. that's always going to be there and if we had per diems co cover that you're covered but instead they're covering all the wrecks and all the positions that are unfilled so there's nobody around when you need a training program you're cutting down to muscle. nobody's left. we're not getting to a world where everything goes away. it's always there and you need

toan toance -- to anticipate that. thank you for hearing this. >> thank you, next speaker. >> good afternoon. i'd like to thank the board and everyone here for their time and attention for listening to this important issue. my name is cheryl randolph. i've been a registered nurse at san francisco general for the past 22 years. i take care of the overdose patients and make sure they continue to breathe. i take care of the trauma patient who thought this was just another day and now clinging to life. i take care of you, your friends and your family. i've always been proud of our dedicated and professional e.d. staff but i'm not proud now. now i'm afraid on a daily basis. i'm afraid this is going to be the shift when a patient's going to assault me more severely than every other time this has happened. i'm afraid this is the shift when i make a fatal mistake because i'm trying to do more work than a single nurse can safely accomplish. i'm afraid this is the shift my

nursing license is in jeopardy and not conforming to the required standing of care and when my experience and training don't matter because people have needlessly died. e.d. nurses have always been willing to suck it up and go without breaks because it's always short staffed and take care of more patients and we try to do right by fellow nurses. here in california nursing is protected by ratios. meaning a particular number of patients to nurse. while that protects us both it limits how many patients may be treated in a timely manner. on a daily basis my e.d. is impacted by patients taking 50% to 75% of the available beds and wait hours and sometimes days. that means the e.d. nurse takes care of floor patients in the waiting room swells with patients who wait for hours and hours. we need to refocus on patient

safety by ensuring safe nursing staffing. i respectfully ask the board to approve funding or any other measures to help staff. >> thank you, next speaker. >> i'm a registered nurse. for nearly 10 years i worked at san francisco hospital trauma department as an e.r. nurse while i left sfgh after my first child the mafg -- amazing nurses and doctors are still near to my heart i'd like to ride a statement for someone who wants to remain anonymous for fear of retaliation. the staff has been one of the more poorly run hospitals i've worked in but has gotten so much worse. this administration is known to offer false promises to anyone who comes to them for assistance only to appease them and then do

nothing. i find it extremely upsetting now that our strong union folks have called the administrations out those same administrators come running to our department when board of supervisors visit to buffer and present a misleading view to you of our department. in all my years at sfgh and when i've seen my chief nursing officer in our department. what are they trying to hide? when nurse were threatened they shut the door. the budget sin surplus yet administrations have not been paying staff nurses and clerks for overtime. i'm going skip the letter and when came from new york as a trauma nurse from the time i was

interviewed and on to the floor it only took three weeks sow i know -- so i know the problem can be fixed. >> thank you, next speaker. >> i work in emergency department as a nurse r.n. and been there 28 years. i've been there a while and it's been good to me and i've seen a lot of changes and different situations but i feel we're not properly equipped to manage and take care of the behavior and psychiatric patients which is ef departmentally increasing because of the homelessness and meth use and we're in the emergency department and we have four rooms for them which are monitored but the rooms are doubled. this is not right. it's very difficult to look the

highly difficult stressful patients and unfair to the other patients and unsafe for the staff and i've seen many situations, violence has escalated. i'm one of the nurses recently violated against and was there the day the other nurse who reported was assaulted. so i just feel it's difficult. i know they're having a hard time and on red alert. since we moved to the hospital i feel they've not been great because of the geographical distance. the psychiatrists rarely come to the emergency department and we become the p.d.s. thank you. >> i retired in 2018 from 12 years on the lift team or safe

patient handling service and it's not just nurses in solidarity but cnas also have the same problems. i was on the lift team and the team should have two. if either of anyone called in sick or was on vacation you worked by your several and that's the way they rolled. i submitted to my superiors some ideas for creating a safe patient handling department including an educational component for bedside safety for the nurses but basically ignored. i love the people and love the work but i couldn't stand it and bailed, i have to say. there is a moralee -- morale problem there and it would be a great morale shift if you staffed sufficiently and it's come to my attention it takes four supervisor to put a motion

on the ballot asking the people if they would like to return the name of the hospital to san francisco general hospital. i think that would do wonders for morale. >> next speaker. >> i'm mike hill a nurse in the e.r. since 20134. 2014. thank you for letting us speak. i was going to raise doubts in your mind in handling disasters and preparedness and i think it's abundantly clear and we have two confirmed cases. we can't even staff for a regular patient load. we joke how many people are in the waiting room, 40, 46. how many people are we holding that can't go upstairs? 20, 30?

how many hours have they been here, 26 hours? 36 hours? this is day to day. how are we going to ever handle a crisis like we're going to be faced with pandemically? s i haven't had disaster training since 2017 and we have a facilitator that retired six months ago. unfilled position. it's crazy, right? we're in the midst of crisis and we don't fill the positions. it's attrition. she's gone. i have nothing more to say but it's historic to feel this closeness with my co-workers and respect and admire all of you so much. >> thank you, next speaker. >> i'm megan green a nurse in

the oncology and palliative care unit and also the same floor 58 is on. it's unbudgeted and has been the default overflow for the e.d. the e.d. has been bombarded with patients as mike said. if there's admitted patients downstairs and no bed upstairs there's nowhere for them to. before the most recent contract negotiations we were frequently being asked to come in for overtime and still haven't been paid and later we were told we were never under staffed. after public pressure we were told we'd get a float pool and don't have one and there's 50 beds in 58 accounting for 38 bedside nurses not including a chart and break nurse and we're pulling nurses from other units.

i worked last friday, saturday and sunday and for two of the 12-hour shifts i got one 30-minute break and one 15-minute break for a 12-hour shift. this happens quite a bit. i'm not sure you want to be taken care of by a nurse with a 15-minute and 30-minute break. my co-worker was covered one nurse per break the other had a decompensating patient that needed to be brought down to cat scan when she left to go to cat scan she had seven patients. we wish we could say it's infrequent but it happens all the time. nurses who are burnt out call out sick. there's been multiple studies and we're told not to come in sick when we're sick and then blamed for short staffing when

sick. >> next speaker. >> i'm a registered nurse in the med surge unit and in supervisor heaney's district 6. mike dingal brought up about not just being a registered nurse understaffing but very much to do with our support staff not being at the bedside to help us. registered nurses have a defined scope of practice and have things we have to address and many things that fall outside of that. however, at san francisco general in the med surge floors if you're a danger to others or of falling you don't have the attention of a nurse's aid to make sure you're safe to address

the issues a registered nurse doesn't have time to address because we're fulfilling our legal duties. it has led to patients who are already angry feeling as though they're being avoided. they've become more agitated. this becomes a direct danger to the nurse. we know in hospitals all over the country assault is a big deal and many nurses every year are hurt and taken out of work for that reason. just a quick example i had a patient who was quickly running out of steam and unable to breathe on her own and addressing her and called for assist. my work phone kept blowing up.it was going and going and nobody could help address it until finally i was able to go to the other room and see what it was. a patient spilled their urine and the floor and needed help cleaning it up. it's not a reason to leave an unstable person's bedside. we need help and to be

addressed. i appreciate your taking the time and i yield the small business of my time back. >> thank you, next speaker. >> good afternoon, supervisors. i'm aaron kramer a registered nurse at san francisco general hospital 12 years and work in the cardiac lab. i would like again to thank you and all my colleagues that came with me today to speak and share a taste of the reality of what he public health care is today as we speak. it's short-staffed and stressful and dangerous. these are people's lives we deal with. we came here today because we need someone to listen to us. it's the feeling of the nurses at general hospital that we as the frontline staff we try and voice our concerns.

we try and speak out and speak up and we're met with this wall and many nurses speak to me as their union delegate they don't want to get involved or want to do anything more at general hospital because they feel a feeling of fear and intimidation and a culture of that and it's the scope of public health for san francisco general. i want to speak quickly on behalf of some of my colleagues. the meat and potatoes of the hospital as reported last week to the health commission 25 vacancies. again, my other colleagues spoke to a contractual obligation negotiated last year to help support med surge with a lift team. still unable to hire and staff that. i have petitions that are trauma

med surge unit. the whole staff submitted asking for help. really quickly for the record, for labor monitoring who i serve as a delegate for we had to file a grievance last year. >> next speaker. >> good afternoon supervisors safai and supervisor mar thank you for having this hearing. i'm with local 87. we represent the janitors and private sector and you may be asking what does the janitors' union have to do with this. we had 86 janitors here this afternoon. we had to pull them off their job today because of the fear of coronavirus. all those janitors were here because they wanted to be able to have somebody speak to them. these shortages in the

department are affecting everybody and nurses are the first responders when they're in a situation and nurses hold us literally physically up when we're at our most vulnerable. supervisor ronin and walter and supervisor heaney, they've all spoken but i wish they would have stayed for the remainder to hear the stories and witness tm of -- testimony. you can't give us the big words and then leave. i'm here because i understand the department has had its setbacks but this has been going on a while now and last year i happen to hear terry anne speak and how successful being able to fly in nurses and contract out nursing was working for the city. i find shame in that because these are workers being replaced and nurses deserve to have

anything knit on the job. -- dignity on the job. janitors are here because we want to make sure we're heard and an understand dr. brown you started three months ago but you're inheriting a ses pool of problems we hope you can guide and lead us to what needs to be fixed. i understand decorum but what you don't understand and everybody else in the back is my family and everybody's families -- [bell] >> thank you. next speaker. >> supervisors, it's incredible you did this. it's what should happen but it doesn't happen and it hasn't happened and so it's a profound thing that has happened. i say this as a nurse who's worked for the dph32 years and i can't imagine life without

janitors. nurses and janitors are working most closely with body substances. let's put it that way. i want to tell you how i got introduced to the culture of silence. there was a budget cut slated to cut our interpreters three years in a row until chris daily said if this happens one more time -- i knew the nurse manager of the interpreters office had important statistics and i was at a hearing the health commission or here and had the naiveté to slide over to the chief nursing over and say why are nay not up here -- they not up here giving the data and she looked at me like i had four heads.

she said he can't talk. he's the boss of all of us. i learned we can go to our head nurses and manager and go to the cno and they'll put a whole different spin on it for the people above them. for a whole host of reasons. the whole culture of silence. culture of safety. we go in the loop we've been going to the health commission for months and months. finally, we speak nothing back. we have to listen to the presentations that really if they're not live they put a nice bow on things and so we chanted a meeting down. what happened? they called the sheriff. they come marching in and came from the e.r. walked away from the e.r. >> thank you. next speaker. >> supervisors, my name is josie mooney i'm a proud member for many many years here on behalf

of joseph bryant who couldn't be here today because he's on strike with health care workers in san joaquin county. this is an emergency. it is not a time for focus groups or more studies or reviewing what's already been done or taking a look at the civil service rules. it's an emergency. what that requires is people act together. so i want to say on behalf of our union that we are prepared to sit down and confront this emergency with all of our beautiful amazing fierce warriors and their colleagues who are back at the hospital now. we have to treat this like it's an emergency and that means emergency measures which you on your own can't do and they on their own better not do.

so it's up to all of us. so i pledge we will be at a meeting tomorrow, tonight, the day after tomorrow, on the weekend, this cannot stand as is. we so appreciate so very much appreciate the hearing and the opportunity for you to hear from the frontline workers what they face every day and we're looking forward to being at a meeting this week to resolve the crisis. thank you. >> thank you, next speaker. >> thank you. i want to follow-up with what she stated. i want to add first we want to thank you for holding the hearing. we would not be here today if it was working. we would not be here today if the labor management committee meetings were working or if the health commission was listening to the r.n.s wen they go and

speak and other health care workers and told the same stories you heard today. these stories represent a small fraction of all the stories across d.p.h. whether they're workers at s.f. general in the community clinics or laguna honda. the staffing needs to be fixed and fixed now and we do need oversight and we do need accountability and that's why we are hear in front of the board of supervisors and asking, yes, more hearings, more oversight, more accountability. please stay on this process and please stay on d.p.h. until we get this solved and we thank you for raising these issues and having us all here today. thank you. >> thank you, any other members of the public wish to comment on this item? seeing none, public comment is closed. dr. urlich can you have -- can i have you back up and it may be

for your team but i want to direct them to you. one thing i heard about and i know you rushed through your presentation and others did swell -- as well but the thing not budgeting to your census. >> when we moved in the new hospital there was uncertainty to what the level of volume would be and quickly starting seeing the number of beds, medical, surgical beds was too low. we have a budget for 164 med surge beds and i think i mentioned to you in my presentation it's typically running well beyond that. so for the past two years we've had what has been called a project budget that has given us budget authority but not physician to staff that unit and that's what some nurses were talking about. we filled the beds with temporary staff. the good news is as i also mentioned this year the budget

proposal to the mayor includes per -- permanent staffing about 30r.n.s sto -- to staff over the course of the year as well as a 24/7 practice nurse to give us provider capacity as well. we feel very fortunate to have that in our budget proposal and hope it addresses some of the issues we've talked about today. >> so my next question would be in terms of the list and there's a list and people that have gone through and interviewed and once they're on the list, are there 1,000 people? are there hundreds if not 1,000 people on the list ready to be hired and we're not hiring them and i'm sure she list is not up to date but is there an active list you're working from in

terms of hiring nurse. >> we have an active list and there's a list based on nursing specialty. i don't know the number right offhand. we'd be happy to get that for you. as i said before, we're devoted to hiring nurses and other team members as quickly as we can so we can best take care of our patients. >> the other thing that disturbed me that i heard in the presentation is this idea of straight overtime and time and a half and can you talk about that, please? >> i would have to defer to my h.r. colleagues about that. >> okay. mr. brown. you have a ph.d. by one of the presenters. >> i have an advanced degree today. so it depends on the contract and looking at the hours the person is working. if they're working because nurses are exempt employees if they're working less than 40 or

80 hours or working overhours it's overtime straight until the meet the threshold. >> you're talking too fast. explain slowly. you spoke about overtime and i understand the concept much time and a half. >> they have the ability to earn time and a half under certain conditions. if there's a part-time nurse not working full times the extra hours would be overtime straight and there's forced overtime under the contract. there's different provisions under the contract where payroll is looking to see when the time and a half kicks in. >> one of the things i heard in the e.r. listening directly to the nurses and i could be conveying this incorrectly, one thing they tried to do and ends up happening from management is the nurses are asked to stay.

will you stay late, we're understaffed. it's a way to get them to say yes voluntarily without having to pay them the extra time. can you talk about that? >> in light of the conversation? >> no, it seems to be a practice outside of the contract and seems to be one that should not be encouraged and in fact discouraged because if you're putting someone on the spot in that moment when they're short staffed from things we heard you're asking them to voluntarily stay extra and then you don't compensate them additional time and a half that seems to be a couple of different bad management practices. >> there may be and i can't speak to what actually has been said in those cases. i do believe in the nursing contract there if there was forced mandatory overtime they'd be paid time and a half versus volunteer. i don't know what the conversation is going on at this

point and i don't know if there's anything they can add because use have to be in the trenches to know. >> i get it. i want to put it out there. i don't think we'll revolve it today. i want it on the record as an area of concern. i think there's areas that are longer term that need to best adjusted and the immediate need with the crisis at hand in terms of hiring in an expedited man perp and the last thing as the head of h.r. because it sounds like a lot of people we heard and it's one i asked for in the resolution was the disaster training. are people getting the appropriate training, if not, what's the plan to ensure they're getting that training. >> for me it's the first time i've heard about the disaster training and i'm sure it's been brought up at the hospital where the training is provided. i'm not sure if susan has information on when or how that's being administered and i

can come back and report if we're not able to today. >> the last thing i'd like to say to close out one of the things i want to highlight si appreciate all the time and effort and energy the nurses put into this today. i know this took away from a lot of the different things. this is their time off and their free time. sounds like they're already over worked and stressed as it is so i appreciate that and appreciate the union coming out and giving their input and thank management and h.r. i know you're new on the job whether you lift or -- left or came back at least you came back with the perspective you understand where the problems are in the process. i'm glad the deputy director of human resources is here as well. i think that this situation n s

necessitates a working group and need dph in the room and maybe the mayor's budget office. i'm going reach out personally to the mayor and her staff on this because we have to make this a number one priority. we just grot -- got an announcement today that a high school was shut down and they clerd the school. these things may be happening more. people were asked to leave to deal with people that have been exposed. these are our first line responders and we can get ourselves in a serious crisis more than it is now. i think we need to commit to putting together an aggressive plan to hire people in an expedited manner. i know we can do it. if we create the bureaucracy and

i understand and respect the civil service process and i know the unions have been involved in that as well in ensuring it's fair and equitable but at the same time we have to put our heads together and figure out how to get people hired in 30 days or less into these positions. and this is years in the making. this is years in the making and sometimes it takes a crisis and a more exacerbated crisis like the one we're facing now to force us to put our heads together and get a solution. i'd like the commitment from dr. urlich and i'll talk to dr. koufax and follow-up with the mayor and her team and put together a plan to work together to come up with an immediate action plan to staff up in an appropriate way. i see her nodding her head.

i'll note that for the record. also, i left out the union and the union should act the table as well. >> so much, supervisor issafai r calling the hearing and thank you to the nurses and frontline workers who shared their stories, organized and demanded action by the city to really address the chronic understaffing and related workplace issues at the e.r. or emergency department at sf general and throughout our city and public health care system. clearly this is a crisis that is undermining the welfare of our frontline health care workers as well as the welfare of our patients. and as many have spoken to today, these are issues that have existed for years or even decades.

you've certainly got the attention and support as supervisor safai and myself and our colleagues on the board and i think we appreciate the leadership from d.p.h. and s.f. general and h.r. updating us to fix the hiring process as soon as possible. we'll continue to work with you and to push you on that to make sure that gets addressed as soon as possible. i also wanted to thank the leadership for sharing the broader solutions with us and address the broader budgetary and transparency and accountability issues that plague our s.f. general hospital and public health care system.

have you our commitment to follow through on the proposals and to address these underlying issues that have led to this crisis in the hiring and for the frontline staff at general hospital. thanks again, everyone. thank you, supervisor is a fa-- supervisor safai. >> can we send the motion. >> clerk: both items are called right now. >> i wanted to make a motion to excuse supervisor hany without objection. >> can we have a roll call on that? just kidding. that was a joke. no objection. so can we make i'd like to make a motion to send item 3 to the full board for positive recommendation and added as a co-sponsor as well, correct?

>> and take that without objection. >> yeah. and then for item 2 i'd like to continue this hearing to the call of the chair. i'm going to confirm when the appropriate time frame is. i'm thinking 90 days to come back and check and the leadership of the hospital and h.r. and others were beginning to work on because i had reached out to them and asked them and highlighted to them the things i needed them to work on. given the crisis at hand, i am going to ask to put together this working group in the interim and we'll work to get that to that aggressively. so maybe what we'll do though we'll continue this item to the call of the chair we might come back sooner than 90 days but we'll let everyone know in plenty of time to get back in touch. the leadership of the union has been in constant communication with me and working with shop

stewards and the frontline nurse. they've been in touch with me. we'll be in constant communication with the findings of the working group and how to aggressively begin to staff up the hospital and i'll make a motion to continue item 2 to the call of the care. >> without objection. >> thanks again, everyone. mr. clerk, is there any further business? >> there is no further business. >> we are adjourned.

sustainability mission, even though the bikes are very minimal energy use. it still matters where the energy comes from and also part of the mission in sustainability is how we run everything, run our business. so having the lights come on with clean energy is important to us as well. we heard about cleanpowersf and learned they had commercial rates and signed up for that. it was super easy to sign up. our bookkeeper signed up online, it was like 15 minutes. nothing has changed, except now we have cleaner energy. it's an easy way to align your environmental proclivities and goals around climate change and it's so easy that it's hard to not want to do it, and it

doesn't really add anything to the bill.

[♪]

>> my family's starts in mexico in a small town. my parents are from a very, very small town. so small, that my dad's brother is married to one of my mom's sisters. it's that small. a lot of folks from that town are here in the city. like most immigrant families, my parents wanted a better life for us. my dad came out here first. i think i was almost two-years-old when he sent for us. my mom and myself came out here. we moved to san francisco early on. in the mission district and moved out to daily city and bounced back to san francisco. we lived across the street from the ups building. for me, when my earliest memories were the big brown trucks driving up and down the

street keeping us awake at night. when i was seven-years-old and i'm in charge of making sure we get on the bus on time to get to school. i have to make sure that we do our homework. it's a lot of responsibility for a kid. the weekends were always for family. we used to get together and whether we used to go watch a movie at the new mission theater and then afterwards going to kentucky fried chicken. that was big for us. we get kentucky fried chicken on sunday. whoa! go crazy! so for me, home is having something where you are all together. whether it's just together for dinner or whether it's together for breakfast or sharing a special moment at the holidays. whether it's thanksgiving or christmas or birthdays. that is home. being so close to berkley and oakland and san francisco, there's a line.

here you don't see a line. even though you see someone that's different from you, they're equal. you've always seen that. a rainbow of colors, a ryan bow of personalities. when you think about it you are supposed to be protecting the kids. they have dreams. they have aspirations. they have goals. and you are take that away from them. right now, the price is a hard fight. they're determined. i mean, these kids, you have to applaud them. their heart is in the right place. there's hope. i mean, out here with the things changing everyday, you just hope the next administration makes a change that makes things right. right now there's a lot of changes on a lot of different levels. the only thing you hope for is for the future of these young kids and young folks that are getting into politics to make the right move and for the folks who can't speak. >> dy mind motion. >> even though we have a lot of

fighters, there's a lot of voice less folks and their voiceless because they're scared. citybe . >> the hon. london breed: well, welcome, everybody. my name's london breed, and i am the mayor. weren't we here just last year, celebrating the victory? first of all, i was at turkey day, and i didn't necessarily sit on lincoln's side to pick sides, i sat on lincoln's side somehow. i don't know how that ended up happening, but i think that i was your good luck charm -- oh, i was with you. many of you know i mean to

galileo high school, and i am a big fan of our high schools and a big supporter and a fan of making sure we continue to uplift young people when they're doing something great not just as athletes, but we know you also have to keep your grade point up in order to play football in the first place. so to balance that at turkey day, and emerge for the second year in a row as state champions is absolutely an incredible accomplishment. when you came here last year, i was really excited, but this year, i'm even more excited because i've got a special surprise for all of you. usually, when you win the super bowl, what do you get when you win the super bowl? exactly. we're going to make sure that each and every player gets a

championship ring this year. [applause] >> the hon. london breed: so you get to design them yourself and figure out what you want on them. it's going to take a few weeks for them to get ordered and set up, but we are committed to supporting your championship ring so you can wear your rings with pride. and i'm really excited that you all are here today because we want to make sure that we honor you. and coach, come on up. [applause] >> the hon. london breed: come on up. >> thank you. >> the hon. london breed: i just feel like i was your good luck charm because i did the coin toss and all that. it was a great day, and it was so fun. >> i would like to say, kerry bader, he said no mayor has been out to flip the turkey

coin. so i hope we can make it a tradition and you'll be out when you get the chance. >> the hon. london breed: but i think it's really important. it's important that we support young people that are staying focused and positive, and the fact that this team has come together as a team and accomplished something so amazing under your leadership is really -- it's a testament to what you do. because i know they hear from you every day, they hear from their parents, telling them the same stuff every year, to focus and to put on your gear. you know, i was like a lot of young people here, and i would tune it out and tune it out. but today is a great opportunity to let you know that your city supports you, that your city stands behind you, and we wanted to do something really special to

make it clear we are proud of each and every one of you for putting in the hard work and getting to this point. and so today is about all of the young mustangs that really put san francisco on the map in a whole nother way. so thank you for this, coach, for this incredible opportunity, and we are looking forward to you designating whoever you want to coordinate the ordering of the rings and how you pick out what you buy. so you can have your school and your year. you know what we do. >> we'll do that. >> the hon. london breed: congratulations. >> that's awesome. [applause] >> thank you so much. it's a great gift. it's totally unbelievable, and i really appreciate that. but we have something for you. >> the hon. london breed: for me? >> so basically, you know you went to galileo, so we have to

make sure you're representing us when you walk-through the city. >> the hon. london breed: oh, you guys are so lucky. we didn't have this kind of stuff growing up. >> just a couple -- couple things just about this here. it shows the legacy of what we have here. >> the hon. london breed: oh, wow. >> this is called dedication, discipline, and desire, and we've been running the program for 19 years since i've been here. you have the dedication to run something every day, you have t the -- dedication to run a program, the discipline to run it every day, and the desire to be a champion. >> the hon. london breed: wow. that's a lot of years. >> and so many travels that you go through, this was unreal. just kind of a different team

than the year before. i tell everybody last year's team was a ferrari. you could do anything with it. this year's team was a buick. we had to run it out. it's amazing we did this, and it's amazing for them because they bought into what we were selling. the best thing is when we went up to mariposa, it's the championship. none of on us kids have been -- none of our kids have been out of san francisco. what's that smell? well, that's cow smell. we rented a room to sit in before the game.

and we went to this game. and here we are, asian, african american, white. different group against a predominantly white culture. and everyone was thinking we would be the ones who broke down, we would be the ones who pointed fingers at each other. we would be the ones who screwed it up. and you would be proud of us, mayor. we didn't screw it up. unbelievable. people there, unbelievable. what we did just awe stirring for me. it's just amazing to see the guys pull together and be like that and represent your city so well. so that was amazing, and for that, we're going to give you the state championship hat because the nor-cal championship, we had to win that to get this. >> the hon. london breed: thank you. >> when you're walking around, make sure you represent that.

>> the hon. london breed: what's that on your finger? >> that's last year's. >> that's last year's. >> the hon. london breed: look at that. undefeated. well, this year, i'm getting the ring. >> hold on. right on. we'll get that. >> the hon. london breed: thank you. and the last thing i want to say is, you know, soak up this mome moment. enjoy every single minute. you're going to look back at this time and realize this was one of the best moments of your life. i know there's some folks from lincoln, so raise your hand if you're a lincoln alumni. they wish they were the age you are right now, in their seats right now. coach, you want to introduce your players? i'm here to enjoy. >> thank you. we have one young man to speak

for us. it's an interesting story. simani came to us from another school his junior year, reardon. he went through a lot of stuff to get on the field. it was unreal, and his parents are great people. so timani, it's your turn. >> i was just trying to say thank you to all the parents and all the alumni and all the coaches and, you know, making this year great, and helping us restate again and helping us and having our back this whole year. most importantly, my teammates because we did it again, especially the last year, all

the seniors this year. we had all the odds against us. we weren't projected to win like we were supposed to, and we had a lot of people, you know, going against us and saying that we wouldn't make it, and we proved them wrong. >> so at this time, for our first group of eight players, brian pinto. [applause] >> jonas francovich. luis quinteros. tyree cross. [applause] >> eduardo garcia.

[applause] >> xavier abrams. [applause] >> jack lau. [applause] >> and at this time, i'll take a photo.

>> our next group of players is john tursano. thank you. [applaus [applause] >> diego ramirez. [applause] >> jeffrey franco. [applause] >> andres montano. [applause] >> tony crossland. [applause] >> all right. take our next group of photos right now.

next group of students, dean batar. [applause] >> nicholas walker. [applause] >> darren erfrey. [applause] >> michael leon. [applause] >> tamani morris. [applause] >> alex mchugh.

alex? [applause] >> our final group of student athletes, philip acuna. [applause] >> alexis velasquez. [applause] >> jonathan chow. [applause] >> sicoti manunua. [applause] >> leonardo gallegos. mikha . [applause] >> mikhail hicks.

[applause] >> and james wish. [applause] >> so we're going to present certificates to the managers

and coaches, and once we do the presentation of certificates, we'll take one big group photo here. i think we'll do it near the steps. all right. here we go. to the managers, cassandra matana. [applause] >> crystal pimentel. [applause] >> sharina gutierrez. [applause] >> and elise hammond. [applause] >> and reilly zuleta wong. [applause] >> thank you, managers.

>> and last but not least, our coaches. coach pereno, of course. [applause] >> coach andre walker thomas. [applause] >> coach greg wood. [applause] >> coach edison zau. [applause] >> sheri bader.

[applause] >> and coach mark walker. [applause] >> and again, i'd like to invite principal sherry bellisi to come up for a photo. >> the hon. london breed: again, thank you to all the players, the coaches, the managers, the principal, the teachers, the alumni, the parents, the friends, the family. congratulations again, and i

think what we're going to do at this time, since that concludes our program, we're going to go probably take a -- go down to the rotunda at the beginning of the stairs and take a picture. in the meantime, stay focused on your grades. make sure you don't give your teachers and parents a hart time this year. walk around like champions because you are champions, and make sure that everybody knows it when you step in the room. thank you, and congratulations. . >> shop and dine the 49 promotes

loophole businesses and changes residents to do thirds shopping and diane within the 49 square miles of san francisco by supporting local services we help san francisco remain unique and successful where will you shop and dine shop and dine the 49. >> my name is neil the general manager for the book shop here on west portal avenue if san francisco this is a neighborhood bookstore and it is a wonderful neighborhood but it is an interesting community because the residents the neighborhood muni loves the neighborhood it is community and we as a book sincerely we see the same people here the shop all the time and you know to a certain degree this is part of their this is created the

neighborhood a place where people come and subcontract it is in recent years we see a drop off of a lot of bookstores both national chains and neighborhoods by the neighborhood stores where coming you don't want to - one of the great things of san francisco it is neighborhood neighborhood have dentist corrosive are coffeehouses but 2, 3, 4 coffeehouses in month neighborhoods that are on their own- that's

>> 7 and a half million renovation is part of the clean and safe neighbor's park fund which was on the ballot four years ago and look at how that public investment has transformed our neighborhood. >> the playground is unique in that it serves a number of age groups, unlike many of the other properties, it serves small children with the children's play grounds and clubhouses that has basketball courts, it has an outdoor soccer field and so there were a lot of people that came to the table that had their wish list and we did our best to make sure that we kind of divided up spaces and made sure that we kept the old features of the playground but we were able to enhance all of those features.

>> the playground and the soccer field and the tennis fields and it is such a key part of this neighborhood. >> we want kids to be here. we want families to be here and we want people to have athletic opportunities. >> we are given a real responsibility to insure that the public's money is used appropriately and that something really special comes of these projects. we generally have about an opportunity every 50 years to redo these spaces. and it is really, really rewarding to see children and families benefit, you know, from the change of culture, at each one of these properties >> and as a result of, what you see behind us, more kids are playing on our soccer fields

than ever before. we have more girls playing sports than we have ever had before. [ applause ] fp >> and we are sending a strong message that san francisco families are welcome and we want you to stay. >> this park is open. ♪ >> we're here to raise

awareness and money and fork for a good accuse. we have this incredible gift probably the widest range of restaurant and count ii destines in any district in the city right here in the mission intricate why don't we capture that to support the mission youths going to college that's for the food for thought. we didn't have a signature font for our orientation that's a 40-year-old organization. mission graduates have helped me to develop special as an individual they've helped me figure out and provide the tools for me that i need i feel

successful in life >> their core above emission and goal is in line with our values. the ferraris yes, we made 48 thousand >> they were on top of that it's a no-brainer for us. >> we're in and fifth year and be able to expand out and tonight is your ungrammatical truck food for thought. food truck for thought is an opportunity to eat from a variety of different vendor that are supporting the mission graduates by coming and representing at the parks >> we're giving a prude of our to give people the opportunity

to get an education. people come back and can you tell me and enjoy our food. all the vendor are xooment a portion of their precedes the money is going back in >> what's the best thing to do in terms of moving the needle for the folks we thought higher education is the tool to move young people. >> i'm also a college student i go to berkley and 90 percent of our folks are staying in college that's 40 percent hire than the afternoon. >> i'm politically to clemdz and ucla. >> just knowing we're giving back to the community.

>> especially the spanish speaking population it hits home. >> people get hungry why not eat and give