Transcripts For SFGTV Government Access Programming 20240713

Item 5 report back from the finance and Planning Committee from today. Thank you. I am sure commissioner chung would have been pleased today in our reports on the monthly contracts we were able to get some outcomes. The outcomes were quite satisfactory. On the block of the monthly contracts that included the Fountain Institute that is actually a Diversion Program and then several programs that actually were looking at improving employment from the university of california and the positive Resource Center. We spoke somewhat at the positive Resource Center if that information was getting back to primary providers in a way that they may find it useful to understand how their clients were assisted beyond the medical illness. We heard request for a retroactive contract with the San Francisco Community Health authority, San Francisco health plan, administering the San Francisco covered mri program. It is a contract that goes back four years. Because of the changes of funding in which the Services Rendered by the San Francisco health plan on behalf of the mra program and changes in the mra program, there have been some delay, therefore, being able to actually pay for all of the services which the San Francisco plan continued to render. The retro activity will include also an additional two or three months to the end of 2019, at which time all the San Francisco health plan tpa type contracts for the covered mra and other tpas would be brought fort to the finance and the commission. At that time we will be able to understand better the allocation of the types of services being rendered for those people in the various programs. Barring that, then we also have one more contract which relates to an outside vendor to perform mixtures of different compounds and types of medications that we know longer do, and it is a certified contractor from the fda and will giv give us a Super Service at the general for those types of medications. At the consent calendar we will ask for consent on all of these contracts. Questions from the commissioner . I apologize. I made a mistake as we went forward i skipped general Public Comment. Hold any questions on the report back and go to item 4, general Public Comment. I apologize. It wasnt intentional. I hold an egg timer. Everyone gets two minutes. When the buzzer buzzes, finish your sentence so the next person can come forward. For general Public Comment, mike hill, crystal duran and heather roninger. I am one of the nurses in the er. Our concerns are about General Hospital Emergency Department staffing issues, transparency, lack of, promises made to us at the joint commission that were supposed to be built into our contract. For instance, the ratio change in the er. We havent had any information funneled down to us how that will be accomplished. We assume they will hire temporary staff for the changes. That is not the safest way to care for our patients. If that is the plan, but we dont know the plan. There has been multiple issues. Care start is another implementation that didnt respond to any of the input from the nurses that have to work the care start program. It is not safe to our patients. There are so many different issues the other nurses with me will speak about. I wanted to introduce those problems in the er. Would you identify yourself for the record . Mike hill, nurse in the er. Thank you. Good afternoon, commissioners. I am actually going to read a letter on behalf of one of my colleagues. One of my colleagues felt fear in speaking out because of retaliation. I will read this. I am crystal. I am a nurse in the Emergency Department at San Francisco general. For nearly half my life i worked as a nurse in the Emergency Department at San Francisco general and for the department of Public Health. Our department is pushed to unsustainable point. The ed is a disaster scene almost daily. As safety net of the city we reflect the picture of the community. The department of Public Health and city are not well. Our population is more complicated and desperate. Imagine unhoused with cancer, diabetes. It is cruel and heart beating. We are a special group. We are drawn like special forces to this department. We have the knowledge and the skills to bring back people from the dead, literally or care for an 85yearold fractured hip fall patient, 7yearold hit by a car. Kisdisaster is taking a toll. One colleague tried to decrease antidepressants and cried and had to go on it. A group of p103s are on a six month leave of absent for stress and Mental Health reasons. We have contract rns making 30 of total staff. I have never been in such a hostile stressful environment not only from the management but from the patients with complicated desperate needs. They are promised by leadership, dont worry, we will take care of everybody. Do you think the zuckerberg building with hundreds of millions on lobbies, balconies and hallways is providing effective quality Public Healthcare . Really . What percentage of our patients would agree with you . We see the multitudes it is failing. The sad suicidal teenager doubles up in a room with a person in a severe combattic episode or the 90yearold with dementia next to the psychperson who cant get in the group hope. They are on the street. Finish up, please. Thank you. It is time for the painful honesty, the abuse scandal, people jumping out of the windows and the admitted patients in the ed getting bills for care impossible to provide. Please finish. The hundreds of care patients are waiting in the triage area and getting a full ed visit. The goal of numbers and ignoring front line staff has costs which may include juror death or detriment of patient as is and staff we want to care for mom, dad, sisters and brothers. Please help us. Ladies and gentlemen, please respect the people be anhind you. There are a number of people to speak. We are giving you two minutes. Please respect those folks and give them the opportunity to speak. We want to hear from all of you. Thank you. I am krista durand, er nurse. Contract bargains is over. Now there is no reason to think we are asking for raises. We are here because we said we would return. The leadership style at San Francisco general has a culture of intimidation is so severe we fear interaction with management. Our rn director pushed 50 of the best leaders out in less than four months. Why wasnt this a red flag to the administration . This is having detrimental effects of the Mental Health of the staff and distracting them from providing staffing care. Adding an additional layer of leadership not transparent to maintain control is having direct effect on patient outcomes. Front line staff are being dictated to risk licenses. They are aware of it and has done nothing about the administration poor implementation of programs. I became a nurse to provide compassionate and competent care. It is my duty to advocate for the patients. The petition we sent to you guys shows a lot of violations. If you turn a blind eye now you are going to be part of the problem. We sent multiple letter goes with the same outcome. You let Administration Lie with numbers and charts. Now we have submitted the explanation of the crisis. What are you going to do . Are you going to do something what people diane Staff Members are injured or commit suicide . I am heather a nurse in the er12 years. I have been here before. I thought about how to convey the severity of the situation to you. We tried emotional pleas that havent worked. San francisco general is about compassion, not quality care, data. These are data points to consider. 25 to 30 of the emergency beds are housed with admitted patients every day. We get zero nurses to help support their care. 50 of our most trusted respected and experienced leadership staff are forced out of positions in the last four month. 50 . Our department houses from eight to 12 behavioral 12 Health Patients in acute psychiatric bases in space designed for four. Resuscitation area exceeds level of 15 to 17 patients. It is designed for six. We discharge 700 patients each month out of the waiting room. That is where they receive all of their care, in our uncomfortable perfectly public waiting room. 63, that is the number of nurses who have signed the petition sitting in front of you today asking for your help. Asking you to engage. You dont need lean workshops and Software Programs to understand what is going on with our patients. You need to talk to the staff. You need to listen to what they have to say. Thank you for your time. Thank you. Those are all the slips i had for public testimony. Does anyone else want to speak on general Public Comment . Call the next item. Thank you everyone who chose to make Public Comment. The petitions are in your packet for item 7. It is altogether. I want you to know it is there. Item 5. We have gone through with commissioner chow, review of the finance and Planning Committee meeting. I would like to know before the concept calendar the dph staff asked to change the amount on the second contract. They had incorrectly figured out the contingency. 4,431,259. As you vote i want you to have the right amount. That is for the San Francisco Community Health authority contract. That is correct, thank you, mark. That reduction was with a recalculation of the approximate 12 for the 2019 fiscal year. Since the other years had closed. The new amount is actually in the San Francisco health plan contract. The commission would like to move those items on to the consent for your approval on the consent calendar. There is one other item on the calendar which i assume ultaup separately. It is the resolution on alice chen. I will defer to you on alice chen. Why dont we do this first then. Thank you. All those in favor of accepting the finance committee report. Opposed. Hearing none it is adopted. Now we go to consent calendar. The resolution for alice chen. Correct. The consent calendar for resolution 1913, honoring doctor alice chen requested by the Health Commission and a draft had been presented to doctor chen at a reception at the San Francisco general for her. I would like to move that consent. All those in favor signify by saying aye. Aye. Next item. No Public Comment for 6. Item 7 the San Francisco Behavioral Health adult residential facility. Mr. Pickens do you need help pulling up the presentation . Good afternoon, commissioners, roland pickens, director of San Francisco health network. I will be joined by my colleague Kelly Hiramoto former director of transitions for the San Francisco health network. I am here today to share with you some of the background and circumstances pertaining to the adult residential facility located at 88 88 7 00 p. M. At 8 7 00 p. M. Atrero. I hope it informs you about the current set of circumstances. So in todays presentation i will start with Background Information on the bhc which is the building in which it is located. Next i will provide an overview of the program. Then i will present the facts and circumstances that led to the current plan and, finally, i will review where things stand now in the proposed next steps. Currently, the Behavioral Health Center Provides both locked, subacute and patient treatment and unlocked delayed egress Residential Care for adults and seniors who have Behavioral Health needs. However, the bhc didnt start that way. It has a long history that has evolved over time to meet the changing circumstances based by those in need of Behavioral Health services. A brief review of the history includes that the facility first opened in 1996 as the Mental Health rehabilitation facility called the merf. It was then a 147 bed psychiatric Skilled Nursing facility. Then in the early 2000s as the environment in San Francisco began to shift toward the need for more lower level residential beds, in 2003 the mayor of San Francisco established a Blue Ribbon Committee for a new design for the services provided. That process resulted in 2004, thmerf moving to a three program mixed use facility consisting of a 47 bed secure and locked Mental Health Rehabilitation Center on the third floor. A 59 bed psychiatric on the second. 41 bed residential facility. In 2005 the adult residential facility was licensed by the state Community Care licensing and began receiving first admissions. That leads us to what we have today, which is again on the third floor a 47 bed merk also called institute for mental disease, locked subacute Mental Health unit. On the second floor a 59 bed Residential Care facility for the elderly, also considered a board and care facility. On the first floor a 41 bed residential facility. In 2017, we added an Additional Program to the first floor of the Behavioral Health center. That is a hummingbird psychiatric respite center. To familiarize ourselves, the merk is locked subacute of care to elderly houses individuals 60 years of age and over. Again, hummingbird which is a psychiatric respite on the first floor. What you dont see is the arf. I am going to devote the next severals to talk more about its program. The operation of the arf. It is 24 hours each day, nonmedical care but supervised facility for adults 18 to 59 with severe Mental Illness that are stable but still need care, assistance and supervision. Some of the services to the residents are housekeeping of their rooms. Some require assistance with personal care and as they administer medications prescribed by their providers. Where do patients come from who wind up on the arf . They receive referrals from acute care hospitals, locked subacute units like the america and other board and care facilities. It is a licensed residential facility licensed by state Community Care licensing, which is part of the department of social services. I am going to slow down a little more because there is a lot of information that we want to share to make sure you understand. It is important to step back and revisit the circumstances that bring us here today. For many years from 2005 up until 2013, operations a at arf were proceeding. In may of 2014 we submitted a request to the state to expand the number of licensed beds from 41 to 55. However, in december of that year, just 7 months after getting approval to expand to 55 beds we received citations for medication issues that required development of corrective action plan. This was approved by the state and implemented in december of 2014. The plan of correction involved numerous staff straining and education sessions about Resident Safety, Workplace Safety and medication assistance oversight. Some staff to make these errors in the same areas from this they received the retraining. Some of the results of this process was that it led to disciplinary process for some staff which included employee termination. During that time we also saw the unfortunate circumstance of staff beginning to file complaints against one another and reporting each other to regulatory agencies. During december 2014 through september 2018 despite implementing the performance improve meant plan. They were unable to go more than five months without incident or Community Care licensing coming on site to investigate the facility. In september 2018 we were notified the arf was being placed in noncompliance and mandated to attend the conference. We were advised by state Community Care licensing that it was their expectation a facility would need to go one to two years without any additional citations to be removed from noncompliant status. Furthermore it could have resulted in us going to add enough review to result in the loss of the facility license to operate. On december 2018, two months after the nomcompliance concerts we received two level a citations. They are the most serious types of violation. These were in the areas of medication use and the same types of citations which put us into noncompliance. At that t