When, in fact, there are empty beds . At first the county claimed the state forbid them from filling the beds. The state quickly denied this and followed a perplexing periods of excuses for not filling beds. We read there was trouble fills staff positions. Then the story shifted again. They were aware of staff negligence and error so they left beds empty rather than expose new admission to say that. What about existing residents. Identifying staff negligence and error at not correcting it is, in fact, negligence and error. They didnt provide services for people needing care. They deemed the staff incapable of doing so properly. This must not go on. People are waiting for services. Thank you. Commissioners, secretary, thank you all for having this hearing today. I see appreciate the time. Everyone in the audience, i appreciate you coming out. The system is broken. Thithis is a symptom. There are 30 beds to close on december 1st. Six beds on november 18th, 18 beds on the 17th of this month. That is 54 beds between today and december 1st. We do not have capacity to place 54 people. Rye now at the arf and rcfe there are 46 empty beds. I talked to the Deputy Director today and he informed me the state licensing body told him if people are not placed from the bed that is going to close the home to close this month, they will be sent to the emergency room at San Francisco general hospital. This is unacceptable. How much more do we have to spend if 18 people show up at the emergency room with no emergent need except for housing, which we have been providing for a number of years for them . We have open beds right now sitting vacant we could have put them into a mop ago when we month an go. It is because of the neglect from leadership to the people we contracted with. Even the contractors are mistreated and decided a 35 a day rate is not enough. The same kind of care we see given to the staff has been given to the contractors and given to the clients. It is not okay. Time. Sarah larson. Hello i am sarah larson, Mental HealthTreatment Specialist working since 1986 at ph. D. We are so isolated we have had to be on the edge of closing to have a voice. It has taken 20 years to get attention to mismanagement. We are a microcosm of what is wrong. I met to get clarity on where this is going. We found them to be defensive, rude and hogs tile rather on hostile rather than the permanent beds management has the right to make decisions and file grievance. They are suspended arf because of errors and staff conflicts. No conflict management, no team building. It looks like i ca looks like it leadership. New staff are to learn on the job. No clerks and little staff support. The arf would be a great facility if we invested with leadership with a plan to run it. We have been in a crisis of leadership for beds. This is a political decision, not a necessity. We are not on the verge of losing the license. Management is trying to outsource the workers making a living wage with underpaid nonprofit staff. In the meantime our contract with transitions expires in less than six months. Neither row land pickens or the resource representatives admit to the knowledge of the contract. It was signed by pickens and hiramoto. We deserve better, our clients deserve better and the citizens of San Francisco deserve better. Dph has got to change. Robert rogers, judith crane,roma guy and jennifer. You can come up in any order. Whoever gets here first gets to speak. Good afternoon, commissioners. I am judith claim. As a past employee with over 30 years working with the city, i get how difficult it is to institute change. As a mother with a son with schizophrenia currently lives at the arf we cant afford not to. My son entered with the jails after being beaten by eight police officers. He was moved seven times during the first year of treatment. Now you are telling me that it is unsafe for him to be at the arf where he has been for two years . He has finally found some stability. I dont believe he is unsafe. While it is needing major reforms, it provides low barrier longterm care for severe Mental Illness that is rapidly disappearing. He was moved from hummingbirds. It does not provide longterm care for people with severe Mental Illness. Keep the beds open at the arf, that Service Improvements be helped to move them to independence. Schizophrenia is a painful condition. I have witnessed my son suffer. Not only suffering from his condition. He is suffering from our system of care. Please dont reduce the needed resource. Thank you. Good afternoon. Roma guy from taxpayers for Public Safety. We attacks payers for public taxpayers for Public Safety want to and our support. We want to thank you for having this meeting finally and bringing your leadership and listening ears to problem solve not only be this issue but many as many speakers have said to other issues that are in cries cease in this modern era. The arf, from our point of view, is just another mishap in plugging holes in a leaky old barrel. We must change the Healthcare Systems approach at the leadership level, Management Level and at the practice level if we want to meet the challenges of this era. We did it with h. I. V. , and some of you were part of it. I know you are sitting here. We did it with healthy San Francisco. We are doing it with pedestrian safety. Why not Behavioral Health . We are behind other jurisdictions and there are many lessons to learn as well as the ones i have sited in our own county and city. We are not problem solving, we are fighting, not helpful to the people we want to solve problems for e. We have chosen positions we must take them on. Be visible, transparent and accountable in the modern era. Thank you. I am michelle. I think you called my name. I will speak for robert rogers. He left. I am a social worker and i work as a conservator. I am speaking on behalf of private citizens. I think it should be obvious at this point be this is not a good idea. There are enough people saying the same thing over and over again. Front line people in the system every day, and a sign of good leadership is when you recognize that may be you have made a mistake and deciding to not make that mistake if you are getting a lot of feedback from the people on the front line like myself, the staff, the doctors, psychiatrist, every Single Person working in the system thinks this is a bad idea. We should stop doing that. Also, i work on the third floor. I work on the psychiatric facility. You cant tell you how many meetings i have sat in and had to look my client in the eye to tell them that even though they worked through their care, they did everything i asked them. They took medications, went to groups, took showers, they did everything and they are ready to go to a lower level of care and i have to sit in the meeting and tell them there is nowhere to go. We have those meetings month after month, and then to learn there were beds below us they could have gone to. I cant tell you how angry that makes me and how sad it makes me for our system, and if i was my client, i wouldnt trust me after that. How can we have a therapeutic relationship when they do everything i ask them to do, and those are very difficult things, then i cant give them the thing they have earned which is to come out of a locked facility and be able to walk out on the street. Thank you. I have one more. I am jennifer. I work at the locked facility on the third floor of the Behavioral Health center, i am a social worker there. I work with San Francisco residents there involuntarily hospitalized for treatment knowing they are going to work through. Like mitchell is saying, go home and they cant go home for months. There are people there for over a year who cant get out, similar to jail. They cant get out. They need a home like the arf. Two points. One safety concerns put out by dph do not hold water. In the last year from 2017 to 2018 there is one substantiated citation and three at the rcfe one floor up is held open. Going to fill to capacity according to this plan. Also, the staff that are blamed for the citations are floating up. They work upstairs. The plan is to have them go upstairs. They are already going upstairs. The staff work down stairs. That is happening. This argument that one floor is not safe while the other is doesnt hold water. The citations upstairs are about events leading to a clients death. The humming bird extension is not doing harm. It is doing harm. They are locked and cant go home. There are 41 people that need somewhere to go. There is a reason the whole community of the San Francisco front line workers are coming out. They are getting good care. Thithis is a good place. We beg you to hear the word of the public and weigh it against the messaging of d. P. A. To look at what is going on here. Thank you for taking time to hear us out today. Thank you. Kim, San Francisco labor council. I agree with just about all of the public testimony that has gone on here, and i think dph is in a pathetic state. I was here testifying before this Commission Many years ago when laguna honda ceased receiving medicare because of the 700 violations. We are talking 10 violations over a four year period. Dph is not telling the truth. The people who are supposed to be telling the truth are lying. I think it is pathetic. We have called the state to ask them about the status of the arf, and they have assured us. It is on the website the arf is no no way in jeopardy of closing. Why they are perpetrating that is beyond me. This department is playing politics with peoples lives. Their sole job is to care for the folks and they would rather play politics . They need to be ashamed of themselves. If we need to clean house, start at the top. It is time to start caring for the people who come to us when they are most needed. I have been talking to taxpayer groups who should sue the department over there. I was there when Behavioral Health system when this center was built. It was to be a long term Behavioral Health center, and that is what the taxpayers paid for. The fact you changed it without discussing it with anybody . I think you all should be sued. It is pathetic, sad, and dph needs to do better. Thank you. Any more public testimony . Please come up. I am ei am ed de steal. I have a long history of depression and anxiety. This spring it got bad. I ended up in the hospital. I am in the kaiser system. I went to the emergency room. From my personal experience i was able to move from the emergency room to the hospital fairly quickly within six to eight hours. Other patients with me were in the emergency room two or three or four days before they could get a bed. There were patients with me in the facility waiting on longer term beds they couldnt get in. They were in the short term facility when they needed to be in the longterm facility blocking the bed for someone in the emergency room. This is what is going on at arf. If people arent able to get in the system, people are going to die, od, to selfmedicate. I will say to leave beds empty during an acute Mental Health crisis is the same as withholding future in a famine, keeping water from people in a drought. You are making money. It is not right. Open those beds and make more beds for people so we can deal with the Mental Health crisis on our streets every day. Thank you very much. Good afternoon, i am with Community Housing partnership and member of the treatment on demand coul coalition. These were written by david lewis. He served two terms. He had first hand chance to observe the citys Behavioral Health system of care as well as client receiving services. This was at a time when treatment on demand was much more reality. Oneonone conversations with barbara garcia. Providing the treatment in locked facilities was not priority. It was detrimental to recovery. The number of treatment beds were reduced under the leadership of the Behavioral Health services. It may result in under capacity at the San FranciscoBehavioral Health center. The demands off of often resulting from addiction, domestic problems created need for the intensive level of care provided in the facility. De prioritize this facility or reallocate beds for Navigation Center purposes leaves a psychiatric medical need unmet. There will be a percentage of patients that need this level of care. Rather than further reducing we need to provide a comprehensive system of Behavioral Healthcare. We needed this yesterday. We need it more today. Thank you for your consideration. Is there any more Public Comment . I just want to say the arf is anything but unsafe. The staff deserve consideration for their jobs. Thank you. I am a gay man that i hate. I will put this in the hands of the commission. Mr. Pickens will you come back up, before we get into the commissions questions and comments i would like to give doctor colfax an opportunity to respond to the things he has heard. We will come back to you during the course of the dialogue up here. Thank you. I want to thank everybody for coming out today and expressing your opinion. It is incredibly important. I apologize on the part of the department for not getting input earlier and hearing your concerns. I do think that we also need to be clear that with regard to people who turned out today the residents, front line staff, members of the public, that you hold a collective wisdom that as director of health i am committed to getting your input as we make decisions Going Forward. It is very important that the department has a shared accountability for the problems of arf and having visited with some of the staff here today i want to assure you while i do think there is severe problems with the arf and the history of the past five years, that i also recognize and i think the leadership recognizes the incredible work that people do every day at the arf and a cross the dph facilities. I want to express my perspective your work is valued by me. I think when i visited many of you described the members of family and some of you have worked there for 19 years. Not to say there are not issues and concerns. When you see problems consistently in the arf, i want it not to be either other. You can have good staff caring for patients kept safely and providing good care and there can be some problems and those need to be a shared responsibility across the leadership and management and front line staff. To express that Going Forward. Whether the arf stays at 32 beds, whatever hatches i am committed to fix happens i am committed that we can fix these problems together. Thank you. It is in the hands of the commission. Commissioners. Thank you, doctor pickens and supervisor ronen. I wrote down names but there are too many to mention. Thank you for turning out to show how much you care about the Services Provided at the a rf and caring for those in need. I did have a question if you refer to i am not sure if the pages are numbered. Actions taken for Resident Safety where you discussed staffing concerns. There were weekly meetings with hr since 2017 to look at the staffing shortages and how those might be addressed. I believe supervisor ronen said there are 12 positions currently unfilled. I am not sure i if that is the number. What are the barriers to filling those positions if there are weekly meetings and why havent beds been addressed . As i said in the presentation, we got down to three vacancies at the arf but we still continue to have the operational issues and concerns that were affecting the unit. Therefore because we were already on heightened alert from the state, we felt in the best interest of care we could not bring additional patients into the system until we figured out what was going on and try to correct those to open up the beds in a safe manner. Follow up. The Unfilled Positions at the current level of 32 . No there are more vacancies. I think there are actually i dont have it in front of me. At least nine vacancies if not more. What are the barriers to filling those . Hr continues to work towards those. We are filling positions on the third floor. There are no barriers to filling positions for the arf other than the plan to use that space for the hummingbirds program. That is why we are in a pause situation. If the decision is to reopen the arf beds we will have to bring hr to the table and work full steam ahead to fill those vacancies. Thank you for your History Lesson on the Behavioral Health center and thanks to everyon everyoneluso passionately has spoken on behalf of the residents of a rf, the staff and the care and wellbeing of the San Francisco residents. Being a native san franciscan and whose immediate family has had to deal with many Mental Health problems described here, i want to assure you that at least from my sense of my colleagues that we do want to work very, very closely to correct the concerns and to put it into larger context of the lack of facilities and the decreasing lack of facilities that we have to deal within San Francisco and in the bay area for what is actually a growing problem and more complex set of problems that if we can find a way to Work Together in a larger context and systematically, it wont happen quickly but maybe it will happen in the right way. I wanted to ask about the humming bird place expansion. There was a suggestion by one of the speakers, and i apologize i dont remember which one, that one of the things that dph could do is think about th