Hi everybody. I first want to thank the command staff. I appreciate everything you guys do for the Cadet Program and for me to give me advice. Huge shoutout to my family always there for me. Thank you. It is a privilege to receive this award. Thank you. Congratulations, dexter. The next difference maker award is currently a senior at sacred heart where she has a gpa between 3. 6 and 4. 0 throughout her School Career with two jobs at starbucks. Oldest of four and has a natural mother instinct to take care of other people and their needs. Beautiful smile to light up the room and personality you will love and fall in love with her right now. You are the next award de. Congratulations on being a 2020 San Francisco black History Month difference maker. How too you feel . Good. Hi. I want to thank the chief of police for giving me this opportunity and thank my family for being my number one supporters. Congratulations. A round of applause. Thank you. [applause] the next award is the Youth Service organization focusing on Cultural Enrichment for youth and families in the Western Addition for public and cooperative housing with positive activities and events. She came to the bay in 19 7 4 and spent her time working right here in the Western Addition. A change maker, adrian wilson, come on up. Congratulations. You are the resip ye the recipie 2020 black history maker award. Adrian williams. Congratulations. Hello. Hi. Thank you very much. I am not short and brief. This is throughout my life i have gotten awards. Over the 14 years working with the village project, most of them mean a lot to me. This means a lot to me. In the respect that when i started in 2006, i got my first award from the San FranciscoPolice Department and the public library. It is wonderful to be here and by recognized for my work. I love derek, my hero. Thank you very much. I love this da this. Congratulations, adrian williams. Our last but not least final difference maker is the president of the bayview merchants association, first Vice President of the district merchants, member of the [gavel]. Chair mar good afternoon, everyone. The meeting will come to order. Welcome back to the thursday, march 5, meeting of the government audit and oversight committee. Im chair gordon mar, and im joined by supervisor matt haney and ahsha safai who is filling in for aaron peskin. Mr. Clerk, do you have any announcements . Clerk clerk yes. Please silence all cell phones and electronic devices. Copies of completed speaker cards and documents are to be submitted to the clerk. Items acted upon today will appear on the march 10 board of supervisors agenda. Chair mar thank you. Can we excuse supervisor peskin without objection . [gavel]. Chair mar i think its important that we make an announcement for our first cases of covid19. Mayor breed declared a state of emergency locally, and Governor Newsom has done the same for california. I dont mean to alarm anyone, and i im grateful for the wo by these departments and their staff. The reality of this Public Health crisis makes this subject all the more important. The ability of our staff to be well equipped is vital for a good outcome. I visited San FranciscoGeneral Hospital in preparation for this hearing and toured the emergency room. Ive met with nurses and labor leaders. I have immense gratitude for their work, and i have questions i hope to raise during this hearing. Im grateful for the nurses and Public Employees here today. We will be hearing from quite a few presenters today, so in the interests clerk mr. Chair, sorry to interrupt, but at the time, the balance of todays agenda hasnt been called. Should we do so now, before chair mar sorry. So, yeah, mr. Clerk, please call items 2 and 3. Clerk items 2 and 3 are hearings to address concerns raised by zuckerberg San FranciscoGeneral Hospital registered nurses standarding staffing, the use of contract registered nurses, hiring time frames, safety, and bilingual support, and requesting the department of Public Health, zuckerberg San FranciscoGeneral Hospital, and department of Human Resources to report. Item 3 is a resolution urging the administrative of the department of Public Health to include front line registered nurses and resident physicians in their decisionmaking process to implement, to the extent possible, an expedited hiring process to less than 90 days from receipt of application, to aessupplementing staffing requirements with contract registered nurses by implementing, to the extent possible, a ceiling of 5 or less of total staff, to provide annual violence prevention and Disaster Preparedness training for all staff, and to support its bilingual staff. Thank you, mr. Chair, for allowing me to call the items. Chair mar thank you. Supervisor safai, the floor is yours. Supervisor safai thank you, chair mar, and supervisor haney. We called this hearing not because we have a crystal ball, not because i know more than anyone. I called this hearing because the public nurses came out and spoke out in this chamber. Its not often that nurses will come wearing their garb, standing in line, and willing to wait. What they said was theyre overworked, theres staffing issues. Well probably hear some different opinions, but i want to clarify when i say staff. I mean permanent, fulltime positions. Not temporary positions, not parttime, but fulltime positions that will be there when a crisis is faced. Fast forward to todays announcement we just had our first confirmed coronavirus cases. This is a serious Public Health issue, and in the places in the United States where its being dealt with, we are seeing that front line First Responders are having to selfquarantine themselves. Theyre having asking theyre being asked to quarantine, and theyre being asked in some cases in some cases, theyre the ones that have contracted the virus. So that makes todays hearing even more important. Because if we have a hiring crisis in terms of timeline. We originally asked for terms of 90 days, but im going to push the city and ask them to come up with a hiring plan in 30 days or less. We have to have the appropriate fulltime staffing in our department. So were going to hear a lot from the nurses today. Theyve taken time from their busy schedules themselves. Were going to ask the departments to come up first so we can hear their initial responses. Im going to read the initial order of speakers, and as chair mar said, were only going to have anyone speak for five minutes or less so we can move to public comment. I just want to underscore that this is something that has been asked for for years. Not only do we have a crisis on our streets, we have a crisis in the city and county of San Francisco. In the opinion of many people that ive heard from and listened to, it has gotten worse and worse. And because of that, these nurses are at the front line of defense in many cases that are dealing with that. So that if theyre overworked, if im getting messages on christmas eve, theyre being asked to take mandatory overtime. Theyre not going to say no, especially if an emergency room is full. But this isnt just about the emergency department, this is about all the diffe divisions within the entire San Francisco general. It is the only Level One Trauma Center in the bay area, and we need to treat it as such. Lastly, ill say that it is important, as part of this process, that we hope one of the outcomes will be that there will be much clearer lines of communication between management and frontline staff. Because when i went, like supervisor mar, i went and did a tour myself. I just listened to the nurses and the things that they had to say. And the thing that i listened to was morale was very low. Morale was very, very low, and if thats true, theyre not going to feel very enthusiastic on their job. Again, this is not trying to beat up on anybody, we. Were trying to have an open and honest conversation. Currently, it is about 200 days to hire a nurse in this area. If you ask the average person in the bay area, will you wait seven months to get a job, the answer will be no, i have to work to support my family. So i just want to lay the framework for that. I really want to thank my staff for putting this together, working very closely in particular with the leadership of seiu 1021, but the frontline staff, julie, krista, heather, theyre there every day, put transgender on the line, and they have tried to be a put for putting it on the line for every day for the people in the city and county of San Francisco. So i know the situation that were dealing with and the crisis that were dealing with, i dont want to take anymore time. Were going to have a lot of questions, and i know that dr. Colfax and others are going to speak, so the first person im going to call up is dr. Colfax, the head of the department of Public Health. Good afternoon, supervisors, chair mar, supervisor safai. Supervisor safai five minutes, please. Fellow committee members, glen colfax, director of Public Health, San Francisco. I just want to emphasize how much i appreciate the importance of this issue. I trained and worked in the zuckerberg San Francisco general, including in the hiv aids epidemic. I know firsthand that nurses and their care are the foundation of the hospital. Staffing, and the quality of that staff, is paramount, as is and always will be worker safety. This is not only an issue in the emergency room at zuckerberg, but an issue in our health care in San Francisco, our state, as well as nationally. Covid19, or novel coronavirus, has only highlighted these issues and concerns, and i want to be very clear. There is no space between d. P. H. Management and the unions on this on these very important issues. We are taking key steps to address concerns. I have made changes in h. R. Leadership in order to address the long hiring process, which i consider completely unacceptable. You will hear about those steps. With regard to workers safety, we have taken a collective approach to addressing those concerns, and you will hear about some of those data today. But i have ensured that during this challenging time with coronavirus covid19 that the leadership is here to answer your questions, listen to the frontline staff concerns, and take action together. Thank you, and unfortunately for the remainder of the hearing, i do need to turn it over to leadership at the hospital, especially given the recent reporting that we released with the mayor today around the two cases in San Francisco. Thank you. Chair mar supervisor ronen . Supervisor ronen before you go, i know you really have to get out of here. Sorry . Supervisor ronen yeah. I just had a couple of questions. In terms of leadership from d. H. R. , is Mickey Callahan here by chance . Supervisor safai im sorry. I went over the list of leadership here from d. H. R. Supervisor ronen because weve got a crisis, and we have to fix it quickly, but it is happening all over d. P. H. Its not unique, its in every single program. Ive talked to hiring managers in several of your clinics, and every time they hire someone, they embark upon the hiring process, theres new rules and new inconsistencies. And they expect the fill position will be about 18 months. Thats why im asking if Mickey Callahan is here. We have a crisis when it comes to hiring in the city, and so i just wanted to hear from you a little bit more first, i wanted to just share that i got a copy of the workers satisfaction report that shows that 32 of your staff in d. P. H. , you ha d. P. H. You have about 3,000 staff feel that their department is adequately staff. That only about 34 of them feel like management adequately communicates with each other. These are shocking statistics, and so i just wanted to make sure that you hear the level of urgency we have, not only about this particular situation that this hearing addresses today, but about your entire department, number one. The second thing that i want you to know before you leave is i got a copy of the steps in the hiring process. There are 30 steps in the hiring process, 30 steps. I talked to one manager, who told me to get through steps o 1 through 10, its taken nine months, and they havent even taken any information, its just preliminary steps. I couldnt go through the endless information i could go through with you today, because i know you have to run, but this is just the very beginning of this process. Im planning, together with supervisor safai, to hold a number of hearings on this issue, because we not only need to fix hiring at s. F. General, but we need to fix hiring in general. Supervisor safai yes, supervisor. We have the Deputy Director of d. H. R. For Mickey Callahan. Supervisor ronen i think that is great. Supervisor safai we had spoke with them in advance because we knew this was going to be a series of hearings. Supervisor ronen yes, but supervisor safai, i thought it was very important to send this message to dr. Colfax because he is head of the department . And this issue is not limited to nurses in general. It is a sustained problem in the department, and i want him to hear from me on that. And i believe the problem starts at d. H. R. , and i believe that, in the future, mickey calh callahan needs to be here, and i will communicate that to her. Supervisor safai dr. Colfax, did you want to say anything on that . Well, i think Michael Brown is our new director of h. R. Were not only talking about the hiring metrics, which are concerning. But i need to focus on cultural differences, and there also is evident over the years that we were not optimizing our relationship with d. H. R. , and im very pleased to say with director browns help, were identified places where some of those steps arent even necessary. So were clearing out what we dont even need to do in order to focus on what we need to do. And he will go into that detail, but were making clear progress in that work, and i just want to emphasize clearly with the nursing work ive asked michael and the staff to focus on this nursing issue. D. H. R. Has been a wonderful partner in that, and i think thats really going to accelerate progress in this area. Supervisor safai thank you, dr. Colfax. I think before you leave, supervisor walton wanted to ask you a question. Supervisor walton thank you, dr. Colfax, for being here. I understand we are in the middle of a crisis, but i have some questions that i have that i feel you as the head of the department to answer. The first is we have break nurses in a ratio of 1 4, and that 1 4 ratio, which is contractual and probably lawful, we get up to about 1 8. How do you deal with that . So i have the director of zuckerberg general and the director of nursing supervisor walton all of which ive met with and had conversations with, but id love to hear from you. I know they will make presentations later today, and i assume you will get answers to those questions. Supervisor walton second, is it normal [inaudible] supervisor walton versus hiring permanent, fulltime workers . I have always placed an emphasis on hiring fulltime workers. Supervisor walton i think one thing that is pertinent, and d. P. H. Will correct me if im wrong, it is wrong in hiring temporary staff in general. We are frustrated with that process, which we know is ludicrous. Just the last thing i want to say, because you may have just been getting on board, but over six months ago, i asked the department of Public Health to send me a detailed Public Outreach plan that we can use as a framework that tells me all the additional recruitment strategies, all the recruitment strategies, how youre going to hire faster than six months. I havent received anything from your department. And i dont understand how thats possible. I will speak to the staff and make sure that you get that. Its possible that with the change in leadership, that thats why that didnt happen, but i will ensure that the team gets you something as soon as possible, sir. Supervisor walton thank you, dr. Colfax. Supervisor safai thank you, dr. Colfax. I think thats a good transition because were going to call up Michael Brown, head of d. P. H. So if you can go ahead and present, mr. Brown, and then, well have a series of questions. [please stand by]. Even though there does show that theres some improvement, you will see later on in one of the slides that i present to you. Not sure how fast we can get to that, but we are moving this that direction. So the hiring process overview, just basics, the first part is the position. Making sure the position has funding. Theres different processes that go through from our own finance department, and the hiring process. The next is going to be the referral issuance process, where it is controlled by d. P. H. If you see that we have 27 hiring packets ready to go. It doesnt mean that 27 vacancies from disappeared. It may be 15 because were backfillng because someone was reassigned to one of the vacancies in the special area. And then, there is a candidate selection process, and were looking at ways we can be ready. And then, theres the inboarding process. All of this is making sure that the person has all the information that they put on the application. Sometimes, people falsefy information and succeed in the hiring process, and we would have to stall that process, so theres checks and balances that go on. Those are the four ma