Support that employee needs, whether its emotional support, whether they need attention in the Emergency Department or any kind of physical or behavioral support they need. So its 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 nurses life is threatened, how quickly i know there is the deputy sheriff. I just want to make sure the Response Time is quick and thats what im trying to get at. Its not just verbal assault from what i heard, especially with p. S. And what were experiencing on the street with methamphetamine and what that can do to people and what that can do to the nurses. I didnt mention the sheriffs 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 were concerned about in the weeks upcoming and what were trying to do to prevent violent episodes on campus. Thank you. Before we open actually were going to go to were going to ask the union to come up and speak. Before we do that, just going back to the question while youre up here, doctor, of the emergency situation that were 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 youre 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 fulltime staff of 877 when i add it up, it comes up to 158. 7 based on what youve presented here today. Your ftes are 877ful thats just nurses. Supervisor safai thats 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 youre going to hear today. Even without the coronavirus, it seems like this is a crisis for our frontline Trauma Center. What are we going to do i understand r. H. Wants to audit and come up with a hiring plan, but shouldnt we be moving aggressively as possible . I couldnt 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 havent asked. I want to hear from the nurses themselves, but is there anything we havent 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 ive heard from the nurses after working with them, they just dont feel as though theyre listened to. When theyre in the Labor Management meetings and they bring the issues up thats why they ended up coming to Public Comment and why theyre 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 . Thats a great question. And there is nothing more deeply concerning to me than to believe that our staff doesnt feel that i personally, or management teams dont care about our workers and dont want to take care of them and dont want to hire folks when we have vacancies. Im 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 covid19 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 were trying. Supervisor safai do you attend the Labor Management meetings . Do you ever go to them . And if you havent, i think it would be a good idea to check in going forward. Its one of the things we heard. The Labor Management sometimes, if they dont see the top leader, then theyre feeling as though sometimes theyre not listened to in general and kind of the suggestions are going out into the universe. So if havent 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 were 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 lets move aggressively to do that. Thats what the purpose of the hearings are, to work with you, help you. If you feel youre receiving pushback in city government, its 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. Im a nurse assistant at laguna honda hospital and dedicated member of employee of the city and county of San Francisco. Ive worked for the city for 17 years. Im 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 were here to focus specifically on our rns who give Superlative Service every time, but the issues were 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 were raising were raised in 2018 at bargaining. They were raised in 2016. They have always been raised. And so this is not new. And its 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 weve 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. Were taking no more excuses so were here today for solution. No more studies. No more trying to figure it out. You know what the problem is. Fix it. Were 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 were 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 were 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. Im a registered nurse and i was at San FranciscoGeneral Hospital until i was i was my position was eliminated because they werent happy with me speaking about some of the issues were talking about right here. Im now working at the call center that is located up at laguna honda and ive also volunteered for being a field Public Health nurse for the coronavirus so im jumping in the queue because ive 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. Its 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 cant do that, that is not possible. Mr. Cutler, i need you to wrap up. Im going to be stepping out, but what i wanted to tell you, this Public Health nurses recommendation is that you address the fact that there is toxic bullying that takes place from administration and they dont 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 weve done it before, why cant we do it again . And the mayor calling for budget cuts at the beginning of a pandemic is madness. So im 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 were going to call up are stewards heather and martha. Its 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 id like to thank you for the opportunity. My name is heather bollinger. Im 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 dont have that information for you, or im going to have to get back to you, or im not sure who handles that, or i forgot, could you remind me in an email . Youre feeling our pain and im sorry. Its been a very frustrating situation. The presentation im going to speed talk through is edie heavy because thats 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 weve been here. We were here in 2014, 2016. Weve 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, its very nice for administration to say they care and theyve heard us and theyre here and with us. This is why theyre here. This is why theyre with us, because weve 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 its 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 weve 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, were 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 58bed Emergency Department. Thats 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 youve got a functionsal 25bed Emergency Department which is smaller than your last one. Add to the 28 active patients that are in the 25 beds, and youre at full capacity. Now add the 20 patients that are sitting in the waiting room. That is the picture almost every day. And its untenable. And what youre doing is putting nurses in the situation where they know theyre going to fail these people every day. Im not going to go too much into this. We know the budget doesnt meet the current census and it doesnt staff to the current census. If you look at the green line this isnt our data, this is their data. The green line is what were budgeted for. The blue line is the patient load. This is the gap. Were 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 dont 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 six12 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. Theyre using travelers for three plus years. Thats not a temporary employee, thats 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 dont get disaster training, violence prevention training and dont 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, thats what you signed up for and your paycheck doesnt show time and a half. They created a new designation called straight overtime. We cant figure it out either. Been going on a year. Theyre mandating overtime in 2019. How do you how do you work how do you not be completely distracted by the fact that you dont know if youre 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 dont improve care. Our care Start Program ran out of the waiting room for two years. Staff objected to it daily, meeting. There is traffic, emails. So many concerns. No policies. No ratios. They didnt listen to us. The state was called in to evaluate it and immediately shut it down. We know what were 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, theyre seeing less people because theyre on condition 58 of the time. So their census numbers are going down because those patients are in the Emergency Department. They dont have anywhere else to go. Thats