Okay, so good uh good morning.

Morning, good morning, so we call the health committee to order the clerk could take the role.

Supervisor Tam present supervisor Milan present before any instructions you need to provide in person.

The meeting site is open to the public.

If you'd like to speak on an item, you can fill the speakers card in here to me.

And for remote participation, use the raise for hand function online.

Right.

So good morning, everybody.

Sorry for the um inconvenience of being here.

They're doing some work toll in the chambers.

So we were displaced this morning.

We're in this room.

I'm not sure why the other rooms are there.

But we'll do the best we can.

It's great seeing so many people out this morning.

We have an overflow room as well.

Yeah, folks online and got some um major items here.

So let's deal with item A.

First item measure A1.

Good morning, supervisors.

My name is Michelle Starr.

I'm the housing director under the community development agency.

Uh, we're gonna be presenting a PowerPoint this morning and have a written staff report for you as well, which goes over the use and expenditure plan for uh additional revenue that has come in.

Dylan Sweeney of my team should be there, and I believe he's gonna be doing the presentation, but if he's in the overflow room, um I'm gonna I'll I'll launch in.

So if Dylan is there, if he could step up.

There he is.

Thank you.

Good morning.

Um, here to um Dylan Sweeney, I'm the programs and policy manager for Alameda County Housing and Community Development.

Here to present uh the measure A1 program income benefit requirements and graphic expenditure plan.

I was uh may know measure A1 was a voter approved general obligation bond, provided 580 million dollars.

Purchased and improvement of the property to create affordable housing in Alameda County.

Um the bond has now been fully issued from two tranches in 2019 and 2021.

Um those funds were divided among five program areas uh rental development and basement opportunities, first-time home buyer programs, uh homeowner redevelopation and homeowner development, serving both homeowners and renters.

Um and currently virtually all of those initial program funds have either been committed or expended, um, ending with the launch last winter of patron fund programs, first funds, tax default and property loan programs.

I think it's worth noting that the county exceeded its targets for the production of new affordable housing units as well as its 20% of uh unsheltered homeless housing to that goes.

Um, in addition to beating those targets, uh administration of the bond is required to comply with compliance and oversight.

During responsible use of those public funds, they've been drafting and providing reports to the one annual over.

Sorry, measure A1 oversight commitment and providing those to the supervisors, but today we are actually here to talk about program income.

So, in addition to the 580 million dollars, um everyone has generated secondary funding streams.

Well, so there are two sources for these streams.

One is return funding project payments that are made.

And the second is interest earned on invested bond proceeds.

Um these are the uh the funds that were held before they were expended.

Those 500 eight million dollars.

So this is a source of income that will not be reoccurring.

So to date, there has been 48 million uh and 240,000 dollars in program income.

The vast majority of that 43 million is from that's from the bond issuance, and less administration that leaves 33 million four hundred and sixteen thousand change uh available for new housing investment.

Um, so the since these are measure a one funds, they are still responsive to that measure A1 framework, as well as the Alameda County 10-year housing plan that was adopted last year in July 2025.

So the expenditure plan that we provided like lessons that we learned during the implementation of Measure A1 and those five programs focused on maximizing the impact and leveraging uh the scarce funds that we have right now.

So the expenditure plan that we provided lists uh lists four areas uh for investment.

One is affordable rental development, so that's the sort of large tax credit affordable development that you know two rounds.

Uh the second areas two new innovation and small development programs.

One is the Airs First Jails Last revolving loan fund, and that would provide $8.5 million to stabilize re-entry boarding care system here in Alameda County that has been in capacity and then people exiting the justice system to find stable housing.

Um then the second is the shift or the scalable housing in the program, and that's a program which can intended to catalyze and support and non-tax credit, small-scale missing middle development here in addition to those rental development programs.

Uh, this expenditure plan also proposes an ADU loan program, which can support homeowners funding, we apply prices here in Alameda County by building new housing.

Uh, bond funds for the no use.

This expenditure plan includes rental funds for service.

The plan aligns with the broad tenants in the five-year housing plan as well as the um elementary one plan um by maximizing state and federal fund leveraging by investing in innovative cost-effective solutions and by prioritizing service to vulnerable property populations.

Staff report the recommendations are to approve for A1 program income expenditure plan and direct staff to further develop programs of earn contracts to the board of supervisors for approval.

Okay, thank you for the report.

Speakers, I would see if supervisor any questions.

I have a couple of questions, but uh thank you, Chair Miley, and appreciate the presentation and the summary and the update on the usage of funds and clearly exceeding um the goals when it comes to affordable housing.

This is a key mission of this measure.

Um, we have a proportion, our breakdown by cities that were benefiting from A1 and the facilities that are and which city among the 14 incorporated cities received the most.

So funds were distributed in proportion uh to population in the knee of those cities, and there was a formula that was put out uh in measure A1 initially.

We track all that information very thoroughly at our measure A1 website, um, and we can provide that information to you offhand.

Um, we I mean the the funds were distributed in a roughly proportional way, but development is more expensive in some cities than others, so the number of units exactly proportionate to the funds, but I do believe that it's quite proportional and in the funds that were provided uh met the geographic distribution targets that we're in.

Supervisor, we're happy to give you an actual chart that shows you which projects in which city.

Um, but Oakland did receive the majority of the funds.

Um we only did geographic targeting under the rental development program, under the first-time homebuyer program or the home ownership program.

It really was more around, you know, who was purchasing and where they were currently located versus where they actually bought.

Um, but even under the single family uh homeownership rehabilitation program, the majority of the folks are in Oakland.

So happy to actually pinpoint the exact expenditures for you, uh, but we don't have that in this report right now.

I appreciate that.

Would you say it was over 50%?

Went to Oakland.

In the rental development fund, Oakland received more than 50% of the rental development.

Okay.

Thank you.

Um so the categories are listed for the proposed expenditure plan for the 31 reserves.

So this is based on lessons learned, I think.

Does it look at the priorization in terms of where the needs are?

These programs are the prioritization of these programs is based on uh where there's the most potential opportunity to find leveraging and to uh build out innovative and cost-effective solutions with much later allow you to more effectively fund the production of programme.

So um what we identified during the administration that there was a big need at the lower end of the market to work with folks like emerging developers, based organizations who are not able in the tax credit system to produce that the world's getting that would be sort of the priority that's being served in programs like SHIFT, as well as the cares first jails last program, which of course prioritizes the re-entry market identifying what is the faith uh community under the rental to rental development?

24 million.

Um, describe to me.

Is that to build affordable housing units?

Yes, okay.

Now will that be based on?

Because I know with um Measure W, initially we did it based on shovel ready projects.

Is this gonna be based on 24 million isn't a lot of money?

So what's the thinking around this?

Because we need to understand that, Supervisor Cam and I, because if the thinking isn't zeroed in as I think it should be on civil ready projects, I'm gonna speak more about that.

So supervisor, these funds are uh targeted and earmarked for the Broadway properties.

So your board has already given us direction um for that 24 million dollars to be spent on the first and the second projects.

So um that is where those funds are coming from.

So that entire amount will go to the public property.

The first and the second project.

Your board authorized 12 million of that on uh uh week ago last Tuesday.

Um, and uh the next project will be coming forward uh short.

So okay, so the 24 million is pretty much earmarked for the property at Broadway, that's a major development for affordable housing.

What about uh other BBO developers-based developers that have shovel ready projects and they just need a little more money to sort of fill the gap.

So the measure W funds went out, and we have um 10 full projects that we're gonna be bringing to your committee to look at uh next at the next committee meeting.

Um and then care first, jails last, and shift.

Um, we're gonna be focusing on emerging developers and faith-based organizations with those two pots of funds.

Um, most of the of the emerging developers that we are working with, which includes you know, uh uh a lot of the faith-based organizations, they don't have tax credit projects, so we have to devise more um more technical assistance for them.

We have to devise smaller programs where we're paying a higher percentage of their development costs because they can't leverage with tax credits, and so that's what those two pots of funds are hoping to do, both leveraging, and then we also have the tax-defaulted properties program where we have one project moving forward there.

So all of those things are really our way of gearing it to the smaller developers that are not planning to go after tax credits.

Um we don't have any applications uh currently from faith-based organizations that met the requirements.

Um so I would have to meet with your office to get a little bit more detail about what faith-based developers you're working with that have have tax credit projects.

I don't know if this particular based developer tax credits, but I do know their project is pretty much shovel ready, ready to go, and it didn't qualify under W.

That's what I've been told.

Yeah, we're hoping for I'll take a look at that.

Furthermore, there's another developer who isn't um faith-based, uh, nor CBO, but they're ready to go with developing affordable housing units, basically partnership with the school district for affordable housing for uh students, um, families, teachers, etc.

Yeah, those are really important program, and we did get an application from those folks.

They're not targeting the homeless, so Measure W wasn't the right source.

But reality is we need more funding to support all of the possible projects.

As we reported last year, there were over 90 projects in the pipeline across the county, which are ready to go.

And um, the amount of money that we have is only going to support some of them, not all of them.

And so a big part of what our goal is is to, you know, as the board has directed us is to get the biggest bang for our buck, to spread the funds as evenly as possible, to have a geographic distribution.

So all of those things um, you know, really come into play when we're writing our request for proposals and our competitive processes for procurement.

So yeah, we need more money.

We definitely need more money.

And uh we can talk about that at a later health committee meeting.

However, right now, the programs that your board has directed us to stand up through both prior presentations to you is really the idea of the missing middle and shift, um, and then the CARES First Jails Last revolving loan fund to try and stabilize our mental health and our um, you know, folks, our re-entry folks.

And so every time we get a little bit of money, we try and add it to programs that um we think will have a big impact.

And so these are the ones that we're recommending at this point.

Um, but we definitely need more rental development money.

Okay.

How many speakers do you have?

I don't think we have any speakers on this item, but I'll check for on in the room.

We don't have any speakers.

I'll check online.

Are you speaking on item one?

Craig, Mets, are you speaking on item one?

Unmute your microphone.

Thank you.

Are you speaking on item one?

Yes, hi.

Sorry about that.

Hi, thank you, Chair.

Um, my name is Chris Tipton.

On behalf of the East Bay Renault Housing Association, I'd like to offer a brief comments on the proposed SIF development pilot currently under your consideration and how it aligns with Ebra's We Rise program.

EBRA We Rise focuses on a practical near-term strategy, which is identifying existing housing units that are currently vacant due to minor repair or re helpabilitation needs, supporting property owners and addressing those issues and returning those units to the market as efficiently as possible.

The goal is to unlock housing that already exists but is temporarily unavailable while reducing barriers for owners who want to participate.

From our perspective, proposed shift pilot represents a complementary approach within the same broader housing continuum.

While reRise focuses on bringing existing units back online, SHIFT explores the potential to unlock unutilized land through small scale and filled development.

Both approaches recognize that addressing homelessness and housing instability will require multiple strategies, including voluntary, well structured public-private partnerships.

What we find promising about the shift framework is it emphasizes on reducing barriers for all property owners by proposing a model what development risk financing and compliance would be handled by the county and its partners.

SHIP may create opportunities for owners who otherwise would not pursue development.

For some, this could include contributing land, exploring ground leases, or participating in property management roles, all within a clearly defined and professionally managed structure.

Importantly, both we rise and the proposed shift pilot acknowledges that not every property owner will be a fit and that participation must remain voluntary.

From EBRA's perspective, that flexibility is critical.

Housing providers are diverse and solutions are more effective when they offer multiple entry points rather than a one size fits all mandate.

We have a speaker for most people for this.

Oh thank you so much.

Hi, um, thank you very much.

Good morning.

Um, thank you, Dylan and Michelle, for the excellent presentation.

I'm welcome.

I'm an organizer with Oakland in Lena Tams district, as well as a member of the county's mental health advisory board ad hoc committee on care for health last.

I just want to state my strong support um for the proposal by HCD.

I particularly want to uplift the need for the care for last housing fund.

I really urge you to approve this proposal and allocate the 8.5 million dollars toward this innovative housing for desks involved residents.

As you all know, um supervisor Miley and Tim, the CareFirst ad hoc and our residents have been pleading to expand supportive housing for our population for family members and people who have been impacted by these systems.

This is a huge first step to invest in folks at this critical intersection of criminalization and disability, and especially as federal cuts to funding for housing for our most marginalized neighbors impact us every day more than ever.

The county must step in and protect and expand housing access for us.

So I want to just say that in accordance with the 2021 care first jail class resolution that your board passed.

This must be an important next step that you take.

Um please approve this funding and um continue to listen to the family members and loved ones who've been impacted by incarceration, and mental health issues as we share exactly what we need in order to keep this county safe and thriving.

Thank you.

Hello, um, I'm Alison Monroe.

I'm with Families Advocating for the Seriously Mentally Ill.

I'm also on the ad hoc committee of the Behavioral Health Advisory Board for Care First Jails Last.

Um, the Care First Jails Last program had many recommendations, including prioritizing housing for the justice involved, the seriously mentally ill, and substance abusers, people who are hard to place, and this is a critical need from our system.

People come out of jail and out of hospitals, and often they have no place to go that can keep them and can keep them housed and can deal with people like that.

And so I very much appreciate that.

Um there's eight and a half million earmarked here for the carefirst jails last housing.

And I want to thank you for proposing that.

We're on item one.

Alicia.

Oh, I'm here for item two.

Thank you.

We're on item one.

Emma.

Thank you, Clark.

Uh, thank you, Chair.

Uh, my name is Emma.

I am representing uh Isbury Rental Housing Association, and I'm here to support the SHIFT program and implore our supervisors to provide funding for the shift program.

So SHIFT uh is a good uh pilot or a good tool uh for the existing housing strategies that we currently have that's going to solve the issue of homelessness.

So we acknowledge that the program acknowledges that there is existing housing capacity in the county.

Um, however, we do have structural and financial barriers that prevent it from being used.

So what shift is going to do is it's going to explore whether underutilized land can be activated through voluntary well structured partnerships.

So for owners who have land that could support a small number of additional units uh but don't want to take on developmental risk financing or compliance obligations.

Um, shift is a really good program that could offer a path for this owners to uh participate into the program and solving homelessness without the upfront capital investment.

So usually uh from owners uh there are real constraints when it comes to development from construction uh obligations to entitlement processes and selecting renters after uh the houses are developed.

So uh since a county under shift is going to be managing those elements, it really incentivizes the owners to participate in this program and bring more uh housing units into the rental housing market.

So overall, um shift is a really good proposal that we are in support of, and we hope that the supervisors also see it this way, and that we will get funding for the program.

Thank you.

We're on item one.

Hi, my name's my name's Kate Hartley.

I'm with the Housing Accelerator Fund.

I'm the chief lending officer, and I'm also calling in support of the proposal, and thank you to the Alameda County housing staff for their great work.

Um, I'm in support of the proposal, and also in particular the SHIFT program, as other uh speakers have mentioned.

I think it's an excellent program and innovative because it puts underutilized remnant parcels to work.

It's focus on cost controls will ensure that county money can go as far as possible.

And it's an important compliment to the larger scale developments typically funded with tax credits that tend to take a really long time.

The SHIFT program goals are to get housing opportunities, affordable housing opportunities out there quickly and uh efficiently, and uh we know from the housing accelerator funds work with other jurisdictions that there's a lot of excitement around the Bay Area for this, and people are looking to Alameda County's uh leadership on this to to emulate it.

So thank you so much.

This is a great uh creative housing solution, and we look forward to participating um to whatever extent we can in this program.

Thank you.

Oh, excuse me, I was supposed to I want to speak on topic two.

We're on item one.

Thank you, supervisors for uh having a chance to make a public comment.

This is Villa Mandy Camp resident in district three, member of the care first jails last coalition.

Uh the care first, sorry, care first community coalition, but totally in support of the care first jails last plan.

And so I'm very thankful and excited that there is this proposal for making more than eight million available for the people who are involved with the justice system.

I don't have explained to you.

Um I think it's clear enough how needed this is, how much this would contribute to um implementing the jails last and the care first.

Um this is an example of care first.

So please vote for this proposal, approve it, and the sooner we implement it, the better it would be.

Thank you.

We're on item one, John.

Uh good morning.

This is John Lindsay Poland of the American Friends Service Committee.

Uh, I also want to speak in support of uh your forwarding this item to the full board.

Um, you know, one of the things that we have seen in the monitoring implementation of the carefirst plan is that permanent supportive housing, especially uh licensed board and cares tend to fall between the cracks between programs for behavioral health and programs for housing.

Um, that they often see each other as you know, the this doesn't belong to either either one, and so having some funds available for that type of housing and supportive support for rental housing.

We know that licensed board and cares have been going out of business in the county and in the state at a rapid rate because they can't make the ends meet.

And so having that type of support for the groups, often very small family-run businesses that are running licensed boarding cares is key.

Um, and those are also important um services uh for people in transition, people who are trying to get better, people who are um in some type of recovery from a mental illness.

Um and we know that the sources for funding for this type of housing um are under serious pressure um in other ways uh from cuts in federal and state funding.

And so this particular uh, I don't know why they keep cutting off now.

We're on item one.

Zoe.

Hello, um good morning and thank you, Dylan and Michelle, for this really excellent presentation.

My name's Zoe Parsigian.

I'm also a member with Restore Oakland and live in Lena Tan's district, and I strongly support the proposal by the Housing and Community Development and particularly want to uplift the need for um the care first jails last housing facility revolving loan fund.

I really urge you all, like many on this call to approve this proposal and allocate this 8.5 million towards this innovative fund to support housing for justice involved residents with significant behavioral health needs.

Since your board approved the care first, jails last resolution in 2021.

Residents and family members dealing with mental health challenges and navigating the criminal legal system have pleaded with you to expand supportive housing for this population.

This is one of the first times that we have seen a clear and dedicated proposal that actually invests in folks in this critical intersection of criminalization and disability.

As federal, state and state policies continue to disregard our most marginalized neighbors, Alameda County needs to invest in protecting and expanding housing and health care access for us.

This jail care first jail's last fund is a really important first step in that um though through hundreds and millions more dollars are still needed, of course.

Thank you.

We're on item one.

Okay, I would go down.

Okay.

We have no more speakers for item one.

Okay, thank you.

Um, no, Mr.

Chair.

I uh I appreciate the caller's comments and even well.

I um know that the board has been very supportive of many of the programs discussed, including some of the 23 action plans with the Curve First Jails class implementation plan for justice involved, and I think uh trying to get housing for the most vulnerable requires a braiding of funding, whether it's measure A1, tax credits, measure W, and I think this is a good start with this allocation.

So I'm happy to move approval of the program's um graph expenditure plan and moving it to the full board along with directing staff to implement the expenditure plan and to develop the appropriate uh procurement processes and contracts for the full board's consideration.

Yeah, I'll second that.

Let me ask staff a question.

Home ownership come to the mic.

Can you describe how that's going to be implemented?

Um, it's very much responsive to market conditions, so we're not necessarily sure exactly how it'll be implemented.

So we is to look at our seniors who are interested in aging in place, and for like the option of AD property, allow them to move to the location but remain in their community, then also potentially earn income from all of the old house or have them from needs to work out.

And supervisor, can I add that?

Um, I want to add just two things really quickly.

The first is that in an ADU program, our low-income seniors cannot afford the loans.

What we found when we did our technical assistance program in the unincorporated county is that many people raised their hand and said yes, we want to build an ADU, but the commercial banks would not loan to them.

So this would be taking the place of a commercial loan.

They'd be amortized, so the increased income would go towards paying back the loan from the county, but we're clearly going to be working with um folks who want an ADU but are not qualifying under the regular banks.

And then also I just want to say, you know, um, our partners at the Health Services Agency and H did a really great job of helping us understand the board and care world, and you know, this is directly in partnership with them and the work that Jonathan's team did around trying to identify, you know, how can we support the board and care world?

I think you mentioned board and care.

Is that covered under categories?

What?

That's a care's first jails last proposal.

It's really to try and help us support those small operators.

Okay.

Well, suppose I made a motion I second it.

The um not a lot of money, and the best you can based on I think I heard uh the need and the prioritization.

Let's do so.

Thank you very much for your time.

Supervisor TAM.

Hi, Supervisor Milan.

Hi, that's not item two.

This is uh informational update.

Morning, supervisors.

Um, my name is James Jackson.

I'm the CEO for the Alameda Health System, and I appreciate the opportunity to uh have some of my colleagues and I join you this morning to provide an informational update on the health system.

Um we'll start with a presentation of our most recent financials.

Um, and Metzger will present that aspect of the work.

She'll be followed by um John Minus Schwartz, who will give a overview of the HR1, but also state and federal federal financial changes that we believe are relevant and pertain to the following action, which is the reduction in force that has been um initiated by the health system, and to that end, Jet Shatman will present the latest update on the reduction in force.

Um we are happy to take your questions, of course, during the presentation and also at the end of the presentation.

So with that, I will ask Ann to join me.

So I'm Anne Mexker, um, excuse me, BP of Finance for Alameda Health System, and I'm filling in for the financial office.

Oh, next slide, thank you.

So this is our November.

We're going to focus on the year-to-date results.

Um, so you will see that year to date our net income, but 5.5 million dollars, and about 2.5 below our budget target of the um the favorable variance in the year-to-day revenue of $4.6 million.

That has been the trend for the entire five months of this fiscal year.

Um net patient revenue was above budget by two million.

Um, other government programs um was below budget due to the first quarter, which is July through September for the venture eight, we must have a and then we threw it up to the actual receipts.

And then other income was five million above budget as a result of a couple of one-time items.

Um we had a 3.1 million dollar settlement on prior um patient billings, and then uh the Alameda Alliance paid for performance was an additional 1.2 million that we did not include.

So on the um offsetting the positive year-to-date revenue variance is an unfavorable year-to-date expense variant of 7.1 million.

Sorry, the primary driver is the labor cost, which were 12.5 million due to unfavorable staff and wages, higher employee benefits, and offset by a but favorable variance and provider.

For us, the definition of providers is physicians and mid-level providers, which requires DNA, I'm not seeing this um certified and system.

Um, and then the other difference was offset by favorable variants and non-labour, so outside medical services.

Our budget is um too high.

We had a credit that we received at the very end of last fiscal year, but our budget was already done, so we will be running a favorable variance and outside medical probably the entire year, but that was three million and software licenses and hosting fees 1.4.

Next slide.

So this is our um hash collection.

So we have created a trending, it starts at 2021, fiscal year 2021, and it up is up to an annualized fiscal year 2026.

So you will see that our um collection growth has been significant over this six-year period, um, which is the result of the patient financial services team and strong revenue cycle.

And then the other from this is the team has done an outstanding job of collecting on older accounts.

So sort of like one time money.

But as a result of this, we are showing that we are collecting higher than the governmental fee schedule, which accounts for about 90%.

So eventually we expect our cash collections to level out, not be running at 10%, 13% over year over.

But it's a great picture.

The next slide is labor trends with FTEs.

So since fiscal year 23, we've increased 379 FTEs, which has allowed us to strengthen the organization and just sit here, improve patient experience and quality outcomes.

Our labor costs represent 75% of our total expenditure.

So it is a big line item in that area.

And then finally, this is our line of credit, which is also referred to as the net negative balance of the NNB.

And it's forecasted through June 30th of fiscal year 27, which is the far right hand numbers.

So at 630 of every year, we have a target to meet.

So 630 of 26, that target is 95 million.

So our borrowing from the county need to be below 5 million to represent.

And at the end of fiscal year 27, we needed to be 90 million.

In the middle of the year, we are allowed to go about 50 million over the June 30th target.

So that's a little higher black line.

So you will see that we started below zero.

So that technically means that we were in a receivable position with the county.

So they technically owed us money on our line of credit.

We continue to access it, it kind of goes up and down depending on the supplemental funding we receive and our expenditures.

But in the middle of the graph, we are projecting that we're going to be below this 95 million.

Then in the first four months of fiscal year 27, July through October, you will see that we go over our maximum ability to borrow.

This is because that first four months of almost every fiscal year.

We always have this kind of dry period.

And so this is demonstrating that we're going to go over and we are working on developing strategies because we have enough room on our NNB balance at the close of June to cover this period of when the cash is very tight.

Yes.

We don't have your PowerPoint.

I don't see any of this.

So if we were to adjust that, how would that help?

If you were to adjust the block line, your LB line.

So currently we're projecting to be about 60 million over the line so yeah would that be one time or ongoing um well we'd have to be one time to cover prices it we need to be ongoing because then you graph at the very end with you if that helps we would be right at bottom threshold so every year our line of credit would be about five for the so it continues to decrease actually I mean so and is exactly right in the way that she's described it and so we are in active conversations with the county administrator about the N and B because the way it's structured it presents opportunities to revisit um how it's implemented and I appreciate you asking about what would be necessary increase being that's something we are actively discussing with the county administrator and also as Ann pointed out it does go down by five million every year and the reality is we don't cash our structure is such that the county sweeps our cash and that is we agree with that and we understand that but it means that in the way that other organizations have a cash reserve AHS will never have a cash reserve and so the concept that the N and B will continue to go down and have to go away at some point I think operationally does not work as we will always need to access credit because of the dry period that Anne described part of the conversation how do we reconstitute so that AHS will always have access to capital and I do want to point out it's something we always pay back.

So as Ann said we were in a receivable in here and so it's not as if this is cash that we're asking for that we will not repay it just is essentially a credit card that we will use until we receive the funding from the state and the feds which we then pay back to drive the uh the deficit back down.

Okay can I ask the follow up so in you talk about the 60 to 70 million dollar increase in the NNB to help get through this crisis and as you mentioned um you get the reimbursements from the federal and the state government to repay the NNB.

It has to be more than just this year right if if we're talking about the impacts of HR one it would have to be more than just this particular crisis year right yes thank you supervisor that's exactly right so that's part of the conversation that we're having is what is the change to the structure of the N and B on a forward looking basis so that we will be able to access the line of credit that we need which we will then pay back down but it'll never it'll never go away in the foreseeable future as long as um we exist as we currently exist.

Oh okay uh do you want to entertain uh other questions on what she just presented I don't know I don't know if she's finished but I I was interested in that piece what are the questions yeah yeah so you mentioned that uh since November of 2025 uh EHS added 379 employees since no since um sticky pages um since 23 we we don't have the oh presentation material yeah since fiscal year 23 can we so since fiscal year 23 we have increased 3073 i see and i'm happy to leave my printout with you okay thank you um i would like to also this is on the next on final page but a hs we have ended the last four fiscal years in the receivable position on the um I've worked here for about 16 years and first time I had ever seen that in my entire career with AHI I do think we have demonstrated that here and unprecedented times for your record so the very last slide.

So as I just said, we've successfully paid off our line of debt at the last four fiscal years.

And we've just listed some um primary financial um constraints or stress points that are occurring in the current.

So we've returned four three million related alignment um programs funding that we actually received in fiscal year 23.

But the settlement of the funds and whether or not you're able to keep them takes about two years.

So we learned that we have been overpaid by the health group by the county.

And so we returned 42 million dollars, which they then subsequently returned to the state.

Consistent with our St.

Rose affiliate affiliation that we entered into to help provide and expand the safety net down to the southern part of Alameda County.

We um provided $12.2 million in support for them to be able to draw down some supplemental funding under their structure.

And we um are planning to need about 10.5 million for that in April of 2026, but it's pending our Board of Trustees approval.

Um the John George funding, which is a large contract that we have with the county.

Since we um since that program converted under smart care in Calane, the county's been withholding 20% of our billing.

This having more access to the 100% of the billings that services provided would help us with our cash flow.

Um we also are anticipating as um it's no news to anybody in this room, the H1 and federal and state reductions that we require for this couple years, and we've had increased operating funds particularly land benefits over the last several weeks.

That is my presentation.

Segway to John, please.

This is my um co-worker, John.

He's gonna talk about the reimbursement.

I'm going to provide I'm John Middlet Schwartz, Director of Reimbursement, and provide a brief update on the federal and state costs hanging over us and uh what we presented before, but uh what we know this month.

Um, first uh this is this slide is as presented in August at another public meetings.

It's an attempt to project the fairly difficult to estimate the impact of HR1 and follow-on impacts, also federal but also state, and to real emphasize uh first the overall magnitude of the cuts by the federal law that was passed cutting taxes and spending in 2025, uh, and to show the multi-phase nature of it because the biggest cuts take effect January 2027, and then the another major round for AHS takes effect January 2028.

So what we show is three calendar years, different phases, uh state budget cuts, various types uh in 2026 in the tens of millions range, uh 2027, the work requirements uh making it difficult for people to stay on Medi-Cal, reducing uh net patient revenues, patient service revenues, and then another reader 2028, the bill actually targets uh certain supplementals that uh the AFS relies on at this time, so we know how much those are.

So we know that uh the ballpark you get to is by 2028, you have revenue reductions of 100 to 150 million dollars, and those are annual numbers, and they would increase over time because I say phased cuts to supplementals.

2028 is actually the first phase and it continues year year by year, we'll probably not stop reducing until the 2030s, based on our understanding of how that would work.

All of this is without considering the Medicaid dish cuts, uh, that's disproportionate share hospital, which is another major funding stream we rely on.

But this has been a major advocacy effort uh at many different times because there are cuts scheduled in current law that take effect unless Congress continues to delay them.

They were the cuts actually came into effect last year and then were retroactively rescinded when the government remote.

Further delay the cuts actually expires next week.

So we don't know if that's going to affect our cash.

If that's going to the cuts are going to come into effect, that could affect our cash further.

If the cuts were fully implemented and never rescinded, that would be approximately 60 million dollars loss a year.

This one we have.

So that is what I presented previously.

Now on January 9th, the governor proposed a budget, and I imagine that people have been briefed to some extent on this.

The bottom line is that it does not propose major new Medi-Cal cuts yet.

Although it was set to increase in 2028.

But it also showed the HR1 cuts going into effect over the course of the fiscal year, some earlier, some mid-year, and did not propose to mitigate that.

In some cases, increasing, in some cases declining.

This of course is going to turn into an overall budget to be passed by the end of June.

But the proposal, as the governor put it out, did emphasize that this is dependent on state tax revenues, staying as they have been, which depend on income tax revenues, which are uh a lot of that depends on the stock market.

So it held out the possibility that when the governor submits a new version in May, that could look very different if there have been uh major changes to the stock market.

Uh the governor also uh expressed an intention to address the subsequent year uh the subsequent year deficit projected even after he's out of office.

So we don't know what that will look like.

Uh so overall, this is not new.

Uh we're not seeing cuts in this budget year, but we are seeing continuation of the headwinds of HR1 and of the state cuts that were passed in uh June 2025 before HR1 was passed, uh, which are continuing to uh we're starting to see effects.

Also, as an update, um, the DHCS, the state health agency didn't give updated estimates of how much enrollment cut they expect related to HR1, which is a large part of our current revenue drop projections in the longer term uh for next January, and the work requirements.

They estimated based on further internal analysis, 200,000 fewer Medi-Cal members in June 2027, one million fewer January 2028, 1.4 million fewer in June 2020.

They also estimated the impacts in hundreds of thousands uh for some other cuts, the big the biggest other one being members having to re-verify their status, go through all the eligibility checks once again every six months, not uniformly, but quite a lot of uh medical vendors would have to do that, which makes more people drop off the program because it is it does remain with or without work requirements a uh difficult application.

Uh so the bottom line is uh these are uh still estimates, uh, but we are getting closer to an understanding.

We won't really know until it's happening.

Uh, depends, as I've said in previous presentations on state rollout, how user-friendly the state process is, especially for verifying work or what they call community engagement.

But uh, this is certainly in the same ballpark of cuts uh that informed the previous estimates of how much work requirements would affect our uh patient service revenue based on a material percent of Medi-Cal members actually losing coverage as a result of work requirements.

And once again, not because they do not work or do not have good reasons, but because the documentary hurdles are as uh are significant.

Uh, that is my present logical supervisors.

So the uh rural AHS budget uh this spring.

So we intend to or by by June by the end of so we do intend to uh further refine our estimates and have an updated estimate, I should have of all the of all the cuts and what we're what we're estimating and how we're uh and what we're doing about it as part of the 26-27 budget.

Do you have a sense of when you'll adopt what I'm looking forward to because I think it'd be helpful if normally this committee have a presentation on your budget before it's adopted by the board of trustees?

So yes, okay, great.

So we'll try to schedule it minimally for this committee.

It could be the full board, but at least keep the committee to look at it.

That would be sometime in June.

Okay.

So that's your channel.

Uh yes.

And I'm sorry, I'm trying to uh understand statement in here about the withholding of the 20% of the county.

Uh I can speak to that.

Uh so Cal Aim was uh CalAim did many other things, uh, but in this context, it is changing how uh all counties pay for behavioral health services, and uh so it meant that instead of billing on a cost-based methodology, we now bill county on a fee for service based methodology.

Uh this has had a lot of implementation pains, and one of the things that happened that affected our cash as Ann was presenting, is that they bill us on it, sorry, they pay us on an interim basis based on the days and uh emergency service hours uh that we documented them, but then they take uh make a reduction uh to what we are owed to as to account for the possibility that on final reconciliation we are owed less.

That deduction used to be 10%, now it is 20%, which affects our cash materially.

How's that uh reflected in like your your budgeting?

Is it more that more than just cash flow or is it affect your uh in revenues?

And also, what was the rationale from going from 10% to 20%?

That was um that was uh the county behavioral health.

And uh, we don't have a clear picture now.

So I think it answered that question.

Yeah, so I don't have don't know why it's why it was 10%.

I don't know why it was 20%.

Um so what we do is we um book an estimate every month, and by June, um we queue up to the actual payments as part of our annual fiscal audit.

So whatever is paid through like about September 30th, if it relates to the prior fiscal year, we should our revenue up to that, so essentially mirroring the cash flow.

Okay, so so it's strictly just a cash flow situation.

Okay, thank you.

I'm gonna go a question about uh uh billing and the windfall.

Uh my understanding is that we heard John mentioned uh we uh we've been implementing a billing system that's been in uh taking our way through it, we can progress.

Uh, but I can ask Bayerald specifically for that, and I'll follow up later.

Yeah, because I'd like to know the rationale from going from 10 to 20, why rationale for it being 10 and what kind of money are we looking at historically?

Yeah, obviously it affects their cash you know revenue.

Right, yeah.

Okay.

And next up, uh Judge Hapman is going to present regarding the reduction of.

Thank you, John.

Thank you, James.

My name is Jed Chapman, and I am the chief Human Resources Officer for Alameda Health System, and I'll be presenting the uh information regarding our reduction in course update.

So a little bit of background information.

Um, when we realized what was happening in the impact of HR1 and what our budget looked like, we actually called a meeting of all the labor organizations.

That was November 13th and 14th.

We discussed HR1 and would discuss AASL over there.

Then the executive leadership team met to discuss how to operationalize the project and mitigate the impact of patient care.

That was the beginning of the RIF process, the reduction in force process.

Unions were noticed that there was going to be an investment in force on December 19th.

And there was one meeting, I believe that was held uh the week of December 22nd, but uh several of the meetings began in December 29th and right after the first of the year, and that was part of impact bargaining.

Total impacted employees, 247, when these slides were presented, and we just recalculated, and now it's 229.

So that number has gone down a little bit.

Labor unions that were involved were acne, BCC, SEIU Local 1021, the general unit, nursing, San Leandro Hospital, and Physicians Unit, SEIU, UHW, and CUNA.

And prior to the um notice of union to the unions, AHS offered two voluntary separation programs.

One was the voluntary resignation and the other one was the incentivized retirement program.

We actually had a total of 73 that took the opportunity for the voluntary resignation or the incentivized retirement program.

31 from the voluntary resignation and 42 applications were submitted and approved for the incentivized retirement program.

So for the voluntary resignation with the severance program, what we did with that is we um had eligible employees to not a notice for eligible employees to be able to retire and receive a severance package based on their years of service and an additional three months of COVID recoverage.

And the information is there from the years of service from zero to five all the way to 2012 years.

Severance payments were will be paid in a lump sum payment by check.

Um applications, uh applicants accepting the program may not reapply for a position for a 12-month period of time.

Next slide, please.

Employees received a severance package of 17 weeks of pay and two months of additional COPA.

We also uh notified employees and that anyone that was in the ASERA pension plan should contact the SARA, anyone in AHA AHS's pension plan should contact AHS for additional information.

Next slide.

So this just gives a little bit of information on the dates uh that the programs, both programs were offered.

December 17th, the program was actually announced.

Um, I mean November 17th, I'm sorry, the program was actually announced.

Employees had 30 days to make a decision.

December 17th was a submission of applications to their immediate supervisor for a submission to payroll service center.

January 2nd, the notifications uh of approved applications were sent.

Uh the DSRP, the resignation, the projected date of separation was January 9th, so all of that has been processed.

And the entire recentive pro uh incentivized retirement program.

There were three choices that employees could select January 2nd, January 9th, and January 16th.

So those are also being processed or have been processed.

So communication that was made to impacted employees for unrepresented staff, they were actually notified of enforced on December 19th.

Initially it had an effective date of February 23rd, and that was actually extended to March 9th.

For uh the unrepresented staff, we had meetings, individual meetings that were in person and or via Zoom.

For represented staff, they were originally supposed to be noticed on December 23rd.

However, we heard from our Board of Supervisors, Board of Trustees, and other public officials, so that date was moved back to January 6th.

The effective date for represented staff separation will be March 9th.

We have continued to meet with the unions in terms of impact bargaining, in terms of seniority lists, in terms of issues and concerns that are happening regarding the risk.

So we are still in negotiations with them on that.

Additional steps that were taken.

There were presentations.

I mentioned the November 13th and 14th date.

There were also presentations that were made on our leadership desktop chat.

What that is is every Wednesday from 12 to 1.

We have our executive leadership team as well as senior leaders that are on a desktop chat, and we invite all employees to attend to ask questions, bring up concerns, anything that they want to talk about.

We actually have speakers, we have presentations, and employees can ask any questions that they want there.

We've also created an external website for those impacted employees to be able to ask questions and request information and resources and gauge and reaching.

For the impacted employees that are unrepresented, we've held two HR forms.

We held one December 30th, and we held another one as uh early as January 22nd.

And that was for them to come, ask questions, get resources, anything that they needed, we're here to provide.

The other thing that our HR team is working on, along with our PACE communications team and legal team, are resources for EDD interviewing skills, resume writing skills, looking at other internal opportunities that our impacted employees may be able to apply for.

We have been, as I said, meeting with the unions on impact bargaining.

I talked about our recruitment team working on internal postings and our impacted staff will have priority over any positions that are open.

Our OLA team, which is our organizational learning and effectiveness team, that's our training team, have developed and scheduled the trainings for the resume writing.

And then we also have we worked with our EAP program to provide resources to those impacted employees post the reduction in fourth for an additional 18 months.

And that includes counseling, financial counseling, resume writing, mental support, and that's for employees and their families.

Additional information.

So anyone will have access to that.

At the end of uh the employees' paid leave because they received it when they received the notice, they received it with 60 days pay.

So at the end of that paid leave, they'll receive any severance and any accrued PCO.

Unrepresented employees also received instructions on how to pick up their belongings.

Many of them had already picked up their belongings and their items, but on January 22nd and January 23rd, the remaining items were picked up.

Information for representing employees that were sent notices on reduction in force.

They were actually sent their notices on January 6th, as I mentioned earlier, with FedEx and personal email.

We have been meeting with our labor unions regarding seniority, bumping rights, classifications, and possible cost savings.

The effective date for unrepresented and represented employees will be March 9th.

And then we have designated recruiters from our HRT to be able to provide assistance and support to impacted employees interested in applying for open positions at AHS.

And that actually concludes my presentation.

I'm happy to take any questions.

Thank you.

Yes, thank you for that summary of what has transpired since November.

You mentioned that there were a number of meetings with all the labor organizations mid-November to update them on HR1 and the AHS budget.

What kind of feedback were you getting at those meetings?

Well, the meeting that was held on November 13th and 14th was more of an informational meeting.

So that meeting provided information on HR1, provided information on the budget, and what we did at that time is we asked the unions to partner with us to come up with cost savings.

We didn't ask for feedback at that time.

And so when we went into impact bargaining, um we still um and we still are ongoing discussions about that.

But when we went into impact bargaining, that you know, we start talking about cost savings and things of that sort, but we didn't do that on the 13th and 14th.

We just asked the unions to partner with us, and all 19 labor unions were invited to those meetings.

Both meetings were the same meeting, just to make sure that we had um, you know, allowed the unions to be able to participate in one or the other, they both would say meet.

You can do it.

So we have something called GRIF, it's an acronym, but in essence, that's uh a clearinghouse where ideas that we receive are vetted, and then we determine if what's the number, what is the savings that we can realize by virtue of that.

And so um would be happy to share what we've received, and grid can be done anonymously, and so whether it came from labor directly or not is unclear, but certainly we've received frankly really good input from staff about savings opportunities and a myriad of opportunities, and so that's gonna go a long way.

We have a program called 100 million together, and that's really trying to work collaboratively to reach our 100 million dollar reduction target, and the reality is this fiscal year, we believe that the reductions in force will net us about 17 million, which is through the end of uh the fiscal year.

Um, and then if you extrapolate that out over the next year, the number will be higher, but that is for this year, it's a relatively small amount of that 100 million, you know, it's 17 or so million dollars, and the balance of that is going to come via the grit mechanism, um, getting ideas from staff throughout the organization to help us drive the change that we believe is necessary.

Okay, I would like to see that, and uh part of um what I'm thinking through right now is I serve on the board of governors with you on the Alameda Alliance for Health, our Medical provider.

Uh I serve on PAL, the personal administration legislation committee.

Supervisor Miley and I were we formed a joint committee on social service and health to discuss the impacts of HR one, and then we also serve on the budget committee.

So we all are trying to grapple with uh effects of HR one and trying to plan for that, which is exactly what I'm hearing you trying to do right now with this uh reduction in force.

Um we we don't obviously have certainty in what's happening at least at the state level at the moment.

Uh we are making our best projections.

Um, so what I'd like to ask if we can collectively think about this on uh supervisor Miley's point is before you adopt your budget.

Um can you work with Alameda County Health and look at ways in which uh we can mitigate some of these reductions and also look at these savings.

For example, when you talked about the um basically the cash flow situation, when we talked about the negative balance situation, can we uh collectively see because I know we provide measure A funding, we provide rent-free facilities at the Wilmachan Highland facility uh hospital.

I want to be able, but this is a core function of the county, and and we need to make sure that it is intact.

So if we can find a collective way to minimize these impacts before we adopt a budget that would be helpful.

I could not agree more.

Very much supervisor, and we would very much like that.

I'm I'm proud to say that in the five years that I've been in this role, we've never asked the county for anything other than what was already allocated.

We use our negative balance, we've increased our revenue, which is and shared earlier.

We've been able to live within our means and continue to provide excellent care.

Um the universe is changing.

Umuded to it, I'm gonna say it out loud.

The folks who are impacted by the RIF, none of them have done anything wrong.

This is not performance-based, this is an imperative of what's happening from the federal, possibly the state level.

So this is us trying to maintain our core function.

There are no programs that we believe are expendable.

We had to make our choices and the best of a bad situation, and so I do not relish any of the actions that we have put forward.

This is what we have to do to sustain the core, and to the extent, and we will have the Bilson hearings, which we're gonna be coming up, there will be a much deeper granular opportunity to talk about the specifics of the reductions and the programmatic changes.

But um, I just I think you summed it up very nicely, and I I look forward to working with the county, and we felt like we had to do our part because we are gonna ask the county to step up and to do more.

Um, but it would have been inappropriate for us to ask that of the county if we were not willing to lean in and make the necessary and appropriate changes that we I appreciate that.

And um, Supervisor Miley and I were part of the board majority that advocated very strongly to preserve some of the measure w funds for essential services for these kind of situations with HR1.

And so to the degree that we can in your discussions with Alameda County Health, look at programs that may be potentially offset by Measure W, that would be really helpful as well.

You're welcome.

Thank you.

I appreciate that.

And um, you mentioned Alameda County Health, and I just have to say that I was also a former employee of Alameda County Health for the past 11 years and as well as uh former employee of SEIU.

So, yes, the partnership is really important to be able to figure out ways to mitigate the impact.

I also just want to acknowledge um Jed and I had a conversation with the gentleman from the city of Oakland broadly.

Oh, yes, uh huh.

Yes, so we had a we had a conversation, he was with the workforce development board, his name was Michael, and they actually provide resources on helping um impacted employees find resources, seek out jobs.

Um they also uh offer interviewing skills and resume writing skills, but uh he partners the uh a city, he's in the city of Oakland, and they partner with other uh organizations, CBOs to be able to place some of our folks in jobs if they're um if they're actually eligible for it.

So we talked to him we're gonna be working with him gonna send him some information um today or tomorrow just about the impact of our employees and just some over these uh classifications that they have and start working with him to partner as well so um supervisor we had because we want to obviously the county has a responsibility on the section uh 17000 um and we will be holding the balance and hearing believe it'll be on February 18th so we can understand the impacts to programs as results of any um reduction in force uh we need to understand that and it's my understanding once again the hearing will be on February 18th that's a Wednesday I don't um let uh as the clerk or Nika knows the time I don't know the specific time but I do believe it'll be the 18th now and I would be very interested like Supervisor Tams said in knowing all of the possible uh suggestions you've received from folks to um mitigate any reduction in force because I'm thinking about anything around anything around lease space is anything around um I don't know once again we're not on the board of trustees so we we don't know if there's been any uh um say unusual um efforts around uh administration and compensation and that nature we need to look at understanding the complete picture and that's one reason why the board uh is looking for the whole governance piece potentially getting a supervisor on the board of trustees maybe even one for staff and I have a lot of confidence with board of trustees as I do in the CEO because I've been here for a while um 25 years so I've seen the worst of the worst and I've seen things are better and I've seen the challenges so we need to understand all of that as we grapple with HR one and the county grapples with uh Prop One and we grapple with the you know the situation with the state's uh deficit etc we need to look at all this so we can be as supportive as we can with um how to be health systems and ensure that um um we're doing everything in our possible thing we possibly can do like around the reimbursements like around um the net uh neck negative balance you know all those things I feel should be on the table uh I kind of get to sense supervisor tam feels the same way we're not gonna leave any stone unturned um and then the issue I know I've asked the staff about this too the bumping rights I need to understand um people can bump through different positions not just within HALME health systems but into the county as well um because we need to understand that this and then I want to ask a question 73 is that the 73 um is that modernist to be some orty some that still need to be laid off there it was the 229 that were still laid off and there were 73 that took the uh took advantage of the resignation and retirement exactly no offset no offset so it's still it's still like 229 yes um okay all right but I think um those are some a lot of the questions you'd like to supervisor camp about their goes on what she's saying just I think with the the balance and hearings um we'll get more detailed but hear help us with that and I think James you've had conversations with the administrator uh let us know how that's been going.

Extremely well.

Um certainly even with an administrator briefed as well as Director Chaudry about the process as it's going along.

I think we've had very productive conversations, certainly about the planning for Beagleton, but more generally about why we're doing what we're doing, how do we mitigate any impacts to the extent possible?

There will be impacts.

I don't mean to suggest that there will be no impact, just trying to mitigate those impacts.

So those conversations do continue.

And just uh point of privilege, I want to acknowledge um David Sine, who is the board chair.

You mentioned our board of trustees, and uh he is the chair, David is the chair of our board, so thank you very much.

Uh Chair Sign for being present.

Would you like to say anything before I open up to the public for comments?

One thing I'd like to say is thank you to thank you, James.

The one comment I would make is I was really touched by so many of the folks that came and spoke at both of the meetings that we've had recently.

This is a terrible situation.

Uh no easy way to deal with this, and I feel that our administration calculated a way to get through based on the numbers and what's available within our own system, and then we you know bring that to you and say looking wider to the county or whatever, or maybe there's other ways.

But we feel that James and his folks worked up the only solution that made sense to survive, and we need to survive and have a safety net, but with what we're looking at, we're gonna have one that has some holes in it unless we can find a way to plug the holes.

Well, once again, I do think uh Supervisor Tam said it.

We're here to cooperate, good partners, you know, we can be of assistance because I do know you've taken on an additional burden when you took on um St.

Rose Hospital.

You know, that didn't cannot be stated.

That was an additional responsibility, as was you know, a long time ago taking on St.

Leandro Hospital.

Yes, we know that, and that's important to do it.

So the Alameda Health Systems has grown, and I know that's produced additional challenges, and so I think it's incumbent upon the county to see how we can be hopeful.

We've asked you to do some of the things that you can do that, we hadn't made it clear that that's what we want to change it.

I really appreciate it.

You're saying that supervisor because it was clear that the board of soups had an interest in us assuming certainly San Leandro 14 years ago, 13 years ago, and as well as the JPA with Alameda Hospital, um, and then subsequent to that St.

Rose.

But I want to just also say Saint Rose was it was the innova report, the body that looked at it, and it was very clear that if we did not help sustain Saint Rose, that those patients weren't going away, they were going to inundate the balance of the community, certainly AHS facilities and up and non-HS facilities, and so and they would the patients would have to travel to get the care that right now they could get in their community, and so it really it made sense for us to lean in.

Um I committed at the very outset that we would never jeopardize HS core by acquiring St.

Rose, and I'm proud to say that a year plus in, we've been able to stabilize St.

Rose.

Um, they're not out of the woods, but they're no longer hemorrhaging funds in the way that they were previously, and we're very optimistic about some of the programmatic changes that are taking place there, and so as we were able to do with San Leandro and Alameda, we are um bullish on St.

Rose's future.

But thank you.

I appreciate you acknowledging it.

Right.

Well, Tisa, how many speakers do we have?

Sixty sixty sixty, and let's see what time it is.

Um no supervisor Tam, you have another meeting at I have a one o'clock meeting.

O'clock.

Okay, so how long do we give the speakers a few minutes?

That's two hours.

So we're gonna give you a generous one minute to speak, but it'll be generous.

Keep in mind uh has another meeting at one, and I know I have another meeting at 1245, but we do want to hear from all the speakers.

So let's um call the speakers and if you uh have if you're repeating something somebody else has said, you could just say ditto.

Um, is that we're gonna hear from you all.

Peter Macyak, Nathan Hansford, and Drebby.

Good morning, everyone.

Um, I'm Peter Maziac from the East Bay field director for SCIU 10 to 1.

Um, trying to cover my thoughts.

I'm gonna try to reach kind of more verbatim than I normally would.

So when the system is working, we shouldn't have to come here to address the board of supervisors, AHS detective management and the board of trustees should be able to manage their own responsibilities.

So, understand that we are here today because the system is not working, AHS seems unable or unwilling to manage their responsibilities to follow the law and consider patient safety.

Let's go over what we know.

Without union intervention, AHS without union intervention, AHS plan to say off send it layoff notices on Christmas Eve.

AHS has unilaterally created a mysterious paid leave policy and used it to remove hundreds of workers from healthcare sites, creating service cuts while workers are still getting paid to sit at home.

The very idea of a legally required VLAN hearing never occurred to AHS leadership until the union spoke with the Board of Supervisors in December.

The paid leave has led to service cuts prior to there being a VLANC and hearing.

Documents explaining the need for layoffs, AHS cite a HR1 cuts, but AHS's own financial documents show there are no HR1 cuts in the current fiscal year.

Thank you.

That's your time.

I'll let him finish.

In determining layoffs, AHS has not consulted with the medical executive committee.

In determining layoffs, AHS has not consulted with department chairs, despite lying to the union about it at the bargain across the table.

AHS rolled out notices so poorly they had to retract dozens of paid leave notices and beg worker to return to work.

Layoff bargaining, management had the obligation to bargain over both the impact and seek alternatives.

The union has offered over approximately 40 million dollars in savings, and AHS management seems uninterested.

The union believes there are hundreds of millions of dollars owed to AHS that are still sit and unprocessed work queues.

AHS has requested the union has requested information regarding who made the decision to lay off and what analysis was conducted.

Not only has management refused to provide the information, but they question the union's right to that information.

The union cannot seek alternatives if we don't know the analysis and the decision makers who are making those.

Regardless of how much we all want, need AHS leadership.

At the end of the day, it is the responsibility of the Board of Supervisors to provide health care to the public.

We are asking the boarders to the board to intervene in order AHS to rescind the paid leave and layoff notice.

We're asking the board to then convene a table of all stakeholders, management, union, doctors, community groups, elected officials to collaboratively develop a plan to absorb the pending blow from the HR one cuts.

We are asking also for an audit of the decision making that led to this catastrophic failure of AHS leadership.

Those decision makers be held accountable.

We aren't fools.

And if we work together with transparency and openness and a collaborative spirit, we can figure out how to address these with the least with the minimal impact to the community.

Instead, what we're getting is management decisions on high with zero information and bad faith bargaining at the table.

If you rescind the layoffs and the paid leave, as you saw from their own presentation, there's no HR1 cuts right now, and then spend the spring and the summer of this year to form a collaborative table to get together to figure out how we can all participant, all stakeholders can be involved in this discussion.

We will then come to a solution that may not make us happy, but addresses all the concerns in this room.

So if you like what he said and you come to the podium, just you know, say, thank you, Board of Supervisors.

And so, as the area supervisor and the uh chair at the impact bargaining table with AHS, I want to say, um, I also want to just uh talk a little bit more about the fact that we have identified hundreds of millions of hundreds of millions of problems.

This is not an exaggeration that are sitting in keens waiting to be collected, which would make all of this a moot point.

We have shared all of this at the table uh to no avail.

Not only do we not receive a reduced list, which would be normal in impact bargaining, uh we get stares.

We we have we have met with finance only to be told why don't you just work with us?

Uh, the current situation is untenable.

Uh, this is not bargaining in good faith.

We have we have again identified everything that AHS has said and have repeatedly told them that we have audited the budget with what we have, and there is no need for cuts today.

We do not understand why there are taking place now, with an imposed date of March 9th, with no sufficient evidence that requires that.

Typically, when you do layoffs, public and flag, and as you both know, uh you do it for two reasons lack of work and lack of funds.

There are no lack, there is no lack of work.

Uh Alameda County needs these services.

And there is no lack of blood.

If currently the money is there, we would like to continue to try to find solutions to keep the money there.

Um, and so we are asking you today to please uh work with Alameda Health Systems to rescind the layoffs and get people back to work while we can effectively find solutions to them.

Thank you.

Hello, my name is Tim Dreby.

I'm a licensed marriage and family therapist, and I've been working at Highland Hospital Outpatient Psychiatric since 2002, approximately 24 years.

I think back to so many stories of oppression and suffering I have witnessed that are gut-wrenching stories, stories I've never had to sense that the public please or understand.

The place where people uh process years of shelter boarding care homes, hospitals, homelessness, jails, family struggle, alienation, and exclusion.

Many of these stories are complicated by abuse and neglect, by extreme experiences, and by isolation.

The clinic in the clinic we transform this into powerful subcultural stories of endurance and community resilience.

The thought of closure is so concerning.

I understand that many of the day clinics at Alameda County will be shut down at the end of the fiscal year.

I wonder what's going to happen to these stories I speak of without safe spaces.

Current climate, does our local government really want to fold the federal policies of mass deportation, psychiatric incarceration?

That's what these layoffs are doing, paving the way for federal agents targeting vulnerable people for incarceration and warehousing.

We are in stage one now and we are being set up for stage two and beyond.

Where will the clients go and where how will they survive in and out of psyche are the cycle of abuse that is hard to come back from, it's hard to understand unless you've experienced it yourself?

I'm Dr.

Liv, and on behalf of the Internal Medicine Residency Program, I'm here to tell you how the RIF is affecting our residents and why this will affect the feature of care delivery in Alameda County.

When AHS is understaffed, faculty are stretched, burnout rises, and our ability to supervise residents suffer.

My colleagues are applying elsewhere because of the current instability.

When we lose faculty like this, our residents lose their teachers and role model.

Education does not happen in a vacuum.

It requires supported faculty and staff to model state patient-centered fare.

Residents are asked to absorb gaps created by rips, morale declines, and recruitment is affected.

This matters because AHS depends on its trainees to staff the hospitals and clinics at High length.

Many of our graduates choose to stay and work here at HS.

Training here becomes synonymous with burnout and chaos.

Fewer students will apply and fewer residents will stay.

This is not hypothetical.

We recently lost two residents to other healthcare systems who before would have stayed in roles that are difficult to fill and critical for patient safety.

The dysfunction has become unpenable for bottom line the rips will lead to weakened training, failed recruitment, and loss of the workforce AHS relies on to serve our community.

I've worked for the past two and a half years.

Our program is truly one of a kind.

There's no other program like it in Alameda County.

With severe mental illness.

And case management, clubhouses, and weekly therapy are no substitute for the kind of care that we provide.

A lot of our clients say that Fairmont is their home and it's a reason to get up and out of bed in the morning.

Many of them go to Fairmont to celebrate holidays because a lot of them are for this.

So we don't just reduce symptoms, we give clients a life worth living.

If our program were to close, our clients would end up decompensating and ending up in psychiatric hospitals or worse.

And once hospitalized, if they don't have anywhere to go after they get released from hospital, they end up in this vicious cycle where they get re-hospitalized and re-traumatized again and again.

So it would take a and that of course costs the system more, and it has a devastating cost as well.

So we are asking the board to rescind these layoffs and work with our union on real solutions.

Yes.

Yeah.

Nick Nelson, Megan Heaney, Mike Thomas.

Try to keep it to a minute if you can.

What's up?

Hi, my name's Nathan Gaines.

I'm the chief of neurology at HS.

I work with a small team of dedicated neurologists.

There's problems like stroke.

Mortality from stroke among African American and black residents in our county, double the national average.

When hospital hospital became a stroke center last year to address this kind of hard to make that and other unacceptable counties outdated.

AHS workforce is uniquely capable of moving the needle on that.

Also treat a much wider range of challenging conditions like epilepsy and multiple sclerosis, conditions where poor systems with poor outcomes.

Patients can thrive with consistent high quality care.

When we joined AHS in 2018, neurologic services were severely limited for killing a lot of our patients.

We invested and we're doing so much better, but it would be all too easy to slip backwards to that standard.

Not cut our way to success.

The county needs to engage with AHS to discuss a more financially stable model to the needs of our patients.

The patients that we serve are the patients most marginalized in our community.

Our patients who are refugees and immigrants, those who are dealing with housing insecurity, your neighbors who come in after trauma.

Our team is excited and privileged to care for these patients, but we cannot uh tolerate these cuts.

Uh these cuts don't heal.

Like fair does.

Jake Nelson, Mike Thomas, David Duong.

That's my PD.

My name is Dr.

David Duan.

I'm the residency program director for emergency medicine and your DACA Highland for 11 years and SCIU doc.

We won't have the resources for just baseline quality care and turn medical training.

And this isn't because of HR1 or the RIFS.

This has been going ongoing and it become a nightmare.

We have enough staff.

Our Europe becomes overloaded patients coming by ambulance there's no place to put them so our residents are doing trauma resuscitations and stroke activation.

Like ask them to do CPR with one hand.

And this is not teaching our future residents our future physicians to correct uh correctly practice medicine.

They have to go in the lobby to do blood work as opposed to being at the bedside with their patients because we don't have the phlebotomists this is not good medical training for portions of our accounting the just financially stable and we think about high age that can be better this is not sustainable.

We can't keep on cutting current financial model it's failing and math it just points a substandard care at Highlands but also what about our services at San Leandro and Alameda they will get cut also we are so dedicated to our patients.

We have to find a more financially staple model so we can forget Dan Allen Caitlin Bailey Monica Berletti I don't see Dr.

Allen Caitlin Bailey at the end's called on up and speak don't hesitate just come on up and speak good morning my name is Caitlin Bailey I'm an emergency physician at Highland Hospital.

I'm the medical director of that emergency department I am privileged to work with this community and I thank you for letting me speak here I've been at Highland Hospital since I started my training at seven I love it.

I've worked there continuously since that time I am deeply concerned that the threat to our patient safety is being very underappreciated right now.

These cuts uh this reduction first force is a gutting of services that's what it is and it is catastrophically dangerous for our patients right now as Dr.

Duong said arriving traumas and paper in the hallway without procedural equipment monitors John George I worked all day yesterday John George was on divert they could not accept any ambulance traffic from Highland because they're full because of the gutting of outpatient services there.

You cannot save money on car costs by not buying gas anymore.

Car is going to break down and that is what's happening for our patients.

I'm not even going to focus on the workers although they're critically important our patients are in danger right now because we cannot operate the hospital with the reduction in fork as it is currently hi my name is Monica Berleni I've had the privilege of working at Alameda Health System last decade I'm currently as the chief of gynecology I'm here today speaking on behalf of the obstetric Smith gynecology department what Dr.

Bailey and Dr.

Duong said is absolutely true.

What's happening in Highland right now is very unsafe um and for labor delivery we serve a very high risk patient population who has nowhere else to go these rifts were made without collaboration with clinical leadership what's happening right now is very unsafe black burden people face a mortality rate that is more than twice the national average this fact was recently returned to the headlines when a black midwife named Janelle Green Smith died during childbirth if you don't step in and help us, we will be making uh headlines for the wrong reasons.

Please, please please help us.

Um, this is not good, and people are not going to do well we're closing down.

We are we need to close the referrals.

We can no longer our patients have nowhere else to go.

Our outpatient services are also very limited right now and also not safe.

Please please help us.

Good job.

Good job.

Hello.

Dr.

Dan Allen, I've been the chief of plastic surgery at AHS for 27 years.

We do reconstructive plastic surgery, uh, specifically all medically necessary procedures, no cosmetic surgery.

We treat breast cancer, we treat large skin tumors all over the body, we treat severe injuries, limb-threatening injuries all over the body, and we help other surgeons cover vital structures and close difficult wounds.

My patients need follow-up, and they cannot be abandoned.

My sense as a clinician is that the administration of AHS is extremely financially stressed.

The reduction in force designated plastic surgery for elimination, but this is the elimination of a revenue generation specialty.

We do a lot of cases that generate revenue.

Plastic surgery also treats a long list of problems that other doctors cannot treat.

And so that creates a care gap, a vacuum of care, and reducing the plastic surgery clinic creates the risk of patient abandonment, which is very serious.

So I urge the board of supervisors to assist our administration with their financial problems and save Wilmachan Highland Hospital and our other public hospitals.

Maria Trellisca.

I'm really honored to be with such an incredible group of people here.

I'm not a doctor, I've been an educator for 30 something years, 20 years at Chabot College.

My students and their families have depended on this whole network for their lives.

Good friend of mine, the son was saved and the ER here.

I've delivered, taken other people to the ER.

This place is essential.

What we're watching is the same thing that we watched in Washington, DC, with this assembling of firing of scientists, the destruction of the EPA, everything else.

I assume, and I think that I'm right, that you do not want to participate in that kind of dismantling.

We are in the middle of a crisis.

We, and it it demands extraordinary activity, not just the anesthesia of numbers that we've seen, this number and that number.

Every one of those people who's getting RIF, their life is being cast into who knows where.

So now is the time, no business as usual.

We see what's going on in Minneapolis.

Politicians are there having to stand up.

This is what we're facing.

It's a life and death situation for the people of this county, the people of this state, and the people of this country.

It's time for us to make our own history, and I hope that you're ready to join us.

Thank you.

Yeah.

Germanian, Jenny, Adijomo, Maria D'Souza.

Your name was called, come on up.

Baltimore names.

Philip Gossenhauer.

All right, I'll go.

My name is Dr.

Sassenheimer.

I'm one of the palliative care physicians in Alameda Health System.

And it's been my great privilege to take care of our patients who are living with serious illnesses like cancer or dementia, heart failure.

Every day, my colleagues and I work tirelessly to support these patients and alleviate their suffering, center their values in personhood, and make sure that they are able to leave lives with dignity while facing serious illness.

Supervisor Miley, Supervisor Tam.

Let me be clear.

Our ability to effectively care for our patients is already at risk because of the proposed layoffs.

In my division, we've already had to suspend some clinical services.

We had to stop services at a skilled nursing facility.

Our patients have been trying to call our clinics at the reschedule appointments or get repoils on their medications and have been unable to reach them because they were placed on leave with almost no notice, not even allowed to change their voicemail to let our patients know who else to call.

This has resulted in patients ending up in the emergency room in pain crisis, overflowing what's already an extremely busy emergency room and taking attention away from people whose lives are more imminently at risk.

This is a threat to the safety of our communities and really is at odds with the mission of Alameda Health System.

So I implore you to work with the unions, find ways to stop these layoffs and continue to fund the essential services that all the people.

Members of the Board of Supervisors, thank you.

Thank you for allowing me this opportunity.

My name's Dr.

Manjunath.

Um I've been the division chief of nephrology.

I've been at AHS from 2011 onwards.

Um our nephrology services provide life-sustaining care for some of the most honors of patients of the county for patients with kidney failure.

This care is not optional.

It is the difference between life and death.

Many of these patients are low-income, uninsured, or medically complex, and AHS is their only source of care.

Nephology includes dialysis, which is literally life-saving in medical emergencies, without which they will die within hours or days.

Continuous nephralogy care prevents crises, keeps them out of the emergency room, which is already overwhelmed and allows them to live longer, more stable lives.

When nephrology services are lost, patients decline, the ARP is a thin crease, and preventable deaths occur at a far greater cost to both families and the county.

To preserve these services, we are protecting a core life-sisting part of our safety launch.

I respectfully urge you to now act and ensure that these essential services remain available.

Thank you so much.

Yeah, good morning.

My name is Dr.

Betty Liu, and I am the interim division.

I've probably served as a physician at AHS for over 13 years.

My division provides care to thousands of county residents suffering from serious gastrointestinal and liver.

These are patients dying from liver failure due to cirrhosis, patients with liver cancer, patients with inflammatory bowel disease, and patients with colon cancer.

We also perform life-saving colonoscopies that detect and prevent colon cancer before it becomes fatal.

In the face of unprecedented Medicaid cuts, HS executive leadership is now planning to eliminate over 200 physicians.

Cuts directly threaten our ability to provide safe, timely, and life-saving care.

We cannot cut our way to success.

Alameda County has a legal and moral obligation to ensure access to health care for all its residents.

I urge the county to actively engage with AHS to develop a financially sustainable and clinically responsible path hold because right now the health and lives of thousands of Alameda County residents are being faced at serious risk.

Thank you.

Highland, Island Hospitals.

And I can truly say if I wasn't there, I wouldn't be here right now.

I can tell I can just tell that you guys are trying to help and you guys are trying to support, which makes you part of our family.

I would like to tell you who some of your family members are.

Greg.

Victor, Rosa, Tony, Barbara.

Zackie.

Linda.

Kevin.

You passed.

Savi.

Lorraine.

Agenda.

Cynthia.

Clark.

Gale.

Patrick.

Wanda.

Brandel.

Mike.

Tony.

Cynthia.

Andre.

Dantel.

April.

Alan.

Cameron.

Bakoya.

Lana.

I guess that makes us all family.

Joe Fox, Marta, and Sonia.

Good morning, everybody.

My name is Michael Barrow.

I'm an EMT firefighter who is not currently working.

In 2024, I suffered a catastrophic injury to both my shoulders where it's one of my labor home and through my network of firefighter doctors and everybody that we served.

I asked them where the hell would you guys go to get your shoulders fixed?

They all sent me to Highland Hospital.

When I got to Highland Hospital, I got incredible help.

I continue to get incredible help.

I'm at the 18th month of my 18th month process of recovering to getting back on the job.

My whole identity is firefighting.

It was something that I thought I was going to lose until I got to Highland Hospital.

It was heartbreaking.

I didn't know what to do, but within my identity as a firefighter, I'm a very physical person.

Anything that's in front of me, they call me, I break it down.

I can do that again.

I can go back to my job and I can save people consistently again.

What I do know is I did not understand any of the numbers that I was shown today is that I had my own numbers because these are the people that impacted me that I had it super easy to think of because as I said, I'm going through the process.

I've had three orthopedic surgeons change my life in some way.

I've had two radiologists help me out in the medical process and have my surgeries, four anesthesiologists that ask way too many questions, five nursery, five physical therapists, had three different outpatient things due to this because I had to go to sleep therapy because they noticed that my sleep wasn't doing right.

I go to like some electro therapy where they're shocking my arms to make sure my muscles were working right, uh, and a chronic endocrinologist.

I had to go see for whatever reason.

I am so sorry for how I react after surgery, it's just what I gotta do.

Six clerks.

That's 36 people in total that I remember fully coming to my aid and helping and changing and pushing my out of those 36 positions, that out of 229, and I don't know Math Ravel, I think is like 16%.

So that means I'm losing a part of something that changed my life for it.

I'm losing somebody that gave me back my identity, and that means that the communities that continue to serve as a firefighter EMT are gonna lose somebody that's only trying to help them because people aren't there to help him in the first place.

Uh so I just really hope that we uh get rid of reductions of force because patients aren't getting reduced at any moment.

And uh thank you for talking about.

I'm Joe Fox, uh physical therapist at Island Hospital.

I've worked for Alameda Health System um for 28 years.

Um in 28 years, this is the first time I've seen a reduction enforced, wipe out entire departments.

Um I know that Paramount Hospital, the Fairmont Outpatient, physical therapy, speech therapy, occupational therapy, ideology, outpatient behavioral health are all eliminated.

Um the staff are told they still have to come to work right now, even though they're eliminated.

Um their positions are, and that's because the patients need care, and there's no one to care for them.

So what's gonna happen come March 9th?

Who's gonna be there to care for them?

We keep asking for plan a plan.

I think I'm gonna be one of two outpatient physical therapies for all the Alameda Health Systems.

Anyway, um.

Alright.

Just hearing about all the programs eliminated, and all the patients of ours that are gonna suffer.

I mean, I'm just astounded each time I'm up and I listen to everybody else, and who's what carbon service eliminated?

It's it's horrifying.

And I guess you have the opportunity to save a lot of lives.

Hello, nerd, so please bear with me here.

My name is Martin, so I'm an orthopedic physician assistant.

I work at Newark Wellness Center, surfs the South Bay, and uh I've worked for Alameda Health System for many years, for the last many years on orthopedics.

I started working in Newark because we needed to serve the patients in the South Bay with orthopedics.

Um, my job is to help people get back to walking, being mobile, and working.

I'm the only orthopedic provider in the South Bay.

Alameda Health System has put me on the planned layoff list, which effectively eliminates orthopedics or South Bay or Alameda Health System.

Uh Alameda Health System says they will absorb the South Bay patients by having them go to Highland.

Right.

Problem with it is that many of my patients have limited transportation and cannot travel to Oakland for orthopedic care.

In addition, many of my co-workers uh in orthopedics at Highland are also on the layoff list.

My concern is that our South Bay patients will go without the necessary orthopedic care.

They need um AHS layoffs will dramatically affect patient care.

Please protect our patients.

Vote no to AHS layoffs and yes to funding.

Hi, I'm Chelsea and Marty.

Um I'm a licensed psychotherapist and outpatient behavioral.

So we're with Alameda Health System.

So they're trying to close our IOP programs.

Ditto to all the harm that everyone has already talked about that, ditto to the overwhelm with John George psychiatric because of that, the overwhelm of Highland emergency room and the county even paying more money in the long run.

But what I really want to emphasize to you is despite what management has said, there has been no medical expertise in determining these cuts at all.

Our department has not been um collaborated with, there's no collaboration with us, and we've even come up with our own solutions to gain more revenue, and nobody wants to hear what we have to say, um, and no consideration to the damage to our patients.

We literally are gonna be forced to tell our goodbye.

We are abandoning you because there's no other program like ours in Alameda County.

There's nowhere for them to go.

And sorry, we're doing this because uh management thinks you're disposable and they don't want to collaborate with us.

Let's stop this madness.

We're here to please ask you to resume these cuts.

Who management accountable to truly working with us because there are other ways, and this might not happen.

Thank you.

What Chelsea said.

Good morning.

My name is Neil Liebert.

I'm a licensed therapist at Highlands, uh outpatient behavioral program and a crowd member of SEIU 1021.

We'll serve this system for over 16 years.

I'm here today because we're not just talking about a building or a line out of budget, we're talking about a lifeline.

Closing Highlands Hospital outpatient behavioral health clinic would be a catastrophic mistake for three reasons.

Our clinic is where people go, so they don't end up in the ER or in the back of a police car.

Islands outpatient behavioral health clinic is the proactive shield that keeps manageable conditions from becoming life-threatening crises.

Also, many of our clients have nowhere else to go.

Uh, they rely on the specific services only we provide.

If we close these doors, we're not only redirecting them, we are abandoning them.

Finally, when mental health goes unsupported, homelessness rises, unemployment increases, and our emergency rooms become overwhelmed.

Closing this program won't save the county money.

It will once again shift through cost and responsibility to Santa Rita and John George.

At a much higher price to the taxpayer, the devastating cost to human life.

Stop the cuts, rescind these layoffs now.

And AHS engage in meaningful negotiations with the union.

You have a moral and fiscal responsibility to keep these doors open.

Please choose to invest in stability, dignity, and recovery.

Cutshold.

Ditto to everything said.

Casey Kettering Highland Dietician, Supervisor Tam's constituent.

Amidst the heartbreak that is the U.S.

right now, the dismantling of our safety net health care threatens our foundation, and AHS hoping the Trump administration.

Some of the intensity of threats has been rolled back to late as of January 22nd.

Calculus of anticipated loss if the Senate passes it.

Yet AHS Admin refuses to change any of their detrimental decisions.

Did you know the union found 22 million dollars that the financial department and the C suite had no idea they had?

That also hasn't changed the how these things and our experience since initial layoff notices on December 4th confirms the C suite and Board of Trustees have no idea what they're doing and do not care about the impact of their actions.

Cuts made were not consulted with department heads to confirm functionality or integrity.

The rollout was chaotic, sloppy, and unprofessional.

Seniority list was checked only after initial notices were sent, such that a tremendous amount of people who are not expecting it to be caught suddenly were upon official notice.

The next day they rescinded paid leave for 30 to 35 people because it was sent in error.

The positions cut are creating literal unsafety as well as hemorrhaging precious funds through necessitating paying out overtime to maintain functionality.

They cut the only phlebotomists in Highlands uh emergency department.

We are probably crash, rooms can't be turned over because there's not enough staff to clean them.

We have dangerously slowed wait times of EMT vehicles because of the holdups.

All of this could have been anticipated and planned better, especially because positions are still budgeted for through June 2026.

C suite and board of trustees do not know how their system works and have been too arrogant to work with those who do know.

Rescind these layoffs, bring this crisis to the full board because it is truly the county, not just the health committee.

Hold the C suite accountable for returning to the drawing board to elucidate what resources they actually have that are not being utilized.

There is more, we're guaranteed, and ensure cost savings measures are implemented first so that changes to services and jobs are minimized.

Replace the board of trustees, replace execs that are more concerned with lining their pockets than the health of the county they serve.

Please protect our health system because these people are not.

Currently working in outpatient therapy clinic at Highland.

Um, with the current layoffs, they are planning on eliminating an entire facility.

My colleagues have stated at Fairmont, laying off physical occupational speech therapists, reducing outpatient therapy services by over 50% in the system.

In that clinic is the only pelvic physical therapist, the only vestibular therapist, the only neuroclinical therapist, and only outpatient speech therapy services in the system and severely limits neuro and hand specialty occupational therapy.

The collective wait list for all outpatient services in our system is at over 4,000 patients.

Many patients wait months to years, and some never even receiving it.

As many of the colleagues are working with for these layoffs, they were barely getting by.

After the not deny our union to find real solutions for these cuts.

Yep.

Cuts don't heal.

Yes, Michael K.

Hello, I'm Riley Gardine.

I'm a dietitian at Highland Hospital.

I'm here to oppose the reduction and force at Alameda Health System, which is really just a euphemism playing off essential workers and screwing over our community.

If we can't trade safely treat our patients, you can't safely stay open.

The Afghan healthcare worker names only that.

We're not a factory where we can simply produce less.

Less funding won't mean that patients suddenly need less care or that they get in less car accidents.

We're the only trauma center in the East Bay.

Already operating in the critic.

Because people won't be able to work.

If people like James Jackson got care at AHS, he may never get the follow-up community.

And that foot may never heal.

Our community, the one that people voted you into CERT, gonna suffer irreparably.

So if you let AHS continue with their plan and can't find the money to stop these layoffs, which it exists, we're the richest state in the country.

There's so many billionaires that live here.

People are gonna die, and the blood will ultimately be on your edge.

Our social services are really under attack.

This is a fight.

Which side are you on?

Outpatient behavioral program at Ireland Hospital.

And I just wanted to say I've been in the program now for about three years, and I haven't been hospitalized once, and I do have a history of that.

So that's been a really good in the time since I've been in the program.

And I also wanted to point out as others have that there is no real alternative.

The IOP community is a very unique community.

And if they close that community, a lot of us don't have anywhere else to go.

And I also would like to point out that uh sometimes when you're when you're uh a disabled person as I program, uh, and your disability is mental, not physical.

You're not taken as seriously in the system, and people who do suffer from mental health problems, we're not second-class citizens, these are essential services.

That's the supervisors, thank you for hearing us out today.

My name is Christy Beast.

I'm a speech therapist over at Outpatient um at Fairmont Hospital, representing our department.

And I have some rhetorical questions for um for the board and for the executive team today.

Mr.

Jackson, how long was your wait time to get physical therapy?

On par with the 1800 people who are also waiting to get therapy through Fairmont and Highland hospitals.

Do you have to wait six months for your therapy to begin or were you able to get services because you're even with our insured patients?

I have folks coming to me that tell me that Center for Neuroskills or other places in the community are not accepting new patients right now.

I'm sorry that we don't have any other place for you.

The closest you can get in is Highland, that Fairmont Hospital.

Um, so I'm seeing these people for brain recovery that would otherwise prevent them from going back to work with communities to be um functional citizens, right?

To be contributing members of their communities as they want to be.

I am here with my coworkers to help make these people's lives better to reintegrate them into the community instead of leaving them bereft of any services that might help them.

Thank you for your time today.

My question, my last question for you is if these cuts persist, how will you sleep at night?

Knowing that you have the power to stand up to this fascist takeover of our nation, and instead you chose to cave to the threat of financial pressure on a distant horizon.

Thank you very much.

You do have all the media.

Good afternoon.

My name is Dory Salman.

I've been an occupational therapist since uh 1991.

Um, and I have not seen these kinds of cuts happen in all of my years.

Um, as you know, and other people have said, occupational therapy, physical therapy, speech therapy, um, are all at Fairmont and they're all on the cut list.

And it's just mind-boggling.

How are people supposed to return to work?

Um, we're one of the only places that have lots of services, as explained before, pelvic floral therapy, vestibular therapy.

We're the only neurological therapists most that serve the most floralogical therapists, the occupational therapist, the physical therapists, and not to mention the audiologist, which is the only one in our hospital.

I ask that we please visit these cuts and to coordinate transparent process and a central mitigation to mitigate the risks and ensure responsibilities on the implementation of these cuts.

Thank you.

Thank you, supervisors, for the opportunity to speak.

My name is Short.

I'm an emergency medicine resident at Highland Hospital.

I was born in Oakland.

I was educated in public school here, and I've spent the last decade of my life trying to become a physician that deserves the trust of my own neighbors.

So let me be crystal clear about what these try these cuts mean for us as residents and people working in the emergency department.

We are the ones who work 80 hour weeks, nights, weekends, and holidays to make up the safety net of this community.

So we know what we're talking about.

These are not hypothetical for us.

We are the ones who have patients die on us because of hypothermia after they are discharged to the street.

We're the ones who take care of homeless patients who have become homeless because they do not have access to rehab mental health services and fall victim to extremely preventable complications of their injury.

And that's before the cut.

As you guys know, Highland is a stroke in a STEMI center, and we're the only level one trauma center in this county.

So you may be coming to us and your families may be coming to us.

If you ever need our services, you will want us to be prepared.

You will not want us to have been gutted by the decisions of our own leadership.

And I want to ask you don't you think that your constituents deserve the same level of care that you do?

I would ask you to come spend an hour with us in the emergency department.

You would see instantly how much of the morbidity and mortality in this county is preventable.

But if you cannot come work alongside us, then hear this clearly.

Our patients live and die because of decisions that you guys must be prepared to make and understand the consequences of those decisions.

Please listen to us who are actually working on the front lines and remember who you work for.

Everyone, my name's Kayla Anthalette.

Um, alongside Hope Shorts, X Island Hospital, and I'm a regional vice president for CIR SCIU, which is the union that represents resident doctors to doctors and the doctors at Highland alongside SCIU 10 to 1 are here to ask or beg whatever's necessary for your help during a really demoralizing time at Highland.

As has been said before, I'll echo again.

We already work in an incredibly low resource setting.

We operate at a daily deficit in terms of equipment, staffing.

That's prior to any of the layoffs, more cuts to our already overstretched food design.

Devastating for our patients, our own safety, our patient safety, our medical training.

I'm sick of seeing patients with critical illness in our waiting room chairs.

Last night I had my second patient within a week of pulmonary embolism that was seen all night in the waiting room, staffing shortages on the floor.

We have no room for staff reduction.

The decisions to lay off essential and workers and gut entire departments have felt thoughtless, irresponsible, short-sighted, and have ultimately revealed how little the administration understands about the clinical work that we do.

It has been frankly embarrassing and dangerous over the last month to try to provide care to the Verity Gurgan residents of this county.

I mean, we do not have a cafeteria on the weekends.

They laid off our ED phlebotomists, which is proven to save hospitals' money over and over again.

They're turning off staff's emails prior to their layoffs.

Additionally, the administration is often making choices that in the end are going to cost AHS money and leave Alameda residents without essential services, and it's already begun.

We on the ground have the answers.

Saying that they have been open to feedback is a lie.

Just as a reminder, we are a non-for-profit hospital.

We're here to serve, and we need help.

Please stop these layoffs.

Get creative, find the funding.

Please let Highland to continue to care for Oakland.

They deserve it.

Hello, my name is Brett Lash.

I am a primary care physician at the Highland Adult Medicine Clinic.

And I've been working in service to the people of Alameda County for over 20 years.

Primary care sits at the center of all AHS programs and services.

I share patience with all of the people that you've heard from today.

These teams, these are the teams that support our patients in their health journeys.

When I'm told that services and other facilities will help cover these losses at AHS, I know that this is not true, and my patients know that it is not true.

Our patients rely on this large team at AHS to help them.

They need interpreters, they need help with transportation, they need culturally competent care and so much more to help them get the care that they need.

These recent cuts were made without significant involvement of clinical leadership and without consideration of how we can grow and optimize our program before cutting critical services.

I am asking this board to please engage with AHS to develop a financially stable model of health care for our people.

Thank you.

This does not take into account the impact the program has on the system as well.

Program actually saves Alameda County tens of millions of dollars.

Since 2020, just with our currently admitted patients, we have maybe have saved the system roughly 28.8 million dollars for higher level forces through reductions in patient facility contact.

We hope this also represents significant reductions in recidivism and contact with the criminal justice system.

Urge you to reconsider closing this program without it, the cost of Alameda County as a whole.

I'm a business representative with the Alameda County Building Trades.

This is one of our stewards of Mark Thompson, Vermont.

We represent the trades employees and the stationary engineering department at AHS.

We just want to say this is potentially an extremely dangerous decision.

It's gonna hurt a lot of people.

We've already heard that articulated a lot today.

It's gonna hurt our members and their families, it's gonna hurt our patients, and it's gonna hurt our community overall.

Our group in particular was already understaffed prior to all this, doing what little they could with the little resources that they had.

They basically help keep that bill, keep those buildings open and afloat.

So the BTCA stands with all the impacted part of units here today and the ones that aren't here today, including our friends at SCIU, acne, and CNA.

And we're calling for the rescenti of these proposed layoffs in totality, unequivocally.

Thank you.

Um is it good afternoon already?

Good afternoon, Supervisor Tab.

My name's Andreas Klover.

I'm executive officer of the Alameda County Building Trades Council, second vice president with the Alameda Labor Council.

We've had a great partnership with the county, and unfortunately, we're not doing that anymore.

And I want to focus on one issue.

Didn't know what everybody has said, but I do want to focus on which one issue, and that's contracting out.

You or not you, but the hospital board is putting the interest of outside consultants and contractors above the workers and patients of the hospital.

We've got contractors, non-union contractors, probably not even paying prevailing wage, doing the work of our bargaining, and you're laying our folks off while there's those contracts stay intact.

We need to revisit that.

Another department I know well, which is my wife's department, nutrition services.

You're putting Morrison's interest, which is the outside contractor above those of the bargaining unit members.

They are laying off folks from SEIU and Acnea, but are they touching the folks at Morrison?

The consultants at Morrison that are basically doing bargaining unit work.

No, they're not.

In addition to there was a comment about closing the cafeteria.

Why are we closing the cafeteria and not the cafe?

Because the cafe makes Morrison money.

The cafe does not provide food for patients, for employees, for the doctors.

No, you'll get a cup of coffee, all the Java you want, but there's no food.

And they have to bring food in from the outside, pay additional money.

So don't just cater to the interests of these consultants.

I know they got money, I know they got influence.

Don't do that.

Focus on the employees and go after those consultants.

They're the first ones that have to go.

Finally, let me just say one thing too.

As president of the Port of Oakland Board of Commissioners, we are more than happy to work with AHS so they can get out of their lease in Jack London Square.

Oh, so count on me to do that.

Can I become a Patterson, Harris?

Hero Kermis.

Hi, my name is Celia Adele.

I am one of the supervisors at Foods and Department at Highland, but mainly I work at Cafeteria.

Given everything what we have said, everything what everyone has said, my concern is as of now, the cafeteria is closed on the weekend.

Our staff, all of here, who are already burdened with a lot of stress with a lot of things that's going on, they don't have any way to eat.

The cafeteria is closed.

We can't leave the premises.

So we have major complaints from all our staff, the SCAU members, all the nurses, all the doctors, the turned in physicians, the security, the sheriffs, everyone.

We can't leave the premises by the contract.

We only have half an hour, you cannot leave the permissible.

Other staff can't leave the premises.

If you're taking care of your patients, 12-hour shift, a 14-hour shift, sometimes 24 hour shift, and there is nothing to eat in a whole weekend.

This is really uh um stripping the bus basic necessity of a life with food really for our staff for everyone that works there, including the families.

So we want to, you know, asking to reconsider reopening back the cafeteria on the weekends.

We know we have enough resources to make it work, so we can have one shift and everyone will be um benefiting from that.

Thank you.

My name is Jordan Patterson.

I'm the physical therapist at Highland Hospital inpatient.

Uh just shout out to all the physicians and all the staff that use numbers of decorated to really justify how much of a damage is correct.

Or for employees.

Um I'm involved in going to the EE every single day and um helping out all my physicians and doctors get people outdate that.

If you were to get rid of my position, that would fall on nurses and other staff to do what our specialized job is.

I received a RIF notice, and the next day I am required to come back in and put on my and provide service to every single patient every day.

And I have no problem doing that because I do it for the love of this county and I can put this community.

I wish that leadership would actually put on for Pental Head and actually go about the right way.

This is a struggle every single day, but we're able to show up.

And I just asked that you guys show up.

Board of Supervisors today was the first time I actually felt some type of hope based on the questions that you were asking.

We hope that you all upon these genius individuals that we call physicians and attendees that are here to all the solves.

You guys are the first ones to actually bring this up, and this has been going on for how many months now.

This is concerning that they're not asking the people that are down in the actual trenches to answer these questions.

I wish David Stane was here right now so I could say this to his face respectfully.

I'm not going to dress a situation of people.

I don't care how guilty you are right now when you want to come up here and say face, but please listen to your colleagues because they actually know what's going on.

Hello, my name is Cynthia Harris.

I'm a proud member of SCIU 1021.

I work with Alameda Health System at Highland Hospital.

I'm a registered nurse and the family of Reddit Center.

Um AH's own presentation shows that there is no cuts or no deficit until June of 2026.

So what is up with the cruelty of announcing this on Christmas Eve?

Yesterday at work, I had to draw blood on a baby with no interpreter services, which I did email the admins on call with no response.

That I'm drawing blood on a baby.

The patient spoke mom, which is a dialect of Spanish, and I couldn't tell her anything about it.

It cut interpreter services.

The routing is a different number, which they didn't share to staff until now.

This happened since Saturday.

Till now, they never even sent a system-wide email with the correct number to reach the interpreter services line.

I spent half the weekend unable to speak to my patients.

Okay.

Our health care will.

Thank you.

Thank you for the opportunity to speak.

My name is Shiva Shrifi.

I'm a nurse and aesthetist at Highland Hospital.

I received my layoff notice on January 6th.

Our anesthesia department provides critical and emergency services, including responding to all the level and trauma that come into the ER, being prepared to take them into emergency surgeries, responding to emergency obstructible cases.

And our department was already short staffed.

I have regularly worked 24-hour shifts to make up for this staffing.

There are countless opportunities for overtime.

So I don't understand how promoting more opportunities for overtime by further short staffing our department is saving a fund.

These layoffs also will result in a reduction of services.

My parents to this day still fit in Thailand.

I chose to work at Highland because I want to serve my community.

The last time I spoke to the board of supervisors is when James Jackson and Mark Frotsky presented false data that led to the closure of St.

Rose's Family Birthing Center.

That was the only birthing center in Hayward.

They did that with promise that they would reopen it.

It's been a year.

Where is that birthing center?

So we followed up on the facial patient safety issues that has resulted from closing that birthing center.

I would guess not.

I watched AHS's mismanagement hurt my community.

And enough is enough.

We need your help, please, because the solutions are there.

This is a result of mismanagement, and we need true leadership.

Thank you.

I will talk about my panelists at CNA.

No one of the impact in place.

We provide basic care and support.

I don't know.

I don't understand why they'll be in the breakdown.

Is that the insignificant in the in care leading?

And we essentially paralyze the system.

Even before the layoff song, DNA have even more work.

If eliminating the system would require more things, more pain is that one maybe present this maybe one.

Wanya Gilbert bounds.

Take a five-minute uh recess.

Supervisor Tim to return to me.

We're taking a five-minute recess.

Here.

Supervisor Miley.

We have a quorum.

All the speakers.

Jonia Gilbert.

Donna Matt.

Hi, my name is Tawanda Gilbert.

I am the chief shop steward of John George Campus with AHS.

And um I'm from a community of a community.

I actually was born in Alameda County as well as my children.

This is a disgrace to me.

Um I am on the bargaining tone.

So part of this impact bargaining, that presentation that you received is smoking mission.

We're at the table, we're asking for information.

It is not transparent.

We have gay cost saving measures and it's crickets.

We're ascending these meetings, we are giving requests for information three days prior.

We come to the meetings, no information.

It's to the point to where it's disrespectful.

I have to go to work and look my co-workers in the face, and they're like to wonder what's going on.

The most disrespect of all is that 23 EBS employees was let off.

75% of them are at our number one trauma center, which is Highland Hospital.

I have pictures that if you saw these pictures of what's going on over there, it would make your head explode.

It's ridiculous.

It makes no sense.

And the thing about it is that I would like for you to do a walk in a day of our shoes.

I'm speaking for the voiceless, which is the EDF workers.

Stop telling you, just show up and see the results of what's going on because they're not listening to us on what we're telling.

And we told them that this was going on as of Friday, and the response was AHS is moving forward with the cuts.

This is exactly what we were told Friday, even though we told them how the hospital looked.

And as a result of that, I worked Saturday at John George, one EVS worker for the whole hospital at night.

And I sent the email with pictures.

So I'm just wondering what that's gonna look like.

My Doug Jones, uh 25 year old, Valley.

Uh currently the uh uh East Bay put up working through SCI United Healthcare workers, represent hundreds of workers at Alameda Hospital, and uh we're in solidarity with the more than a dozen unions uh that are trying to prevent uh AHS from uh damaging public.

Um I I appreciate when they manage to be a little bit honest.

And uh we just heard earlier that the AHS uh chief uh human resources officer testified that they asked the unions who represent caregivers in the November meetings they held with us to partner with management at the meetings regarding the dire financial projections on the effects of HR 1.

Then they said we didn't ask for their feedback.

I think that really lands it.

That's partnership in their viewpoint means acquiescence, and it's not acceptable to us.

And as an example of our desire to partner with AHS, one of the things that uh we said in our meeting with them last year was that Sutter Health is in the process of trying to do damage again to the public health system in Alameda County by doing what they did at Eden Hospital, which is reducing capacity at Eden by over 50 beds when they did the rebuilding Castor Valley.

That means that patients are held in the emergency department for days, it's they're sent to county, and the payer mix is bad, right?

They're they're just taking the private pay patients more open uh more uh consistently, and they're sending the medical and the uninsured patients to county.

Yeah, burdening them physically, and it's burdening the healthcare system financially.

We asked AHS, will you come with us to the Emoryville City?

Make sure that uh the city holds Federal accountable to not taking over 100 more beds out of our community.

Sutter proposes to build a hospital that is more than 100 bits smaller than the Berkeley hospital.

The CEO said to us in response, that may be true that it'll hurt uh uh AHS's uh operations and finance, but it's not my business to tell Sutter Health what to do.

I said in response, you're not telling Sutter Health what to do, you're telling the Emoryville City Council and asking the Emory for the City Council that are responsible, and uh he said, Can you do that?

We asked.

No, I don't agree with that.

That's not working in partnership.

It is uh working to avoid helping us prevent another set of damages to the public health system that is on top of the HR1.

So hopeful that we can get there with the county and AHS to work in real partnership to defend the healthcare system.

Thank you.

And thank you guys for coming.

My name is Donald Mass, and I represent the work at the S D I D O HW.

Uh Alameda Hospital, South Shore and Potridge.

Everything everybody said it's absolutely on point.

It was hot-ranging to hear the last board meeting that we had with AHS and continue this conversation as well.

What I want to touch on is the way that this whole thing was rolled up with us at UHW.

That we was in the middle of like nine o'clock in the night, my phone like going off like crazy.

What's going on?

We are getting layoff notice.

People are sobbing, people is crying, and it was like, am I dreaming.

What are you guys talking about?

Because I was thinking that the day union would have been notified, right?

This is what is happening, this is what the intention I was like.

Calm down, had to stay on the phone with people in the night trying to the next day we get on the email and we want to, yeah, this is what's happening, and was like, but that's not how we do business.

Why wasn't the union notified first before you send out this mass information to folks?

And they were like, oh, we will get back to you and provide you with a list.

I was like, well, we are demanding in writing and verbally that you resent all of this until we get to bargain over it.

So we got the notice, and it was like 12 people, and I looked at the list as a bargaining agent for these billings, and it was on call folks for DM.

I was like, okay, I know these members, I know they are not benefited employees.

So I went ahead and my investigation, you know, do the thing to sign out, and lo and behold, my folks on the ground in the facility said, Yeah, these are layoff workers, and we report back to them.

Why are you laying off unbenefited employees?

No, they are not on they are not unbenefited employees.

They are F1 1.0.

I was like, no, they are not.

And to like tremendous conversation later, they finally admit, yes, all of these folks is uncalled employee.

Well, how did you make the decision?

What thought going to, as everybody was saying?

You went ahead, you do what the hell you wanted and mess with people's lives, and we have to shoulder all of that impact.

So to say all of this, folks, I'm looking in the eyes and say, if HS cannot be serious, then you guys need to be serious about it.

Because these are the folks that the workers that we represent, the patient that we take care of.

They are not, they are not a number, they are human beings, and we need to act like it.

Very unprofessional for HS.

They don't know what they're doing, and say it all, I'm saying it.

They don't know what the hell they're doing, and we need to reel them in and get down to business.

When they wanted us to help them in the political arena, SCIUHW, we suddenly came to their assistant.

We went to Sacramento and lobbied and fight with them for the resources they need with the bail they wanted to pass.

They end up closing down Alameda emergency room anyway.

We're still figuring that piece out.

It is enough.

I know I went over my minute, but hell, it is enough.

It's time to wheel it in and get down to business because this country is in trouble, and we don't want to be participant of this.

History would tell us and treat us the way that we treat.

Thanks for listening.

But please, at the end of the day, if you have any option at all, if you have the power, railing HS because they need some kind of guidance because they don't know what they're doing.

Thank you.

We're gonna lose a quorum soon.

Thank you.

I can have everybody speak if they can.

I'm an occupational therapist at the Highland Hospital for the past nine years, and entire departments are getting cut off.

Um, without life saving services, um, but they're not being considered without consideration of the cost of the patient to the community.

Um AHS has hired contractors with no relevant medical backgrounds to make these cuts, and it shows the way these layoffs are being carried out is reckless and jeopardizes our trauma stroke and STEMI center certification.

Our ability to generate revenue, further putting AHS in the poll.

Clinical leaders were not involved in these discussions, and contrary to what was presented today, AHS has not been present.

The leadership team has not been pressured in these negotiations.

Leadership has sent people who have no sway in decision making to these negotiations, reflecting how little they intend to take our input seriously.

Today, members from the board have suggested the same cost saving ideas our union has brought to the negotiation table, but we have been met with a brick wall.

We're asking for help to tear that wall down within these layoffs and make AHS accountable for our patients, our community, and the devastating impact that these layoffs and the closure of these departments is going to have on people's lives.

Thank you.

Marisa, you're on the line.

Go ahead.

Yes, yes.

Can you hear me?

Yes, hello.

My name is Um Parisa Farrohe.

I'm a therapist working for 24 years at the outpatient behavioral health care health care services of the PHP IOP program.

Um help bridge John George patients to step down to the next low lower level of care, which is us.

We help patients with serious mental illness stay out of homelessness, out of the hospital and out of the overdose epidemic.

We were slated to be shut down completely.

Unpredictable funding has been a staple of community mental health services for decades.

The challenges faced with HR1, Prop 1, and the Cal Ames are a part of the cyclical underfunding of mental health.

This predicament is not new.

In the meantime, the most vulnerable patients of ours with severe mental illness and severe social detriments of health care of health are left unhoused and untreated, cycling in and out of the hospital and in and out of jails, in and out of emergency rooms and in and out of the NARCON in California.

Measures like the one taken by AHS or the reason our homelessness crisis is so difficult to address.

At the same time, AHS is leveraging HR1 and state reforms to reduce costs at the expense of the most vulnerable humans of Alameda County and the faith of health care workers.

AHS did not ask or allow for sufficient feedback to propose sensible solutions that could leverage Prop 1 requirements, BH connect um incentives, and Medi-Cal to keep the light on for the our patients with severe mental illness.

This exact scenario happened at Cedar Sinai Health System in Los Angeles in 2012 when they phased out all psychiatric services, citing mental health reimbursement challenges, lack of parity, and statewide statewide contraction of psychiatric debts.

This kind of mental health services contractions is not new, and it's a part of the reason California is drowning in the homeless crisis, overdose crisis, emergency.

Hi, can you hear me?

Yes.

Hi, so I'm Craig Metz.

I'm the clinical manager of Fairmont Hospital's outpatient behavioral health services, the IOP PHP program.

As you know, our program serves some of the highest utilizers in the county system.

We stabilize them.

When people come to our clinic, their their uh hospitalization days drop by 83%.

It's huge.

Um, what's especially troubling is that this closure is unnecessary.

The first half of our fiscal year we ran a deficit.

Um, but now that deficit has been mostly closed, and in a couple months, if we're allowed to stay open, we'll be making a profit.

Um there's not collaboration, as you've heard.

There's they just started with this combative process.

There's never been a chance for us to collaboratively to show them that we can balance our budget.

And so please do not let them shut our program.

Um, the county is about to start opening up um medical funded people to our program as well.

Um so there's no reason to close us.

Thank you very much.

Tanya, you're on the line.

You have one minute.

Hello, can you hear me?

Hello.

Yes.

Yes, um, my name is Tanya, and I work at Highland Hospital and the laboratory.

Um, a lab assistant too um i was one of the workers that was laid off um i just want to say that um the ahs management and the ceo um and some of the board of trustees and directors um you guys need to probably do an audit on them or at least sit down with them because it's just not consistent with some of the things that they're reporting they have not heard us out as far as union members they have not been open to any of our ideas or our solutions um every day that I'm off I'm seeing that you guys are still hiring people and it should be a hiring freeze I don't understand why they're still hiring people if we're you know if we're having to do a budget cut that doesn't make any sense um had they hadn't laid me off maybe you guys would have had an extra person for ER.

It was really sad to hear that there's no phlebotomist for ER and I'm just really really afraid of what's gonna happen moving forward if you guys if they continue to operate like this I ask for you guys to please stop the layoffs and ask for all the staff to come back and find another solution because this is not this is not it's not working.

You have one minute Sandra yes thank you so much my name is Sandra Marshall I work at Alameda Health System at the Fairmont PHP IOP behavioral health services I work as a psychotherapist and I've done so for the past 10 years.

I respectfully ask the board of supervisors to stop the AAHS from cutting our program and rescinding the layoffs PHP IOP has served the severely mentally ill population of Alameda County for 26 years.

We provided them with an array of essential services that is not available in any other program.

Our program is client centered our clients are able to come based on their specific needs and because of our supportive services our clients are able to maintain their housing which reduces homelessness and they're able to maintain their mental and emotional stability which reduces their time in inpatient hospitals closing our PHP and IOP program would be paramount to patient abandonment.

Please help us continue to serve this venerable population of Alameda County thank you.

Buddy you're on the line you have one minute hi thank you I'm in Lena Tams district uh San Leandro thanks for hearing us out my uh wife is also a physical therapist at Highland Hospital she's seeing patients right now um just called to sort of give you the inside baseball of like our kitchen discussions about what's going on because I also work at BART where um we're facing a similar timeline of uh cuts and layoffs uh the one thing I notice is uh two very different approaches by uh the managements respectively is the last few years BART management along with their board of directors have been going to Sacramento and working to find uh funding solutions what I see from uh AHS is a uh choice to uh conduct the layoffs like a shock and awe campaign um against their workforce very uh and it's indicative of if they're conducting themselves uh like that with uh the layoff process uh you know I'd encourage a full audit on what's uh you know the rest of the organization is like from the administrative level thank you on the line you have hi can you hear me hi can you hear me yes.

Okay, great.

Thank you.

So ditto to everything that's been stated before.

And um, my name's Alicia Caldwell.

I'm a licensed clinical social worker who's worked at Alameda Health System for the last eight years in the outpatient behavioral health department.

And letting go of what I actually plan to say before this meeting, I just want to make a couple comments about some things that happened earlier in the meeting.

First is the speakers from Alameda Health System, especially the last speaker gave a really good spin to the overall situation.

However, the reality of the situation both is and feels very different than what I heard today.

Additionally, there's great appreciation sincerely for both of the supervisors who spoke up in the meeting and let AHS know and the community know that you're paying attention and you really expect AHS to step up and to work in partnership and to seek solutions and to follow the protocols created to protect our most vulnerable patients.

And this is especially important right now as AHS is currently in the process of shutting down the entire outpatient behavioral health department, which includes seven vital programs to our most vulnerable patients without following the established protocol to support patient safety and reduce harm.

Thank you.

Have one minute.

Marie Hopper.

Thank you.

My name is Marie Hopper, and I'm a licensed marriage and family therapist, and I work in the intensive outpatient services program at Alameda Health System.

I'm here to speak on behalf of the patients that will be impacted by the proposed department cuts and to address the mental health crisis that we are all facing today.

I care for the chronically and severely mentally ill.

The patients in our program do not have anywhere else to go.

If our services are terminated, the patients will have to make do without mental health care.

As a result, they will stop taking their medication or decompensate in some other way, ultimately resulting in calls to the police or ambulatory services, more trips to the hospital, and more demands on the already overtaxed public system, resulting in more homelessness, more addiction, more poverty, the very things our county want to reduce.

I know that this will happen because this is what my patients describe as their lives before they came to our program.

Without our services, there was nothing else providing the kind of help at the level that they need.

So I'm asking you, please insist that Alameda Health System keep our programs and um rescind the layoffs.

Thank you very much.

Yes, hi, my name is Lucy Colvin.

I work for over 25 years as a therapist in the uh intensive outpatient program, partial hospitalization program at Fairmont Hospital with these other wonderful folks.

We work with people who are amazing, intelligent people with severe mental illness.

Many people write them off.

I want you to know that you're gonna be told that these patients can be referred, they're gonna have services in the county.

Don't worry about it.

No, the county refers them to us.

The case managers, the psychiatrist refers them to this program.

Access refers people to this program because this is a comprehensive program, which is a step down from John George and inpatient and a step up from wellness and from other less um comprehensive services, and the other thing is we we build Medicare.

This these people are paid for by Medicare, and so we are a revenue generator at the intensive outpatient program.

Very important to know that this is similar to what we heard in item one.

Care first, jails last.

You know, you're providing beautiful program there.

Please, this is a mental health program that is needed for care first jails last.

This is another way to support the board and care operators, which we're talking about in item number one.

Speakers decent more speakers online.

Roller, you're on the line, you have one minute.

No more speakers after these ten.

Hi there.

My name is Dr.

Michael Thomas Show and good afternoon.

Thank you for this opportunity to speak.

Um I'm the interim chief of rheumatology at Alameda Health System, where I've had the privilege to work since 2022.

I care for patients with autoimmune disease that take away their ability to work, to raise children and to live independently.

And diseases like lupus, delayed or fragmented care leads to organ failure and sometimes death.

It's the fifth leading cause of death amongst young black and Hispanic women in this country.

And I see these consequences firsthand.

At AHS, the vast majority of our patients are from minority and economically vulnerable communities that are disproportionately affected by rheumatic diseases and have nowhere else to turn for specialty care.

Safe and effective care depends on every part of the health system working together.

Clinicians, physician assistants, physical occupationally, occupational and speech therapists, nurses, behavioral health therapists, medical assistance schedulers, and the support staff.

When any part of that system is cut, the entire structure becomes unstable and patient care suffers.

Cutting providers and staff who support patient care will not solve our financial problems.

It will create a public health crisis.

It will lead to preventable hospitalizations, disability, and loss of life among pati individuals in this county.

This county is mandated and privileged to serve.

Please rescind these cuts.

I urge you, the board of supervisors, to work with AHS to create a sustainable, transparent fiscal solution, one closely coordinated with the medical staff that does not sacrifice the health of our community.

We're on the line, you have one minute.

Veronica Perez.

Hi.

With the what normally is called a high utilizers or the most marginalized people.

If we're going to the money, it brings quality of life.

No, as far as I know, a lot of the people that I've spoken with in middle management, even upper management, do not understand how the decisions were made.

Contractors that did their um department of efficiency within AHS.

What we want is transparency.

What we want is for AHS to resend the letters, not just to say, oh, we made a mistake.

Please come back to work, but we're still laying you off.

No, I want them to resend all the letters, resend the layoffs, bring us to the table.

We are smart.

We live here.

We will find other solutions.

We cannot leave our populations, the population that we serve, or the frontline staff out of the picture, out of the um communication.

So please resend the letters.

Bring us.

And also my daughter has uh multiple food allergies and has had anaphylaxis, have been too many ERs all over Southern California.

And we actually did go to the Highland um a few weeks ago because she accidentally ate something.

She didn't read the labels properly.

And when she got there, that is the most crowded ER we have ever seen.

And so she freaked out.

And so she didn't want to stay in like you know, she had already done the you know, Benadrill and EpiPen, and so she's like, I my symptoms are resolving.

And she was so freaked out by how crowded it was that she wanted to leave.

So since, like I said, we just live a mile away, we did.

But I don't, you know, if you cut the funding, what if in the future she actually has anaphylaxis and we go there and you know she doesn't get her proper care?

Being an allergy mom has been.

I think it's like mine.

She's allergic to egg, milk, and peanuts.

There's so much that she can't eat, and she has had anaphylaxis where she's pulling the her throat is closing up, you know.

So please don't cut the funding.

Please don't put the lives of our daughter and our neighbors in jeopardy.

Listen to the doctors, listen to the nurses, and please.

Please, please give them what they need.

Hi, my name is Michael Martinez.

I am also part of the complex care management department under the community health umbrella at Highland Hospital.

I would like to implore the supervisors of Alameda County to please get some independent people to take a look at everything that is going on here, starting from the top.

We unfortunately we cannot trust everything that is coming from the C-suite.

We need someone outside of it.

We need someone from the government, the elected officials there to look into everything.

I work in a department that is community help.

It is the people who are absolutely at the bottom of social determinants of health, and they're getting rid of the health advocacy department.

Thank you.

Can you hear me?

Can you hear me?

We can hear you, John.

Thank you.

This is John Lindsay Poland of American Friends Service Committee.

I want to say ditto to the SEIU proposal and many other comments, including a collaborative process over the coming months.

I was impressed that the union has identified funds that management has not responded to.

I actually learned more in this meeting than I did from the AHS management presentation from all the different people who've spoken.

So I want to ask this committee to attach to a BOS agenda or the committee or the FOBOS, the union document on funds that could be used to offset or prevent layoffs.

And second, I know that this is uh was placed on the agenda as an information item, but I urge you to offer direction to AHS to rescind the layoffs and engage in the proposed collaborative process with participation by stakeholders, including you, the union, and management.

And if that means um starting uh setting a special meeting because the time is short, I know you're gonna lose a quorum, then please do so.

Thanks.

Hello, my name is Tashara, and I'm an employee here at AHS Highland Hospital.

I'm part of the care transitions team working with the complex care and health advocates.

We all support AHS as a whole, working hard to prevent readmissions across AHS, providing education and resources to continue the connection of the health care system to every single program that has spoken here today.

Cutting our department child's nurses and health advocates will affect AHS as a whole, and our unconnected patients who don't have the mental capacity to connect to the health care with resultant death and presenting them to present to an understaffed emergency department that is also being cut.

AHS is saying that we have the resources, but you have to find them instead of James Jackson taking walks around the community that he clearly doesn't care about.

Maybe he should take a look at the community of a building that he steps in every day.

Cutting staff and funding is the worst thing that can happen, and not only the family, you know, workers that'll be impacted, impacted, but the families of individual who will lose connection to the services, recall the layoffs.

Hello, Alison Monroe here from FASME.

I oppose cutting the PHP IOP program at Highland and Fairmont.

These programs provide much more support than a full service partnership.

There are other sources of funding.

ACBH in particular should get Medi-Cal, not just Medicare to support the program.

This is an option.

Other counties do it.

And also it should be funded under the Behavioral Health Services Act.

I can't think of a more efficient way to take care of people discharged from a hospital and keep them from going back to jail or the street.

I oppose cuts to nurses at John George.

They're wonderful.

They're doing work that's sometimes dangerous.

And I'm concerned about this corporate approach of permanently getting rid of experienced, knowledgeable, dedicated people.

And I support what John Lindsay Poland said that before you lose the quorum, let's schedule our schedule our special meeting and explore this issue.

Thank you.

You're on the line, you have one minute.

Unmute your microphone.

Good morning.

I'm Karina DeSouza.

I'm a hematologist and oncologist at Alameda Health System.

Thanks for taking the time to hear from us today.

Cancer and heart disease are the two top causes for mortality in Alameda County.

In most recent statistics, cancer in all forms is the leading cause of death among most age groups in this county.

As you may know, there are large racial and ethnic disparities and death rates due to all leading causes of death and in people that are uninsured.

These are the communities we serve.

As an oncologist, I'm entrusted to care for patients in our county at their most vulnerable.

When a cancer diagnosis affects not just health, but families, livelihoods, and futures.

Lung breath, prostate, and colon cancers make up the majority of cancer deaths, and mortality rates in the county are highest among residents of East West and North Oakland.

These are members of our community that suffer from a myriad of socioeconomic and psychosocial obstacles.

It's essential that they are able to seek care in their own community at local institutions where they feel supported and safe.

This is why I look at this hospital.

We are aware of a rumored limit in funding to these essential services starting in June of 2026.

And here on behalf of our division asking that the county engage with AHS to reach a more financially stable solution for our hospital system.

Oncology care involves supporting patients through profound challenges, and quality of care is directed directly shaped by public investment.

Thank you.

Hi, my name is Claire.

Um I'm a registered nurse in the intensive care unit at Highland Hospital.

I've been a nurse for 16 years.

I think these layoffs are being incorrectly framed as a tragic inevitability of a Trump presidency.

These cuts have been instituted in a wildly chaotic and unplanned manner.

I want the board to be aware that the way these cuts have been done genuinely threaten Alameda Health System's ability to survive.

I already have critically ill patients going without life-saving care due to overcrowding in the ER.

We are not at we are at risk of lawsuits, losing accreditation, and people are dying who should not be dying, even with the budget constraints.

The trustees have proven they cannot be trusted with this level of responsibility.

We need the county to step in and recognize this is not an inevitability.

This is an emergency.

Thank you.

You want one minute.

Hello, um, my name is Ivan Khalil.

I'm a respiratory therapist at San Leandro Hospital.

Um we faced cuts in 2019, and um it didn't go well.

So I can't believe that we're sitting here doing this again in 2026.

We're cutting uh the environmental services staff, and I've never seen anybody cut the people who clean the hospital to keep the people who are keeping the infections down.

We get um people from All Saints hospitals with uh CRE infection twice a day, twice a day, and already our EVS staff they are working overtime to uh cover these cuts.

Not only that, we are going without nursing supervisors Monday through Friday.

It's just it's just nursing supervisor management, and those nursing supervisors, they're not covered by the unions, and that was done deliberately, those cuts were done deliberately.

We have great nursing supervisors, and we need that extra um oversight to protect our patients and to protect our staff.

So these cuts.

Um I can't believe I'm having to call y'all from another country to tell y'all this.

So that's the ridiculous thing that I'm seeing health care and other countries that don't do this.

Please don't cut these people, cut these the staff.

We need the staff.

Healthcare in America is already undercut.

Benjamin.

Great.

Thank you.

Um thank you.

My name is Benjamin Fisher.

I'm an activity therapist here over at John George Hospital underneath Alameda Health Systems.

Um, we've been dropped down to a minute, so I'll keep it real short.

First off, um, I'm I'm really asking the board of supervisors to find a way to stop the cuts.

AHS has not shown a budgetary reason that they need to be instituting cuts right now.

We're one of the only public um systems in California that's facing cuts, and even AHS's own budgets doesn't show that we need to be cutting um right now.

Uh Supervisor Miley, I'm really glad that you're asking um the questions that you are.

Um unfortunately, I'm at the bargaining table and we've asked these questions.

As Nathan and Peter said, we ask these questions and we are met with crickets.

I don't know what is going on with AHS's bargaining team, but we come to them with money, we come to them with answers to issues that they have.

We bring up issues that they've never even thought about, and we are met with absolute crickets.

It's extremely frustrating.

I had to ask Nathan, a very seasoned bargainer if this was typical in impact bargaining, and he said, absolutely not.

We are supposed to be trying to find ways to minimize layoffs for employees, and AHS is doing the exact opposite.

There's basic information that AHS needs to be providing at the impact bargaining table that we have none on that we've asked for repeatedly when they wanted to do layoffs over a month.

Hi, good afternoon.

Can you hear me?

Yes, I can hear you.

I'm my name is Sochi Teninger.

I'm a registered nurse case manager in the complex care department and recently received notice of layoff.

Our department is small but highly effective.

We provide intensive case management services to some of the most medically complex patients, many of whom experience severe mental illness, substance use disorders, and our homelessness.

Our primary goal is to connect patients to appropriate care while linking them to critical social resources supporting supporting both medical and social needs.

The complex care team works closely with the ER and inpatient and ambulatory care to reduce readmission rates and ensure safe transitions across care settings.

The proposed layoffs, which include myself, another nurse, two community health workers, and the health advocate team would severely impact our ability to maintain these essential services.

Eliminating these positions would leave some of the most vulnerable patients without critical support, and it would undermine the collaborative efforts we have established with both the inpatient and outpatient departments.

Giving the importance of our work and the potential consequences for patient care and outcomes, I strongly urge that the proposed layoffs be reconsidered and rescinded.

Our team's expertise, relationships, and integrated approach are irreplaceable in achieving both clinical and social goals for our patient population.

And I just want to add that having experienced layoffs myself, Miss Chapman is a liar, and I'm still waiting for her to respond to an email that I sent in December.

Thank you.

Okay, before we lose quorum, Supervisor Tam is still here.

I was supposed to have gone by now, but I'm not sure everybody had a chance to speak.

Um the county, so check with the county administrator, we're gonna be holding the Bealenton hearings on February 25th.

It'd be February 25th.

That labor talked to me for Christmas.

I called James Jackson, I called the trust, some trustees, I asked them to, they would um pull off on the layoffs.

And the appropriate channel for the county to address this is through the Bills and hearings today.

I scheduled and I appreciate Supervisor Tam support on this informational meeting here and today.

This is informational, but we want to get all this out in the public record because people provided some very useful testimony this morning and afternoon.

Very useful, and I'm confident the other supervisors will can listen to the tape or have their staff listening to the meeting.

That's very important in our preparation for the BLIC and hearings on the 25th.

Now, if county council could just explain, because the county's obligated under section government code section 1700 to hold this hearing.

So can I request it?

Go ahead.

Sure.

So the Billington hearing is triggered by the notice provided by AHS that they intend to impose reductions in service.

And the notice is required to disclose the proposed reductions by facility, by service, amount and type of the proposed changes, the expected savings, and the number of people affected.

The billet in hearing is an opportunity to discuss all those issues in public.

So that's on the board.

We will be taking this up and we can give direction, decide what we want to do.

Some of you know uh I've been a very strong um advocate for structural change with Alameda Health Systems, even though I'm confident of, you know, I've said I'm confident of this CEO and this board of trustees.

Over the years, we've had troubles, and that's why we're looking for change.

Uh, and we're seeking that through state legislation, and the change, if we get it, would allow for maybe a county supervisor to be on the board of trustees, and maybe uh we could appoint uh like our health care director.

The reason that's important is because as a board of trust uh board supervisors, we aren't privy to closed session items, legal, real estate, and um personnel.

We're not privy to any of that, but a change in structure would potentially allow for us to be more privy to what's going on internally.

So that's something I've been constantly pushing for.

And the former board supported this.

Um, Supervisor Wilmachan and Supervisor Valle and Supervisor uh Scott Hagerty and Supervisor Keith Carson.

So this board has supported moving ahead with that as well to look to get that change uh through the state if we can get that um uh legislation approved.

So we're looking at that as well.

Uh, that would help us out.

So I'm not trying to cast any dispersions on the CEO, the trustees, but you provided a lot of useful information today that I hadn't heard before.

And quite frankly, I haven't been over to Wilma Chan Highland Hospital in a while.

My ex-wife, uh, we're in very good term speaking terms.

She was a nurse in at Highland Hospital back in the day.

I worked with their okay, and I spent a lot of time over there, both when I was on the Oakland City Council and as a county supervisor.

I haven't been over there recently.

So maybe I'll pop in and do a surprise uh visit just to see how things are going.

But thank you.

Well, the bills in hearing is on the 25th, not the 18th.

The 18th, the 25th.

Okay.

So do we have any public speakers and non-agenda items?

Supervisor Tam's going to walk out the door.

Okay.

I have no speakers.

Thank you.

Thank you