We have implemented a new system in the chambers.

So when you wish to speak for my colleagues, please press your mic button.

Put yourself in the queue, and I will call on each of the supervisors in the order in which they requested to speak.

And the clerk, who has more authority than me on this system, will call and enable your mics.

Thank you.

So the Board of Supervisors welcomes you to its meeting.

The board allows in-person and remote observation and participation by members of the public at its meetings.

The County of Alameda recognizes the importance and valuable role of public participation in government.

Be reminded that disruptive behavior or conduct will render orderly conduct of this meeting not feasible and will not be tolerated.

This includes disruptive conduct that may occur during public comment.

The chair will order the removal of any individuals who are woefully disrupting the meeting so that the meeting may continue in an orderly manner.

For those attending the meeting who would like to speak on the item on the agenda, please submit a speaker slip to our clerk so your name can be called to speak at the appropriate place on the agenda.

Detailed instructions are provided in the teleconferencing guidelines.

A link to the document is included in today's agenda.

If you're joining the meeting using a computer, use the button at the bottom of your screen to raise your hand to request to speak.

When called to speak, please unmute your microphone and state your name.

If you are calling in, dial star nine to raise your hand to speak.org.

Please limit your remarks to the time allocated.

Public comment will generally alternate between in-person and online speakers as determined by the president of the board and subject to overall time limits.

Thank you.

Thank you very much.

At this time, let's move to board remarks.

Are there any board remarks?

Seeing none, uh, we will move to the public comment on closed agenda items.

Are there any public comments on our closed session agenda items?

There are no speakers.

Thank you.

So at this point, we will recess to closed session.

Supervisor Marquez present.

Supervisor Tam.

Present.

Supervisor Miley.

Supervisor Fortunatabas.

President Halbert, excuse.

Thank you very much.

Uh, do we have any reportable actions from closed session?

No, there was no question taken in closed session.

Okay, thank you.

We will come to the order of the day.

Um, we will start with uh an introductory staff report from the county administrator.

Then we will hear a financial update and overview of the proposed reductions in force from the Alamia Health System CEO.

And then we'll have a presentation from SEIU local 10 to 1, 10 minutes, and then we will have board of supervisors questions for both of the presentations.

And then we will open it to public comment.

Each speaker will have two minutes and we will rotate speakers between the chambers and online.

Right now, we have a hundred and thirteen speakers that have signed up.

You don't all have to take the full two minutes.

You can say ditto.

Uh we have 10 online.

We have seven in the overflow room.

Uh, so that will take us to almost three hours of public comment.

And so at this point at this point to manage our time and to make sure you get out before the garage closes.

Um, I will ask that anyone who wants to speak uh submit uh a speaker slip in the next 10 minutes, and then we will close that public um commenting opportunity.

And then once we get closer to um the three hour mark, uh I will reduce the speaking time to one minute.

As I repeat, you do not have to take the full two minutes of speaking.

So at this point, uh, I will ask for a motion to open the public hearing in accordance with the Buulinson Act.

Okay, I would like to move that we open the public hearing pursuant to what's on our agenda.

Do I have a second?

I'll second it.

So a motion from Supervisor Marquez and a second from Supervisor Fortunatabas to open the Buinson public hearing.

May I have roll call, please?

Supervisor Marquez.

Hi.

Supervisor Tam.

Aye.

Supervisor Miley.

Supervisor Fortunata Bass.

Aye.

President Halbert, excuse me.

Thank you.

The motion carries unanimously.

Um let me turn it over to the county inner administrator to introduce the agenda item.

Thank you very much, Vice President Tam, members of the board.

I'm going to read into the record the uh letter that was accompanied the agenda from my office, and just to note that there were three attachments to the letter.

There was the January 6th letter from the AHS CEO to the Board of Supervisors, also the February 11th notice of this hearing with additional detail attached, as well as a February 25th PowerPoint presentation that will be presented by the AHS CEO shortly.

The letter before you has two recommendations.

One is that you conduct a public hearing consistent with the Health and Safety Code 1442.5, the Bealinson Act to consider Alameda Health System's proposed reduction of its local and remote out of state workforce and reductions or eliminations of medical services at the locations that are listed below.

And secondly, that you designate the Alameda Health System to provide 24 hour information service and to receive and respond to complaints from individuals eligible for services under Health and Safety Code Chapter 2.5.

In July of 1998, pursuant to state statute, governance of the Alameda Health System, formerly the Alameda County Medical Center was transferred from the county to an independent hospital authority.

The Board of Trustees that governs the Alameda Health System is responsible for adopting an annual budget and operating within approved budget parameters.

On January 6, 2026, pursuant to the Alameda County Administrative Code, AHS provided the attached notice regarding potential eliminations and reductions of medical services.

In that notice, AHS stated that it faces unprecedented budget cuts due to HR 1, the federal spending bill that slash funding for health services, and additional potential impacts from the state.

AHS also indicated that its proposed program reductions and eliminations implicate Health and Safety Code 1442.5, which requires the Board of Supervisors to hold a public hearing, even though the Board of Supervisors has no direct authority over the budget workforce or other decisions made by the Board of Trustees.

Pursuant to Health and Safety Code 1442.5 on February 11th, 2026, the county and AHS published the attached notice of public hearing on AHS's proposed reductions in services.

The notice included an updated list provided by AHS of proposed eliminations or reductions of medical services that may be subject to a hearing under the BLANCEN Act.

AHS's updated list also identifies additional positions impacted by system-wide right sizing at several other AHS facilities.

Though AHS does not project any service reductions or closures associated with the proposed reduction in force at those other facilities.

As a point of information, in the current fiscal year 25-26 final budget, your board has allocated approximately $134 million to fund services provided by the Alameda Health System.

Of this amount, $83 million is designated for behavioral care services, $44 million for indigent care and health care for the homeless, and an additional seven million for other services such as emergency medical services, including trauma care and public health services.

That concludes my presentation.

And next would be the AHS CEO providing an update on the proposed reductions as well as a financial overview.

Thank you.

Mr.

Jackson.

Supervisors.

Oh, thank you.

Good afternoon, Supervisors, County Administrator, staff.

Thank you all for the opportunity to present.

My name is James Jackson.

I am the CEO of the Alameda Health System.

I and my colleagues come before you today for the this Belenson hearing with a deep sense of responsibility to our patients, families, staff, and the community.

This is not a step that we ever wanted to take.

It's one that we're compelled to take.

Last summer, the passage of HR1 enacted approximately one trillion in federal health care reductions, including an estimated 911 billion cut to Medicaid known as Medicaid here in California.

These changes represent the largest rollback of federal health care spending in the history of this country.

As a cornerstone of Alameda County safety, that 60% of Alameda Health Systems patients are on Medi-Cal.

Combined with other significant fiscal pressures that you will hear about today.

These reductions have created an unprecedented financial challenge for the Alameda Health System.

Due to these challenges, AHS must take a proactive approach to decreasing organizational expenses, including our labor expenses.

Every decision we are discussing today has been weighed carefully.

We understand that behind every program and service are real people, neighbors who depend on us for care, stability, and for dignity.

First, our chief financial officer Kim Miranda will share a financial update.

And after that, I will hand it off to the leaders of the impacted departments who will provide a detailed report on the proposed changes and their implications for the patients and the communities that we serve.

And then I will come back with closing remarks.

So with that, supervisors.

My name's Kim Miranda, and I'm the Chief Financial Officer for Alameda Health System.

I'm going to share with you our December 25 financial reports.

So this is the first six months of fiscal year 26.

We are currently looking at a year-to-date.

Pretty much right at breakeven.

It's 700,000.

We had budgeted to be at about 9.5 million, which is a deficit of 8.8 million.

We're currently working on our preliminary financial statements for January, and our January statements have a loss of 11.5 million, which is going to put our year-to-day loss at variance to budget at 10.8 million.

So a few comments.

Our revenue is actually ahead of budget, 4.6 million.

We have seen slightly higher than budgeted volumes, which is good news.

And we are seeing a slightly less than expected collection ratio.

We were hit with some recruitments, 2.1 million in December by the Medicare auditors for John George Hospital.

And these recruitments go back from years ago, but it is impacting our current collection ratio.

In addition to this, we saw a hit from Measure A.

We had budgeted additional funding that has not realized, been realized, and our operating income is actually above budget from one-time items.

We were successful getting additional funds from some commercial payers through some settlements at $3.1 million.

And we also received $1.2 million from Alameda Alliance.

On the expense side of the equation, we're actually unfavorable $13.2 million.

And most of that is being driven by more than expected labor costs, driven by additional FTE at higher than budgeted rates, and of course, with more FTEs and higher costs, employee benefits and retirement costs are also over budget.

In the non-labor area, we're actually favorable.

Most of it is coming from outside medical services, which are services primarily provided to HPAC patients and ambulance services.

However, we had budgeted more money this year because of a duplicate payment we made to two different companies.

But if you look at the run rate, the expenses are not down, they are consistent with where they were last year.

Our pharmaceuticals are also over budget.

I think we just did not uh recognize how much the COLA impact would be on top of some of the infusion drugs, which are quite expensive.

Also, worthy to note here, we have 5, uh 207 paid FTE.

We're over budget by 74 FTE, and we are 114 FTE higher than we were last fiscal year.

Next slide, please.

So this next slide is a picture of our line of credit or net negative balance with the county.

Um there is definitely a cycle here.

If you go back four years, the low points are when we completely paid off the line of credit.

We were in a positive position with money in the treasury.

The yellow line is where we are today.

We're at about 80 million on our line of credit, and we are projecting to be at the max amount of our line of credit on June 30, which is 95 million.

Unlike the previous three years, we don't have the funding to pay that down to start the next year's cycle.

So right now we're projecting that we will max out on our credit line in around August, and you can see there in September, we are actually 60 million above the amount of line of credit that we have available with the county.

AHS does not have any other cash reserves, does not have any other money in another account or anywhere else.

So this is what is driving the decisions that we are making today to sort of right size our base expenditures.

And if you go out into 27-28, you can see that we are consistently over the reducative balance amount.

So next slide, please.

So why is this happening?

Well, as I described to you, there is a cycle, about 40 to 50 percent of our funding comes from supplemental funds.

It does not come from net pay collecting from patients and insurance companies.

And the timing of those supplemental funds varies, but most of it comes between in the springtime.

So it allows us to pay off our line of credit and then we start again.

But this year we were in a bit of a of a difficult situation.

First and foremost, we were required to pay back the AB 85 realignment from FY23.

That was 42 million on our line of credit.

And unlike in some years, we get a new amount of funding to offset if we have to pay back.

This year we did not receive that.

Certain other supplemental programs were increased as far as accrued revenue, but we will not see that money for two years.

And in two years, we start to see the HR1 impacts of the state-directed payments.

So we were not going to get the full amounts that are in the current formula, determining that we're not allowed that we are not entitled to additional funding this year.

So with the payment of $42 million, which we don't know in advance, we we stand in the county's shoes.

It's not like I have the information myself to figure this out.

We knew in June that we would definitely be paying the $42 million back, and we also knew earlier than that that we probably wouldn't get any additional funding.

Second item on the list is John George.

John George funding under short oil was about $72 million for fiscal year 22-23.

And Cat Lane was not intended to cut funding for John George.

At the same time, the county implemented a new billing software called SmartCare.

And it has been really difficult to implement, and I don't have any information about what is happening with the claims that the county is submitting to the state, but what I do know is that the county is withholding 20% of everything that I'm billing.

And we are working with the county to try to figure that out.

So we are disproportionately affected as a hospital system and as a safety net system.

And my last comment there relates to the fact that we've been in a period of high inflation.

It's settled quite a bit now.

Definitely we're under 3% now, but we were up quite high post-COVID.

And we saw big increases in our labor and benefit costs, along with everything else, pharmaceuticals.

And the government funding, the fee schedules for Medicare, Medicaid did not increase at the same level as inflation.

So that is another significant impact that we are seeing.

Those are my comments.

Good afternoon, Board of Supervisors and our county administrator and everyone.

My name is Jet Chapman, and I am the Chief Human Resource Officer for Alameda Health System, and I'll be presenting the reduction in force to you.

Next slide, please.

A little bit of background.

When we realized what was going on with the HR1 and our AHS budget, our AHS executive leadership team decided to meet with and thought it would be a good idea to meet with all of our labor unions.

So we called a union meetings with our labor unions mid-November, November 13th and 14th, and we held the same meeting and we explained to them the impact of the budget, what was going on and what we were facing.

During that time, we also asked the union to begin to partner with us to figure out a way to have cost savings.

We also met early December with one of the unions.

Our unrepresented employees, when we made a determination on what classifications were going to be reduced or impacted, our unrepresented employees were notified December 19th with an effective date of February 23rd.

Our represented employees were originally going to be notified December 23rd.

However, at the request from our Board of Supervisors, Board of Trustees, and other public officials, it was postponed to January 6th.

So since that was postponed to January 6, the unrepresented employees' effective date for separation, we made the same date as those represented employees, which now is March 9th.

Next slide, please.

So just in an overview of the positions themselves, at our Board of Trustees meeting in November, the board approved the reduction of 372 positions.

Through our course of impact bargaining with our labor unions and evaluation of critical needs and other operational needs, that number now has been reduced, and the new number is 21.

That also includes the withdrawal of the proposing staff reductions at our Fairmont Outpatient Rehabilitation Facility.

The labor unions that were originally involved were ACMIA, BTC, SCIU 10 to 1, the general unit, nursing, San Leandro Hospital, and Physicians, SCIU UHW, and that should say CNA, not CN.

What we did in order to try to reduce the number, and the budget part is we actually had two voluntary programs that we offered.

One was a voluntary resignation program, the other one was an incentivized retirement program.

And out of that pro out of those two programs that were offered, there were 74 employees that actually took advantage of those two programs, 31 applications from the voluntary and 43 from the retirement program.

Next slide, please.

And I'll tell you a little bit about the resignation program with the severance.

So it allowed eligible employees to voluntarily resign, resign, and receive a severance package based on years of service and three months of COBAR coverage paid by AHS.

Now, this is for unrepresented.

For the represented employees.

If there were language in the contract, then we honored whatever that language in the contract was for their severance.

So you see there from zero to five years all the way to 20 plus years, what the weeks of pay would be.

Severance payments will be paid in a lump sum payment, they were paid in a lump sum payment, and applicants who actually accepted the program are not eligible to reapply for AHS for 12 months from the date of their separation.

So that was early January.

For the incentivized retirement program, we reduce the age from 65 to 61, and employees who apply for that and were approved.

They received a severance package of 17 weeks and two months of COBAR paid.

Those employees that were in a SARA pension were encouraged to also check with the SARA administration regarding the program, and then AHS also has retirement programs that we were able to put employees in touch with.

Communication that happens.

So we have a leadership desktop chat every Wednesday from 12 to 1.

And there were questions asked about the reduction in force that we asked, we answered on that.

We provided some information about the reduction in force in trying to stay in communication and let our employees know what was going on.

We also, for those impacted employees, because once they were placed on paid leave, they did not have access to the internal website.

We created an external website for our impacted employees that they could go on, they could check, they could ask information and any information or things that they needed from AHS, we were able to provide to them through that website.

That was our HR legal and communications team that created the external website and it's still up.

For impacted employees as well, we held two human resource forums.

One was on December 30th, and the other one was on January 22nd.

Now, this forum was for unrepresented employees.

Represented, we still are in impact bargaining, so we haven't held those forums yet.

And that was to provide any resources or support that was needed.

Anything that uh the impacted employees were missing or had questions on, we held those forms in order to be able to assist them.

Represented employees, as I said, we'll have to additional forms as well once impact bargaining is over.

Other communication that uh and resources that have happened, our recruitment team, we have internal postings.

So there are some positions that we're identifying that still need to be posted for critical needs or operational needs.

Those internal postings, we are prioritizing those for impacted employees.

So when impacted employees go to the website to apply, if they we're we're instructing them to put uh impacted at the top of their application, and we are trying to prioritize those to make sure that, but we also, of course, have to make sure that their skills and abilities meet the qualifications, but we are prioritizing our impacted employees for that.

Also, our training team, organizational learning and effectiveness team has developed and scheduled trainings for resume writing skills and interviewing skills.

We've had um at least two trainings on each of those since that time.

Our EAP program, one thing that we thought was really good is our EAP program for those employees that are impacted from the date of separation, they can still access the EAP program for an additional 18 months after they're impacted.

That includes counseling, financial counseling, resume writing, and mental health support.

So we thought that was something that we wanted to share with you as well.

Next slide, please.

Um, just a little bit of a more updates and resources.

Impact bargaining is still continuing with our labor unions to discuss uh possible savings.

Our external website is updated on a weekly basis.

At the end of the employees' paid leave, as I said, March 6th is the last date, March 9th is the effective date of their separation.

They'll receive their severance and any accrued PTO will be paid out.

And then I mentioned before that our designated recruiters are able to provide assistance and support to those impacted employees that apply for open positions within AHS.

Thank you.

Good afternoon, supervisors.

My name is Mark Fratsky.

I'm the chief operating officer at Alameda Health System.

Before we bring up all the operators to talk about the programs, I wanted to clarify that we are that there are seven services that are being closed or reduced.

These are highlighted in the balance and notice as either closures or reductions.

You'll also notice there is the category, which is the system-wide right sizing.

Out of an abundance of transparency, we actually listed those services as well as well, no matter how remote the impact may be to patient care.

We have many programs to support our patient population, including our indigent patients.

In order to preserve the main core programs, these cuts are necessary.

AHS is committed to ensuring that program changes do not single out our indigent patients.

And these are broad, non-discriminatory reductions that preserve access to medically necessary care.

So we'll kick off now with um having Rosie Rojas, our director of food services, take the mic.

Rosie.

Good afternoon, supervisors.

My name is Rosie Rojas, and I'm going to speak about the proposed Fairmont cafeteria closure.

So why close the retail Fairmont cafeteria?

Well, there's the obvious reason for need for financial savings.

And looking at food and nutrition services, our core business are our patient and resident food services.

The retail Fairmont cafeteria does not serve to our patients that are inpatient or outpatient.

It is primarily utilized by our own employees and a few others will trickle in as well.

Considering all of our retail cafeterias, Fairmont has the lowest customer volume.

It also has the lowest productivity, and FGI consulting also identified an opportunity to balance the product productivity and staffing as well.

You can go to the next slide.

When looking at the financial impact, when considering labor costs, cost of goods, as well as revenue, we would not realize if we close the cafeteria, we would see a savings of 176,000 each year, a little more than that.

This also doesn't include any investments and capital that would be needed to bring the facility up to par with our other cafeterias.

It is a little bit of an older building.

Here are the specific positions that would be affected.

We have one full-time cafeteria server.5 of an FTE is allocated to cold production.

There is a cafeteria cook full-time that is currently vacant.

And there is 0.2 FTEs that our sanitation assistants utilize for cleaning the cafeteria for a total of 2.7 FTEs.

To the next slide, looping back to what the volume that I mentioned on slide one of my presentation.

Fairmont does have the lowest customer volume.

It's just behind Alameda hospitals cafeteria, about 200 less visitors each month.

And I also wanted to point out the staffing model at Fairmont.

We have more FTs allocated than Alameda Cafe.

So the discrepancy is a little broader than it looks.

But this is in a reflection, of course, of the hard work that the team puts into the food.

They do a really wonderful job.

It really has to do with the location because it is in the service building, it's not attached to any, it's not attached to B building, John George, or any of the other buildings on the property.

So it is a walk for people to get there.

If the closure does um come through we're we're looking for other options to provide food.

Food trucks have been mentioned as something that people may be interested in, so we're looking at that.

I'm also um brainstorming with my team for ways that we can continue to bring celebrations and bring uh people together through food even if we can't sustain uh Monday through Friday cafeteria at Vermont.

And that's the end of my presentation.

Good evening.

My name is Dana Littlepage.

I'm the Vice President of Patient Care Services for the Administrative Service Track and I'm here to discuss the televisitter program closure.

Just want to give a little bit of a recap of what the televisitter program is and it is a virtual patient observation that we use for individuals that were identified by nursing assessment as appropriate for remote monitoring.

It was primarily utilized for low acuity patients at risk for falls or nine violent nonviolent types of behaviors like you know walking falling the kind of thing um excuse me a little nervous um we had monitoring staff that observed patients remotely and alerted bedside teams when interventions were needed um the program was designed to supplement nursing care and potentially reduce reliance on in-person sitters and so one of the things that we did we implemented this around two and a half years ago and what we had hoped to see was a measurable difference in the fall um in the patient care falls as well as patient satisfaction um the overall utilization of the program was about 42 percent and the cost for the uh the program in its um in itself was around 395 thousand a year with there's you know that being said there was no um reduction in the physical sitter cost reduction at all um this are the physical sitter costs about 3.17 million dollars annually and when you look at the um ROI on that program um it was negative and so the recommendation was that we suspend it system wide next slide please so I did a cost like a comparison so we can kind of see the virtual versus the in-person demand and you can see that device utilization was highest at Highland and lowest to San Leandro in Alameda.

So the device utilization for uh tele sitter for the uh virtual monitoring program was about 42% we monitored around 589 patients system wide with a total of uh almost 40,000 hours um of monitoring when we switch over to the inpatient sitters there's a high utilization one because Highland as you know is a high uh acuity for patients who have behavioral um health needs and so those patients who come in require a one-to-one physical sitters and that's something that we are not able to do with the low acuity type of uh virtual monitoring and you could see that um we on in Highland on average is about five sitters per day um alameda about uh 1.5 to you know uh 1.5 for both Alameda and San Leandro and the total cost of that um with set around 700 I'm sorry 70,000 hours is around 3.17 million um annually and you look at the labor costs we can kind of see that it also you know adds up as well and so telesitter didn't reduce the physical sitter utilization it created a dual cost structure um and then I mentioned that the the monitoring the virtual monitoring covered about 40k hours while the input demand for coverage was around 7000 hours annually next slide please and so one of the things we wanted to make sure of is that we had safety continuity as well as clinical oversight and so nothing really changed in terms of nursing continuing to look at the demand that was necessary for patient care needs.

Nursing still determines observational level based on the patient's risk assessment and so that's that reigns true for behavioral health observation requirements fall prevention needs as well as clinical safety considerations and so the clinical escalation pathways still remain in place.

The nurse assesses the patient has a conversation with the leadership on that floor and determines whether we need to put additional resources to keep to keep that patient safe.

So patient safety outcomes will continue to be monitored through existing nursing and safety quality um quality reporting process, and there will be no impact in terms of uh the uh an ability to care for patients that require physical monitoring.

Thank you.

Good evening.

My name is Lily McRae.

I'm the director of community health.

Thank you for having me, supervisors.

I'm here to talk a little bit about the complex care and health advocates programs.

First, I'd like to talk about health advocates.

So I'm going to summarize the programs, then talk about the potential impacts.

So the Health Advocates Programs program is a volunteer and community health workers staff program.

We connect patients to social resources, including public benefits, housing, food and legal services.

We also have a medical legal partnership.

Services are currently non-reimbursed.

The health advocates received nearly 4,000 referrals in 2025 and served approximately 3,300 HS patients.

So the proposed closure of this program will impact six and a half positions for community health workers, and these are the folks that are providing direct assessment and linkage to resources, an assistant practice manager who supervises the program, a program coordinator that's um, I'm sorry, a program uh coordinator that recruits and trains and supports our volunteers, and also supports the community engagement portion of the program, and then an unfilled halftime project coordinator position.

So the impact of this closure is that direct navigation and support for patients with health-related social needs will be discontinued, except in some cases where staff and services are already available locally in the organization, specific uh programs that have CHWs and other providers and staff.

Staff providers and patients will retain access to internal and external resources.

We have the find help referral platform.

We have a SharePoint site that has resources available, and then there's county-based resources like 211 and social services.

This proposed closure will be a savings of 890.

890,000 a year.

Um and the proposal for reducing this program.

Our teams, our complex care teams, we focus on patients, connecting them to outpatient services, critical community resources.

ECM is a Medi-Cal entitlement, and we're reimbursed through contract with Alamune Alliance.

In terms of our volume, in 2025, we served about 500 patients.

The impacted staff for the proposed reduction is 6.6.

This will impact two RN care managers.

The role is providing clinical oversight assessment and care coordination to social workers who conduct behavioral health assessments, counseling, care management, a practice manager who provides administrative support and operations for the department, a social work supervisor that provides leadership for our behavioral health services across the department and directly supervises the social workers, and a point six learning and development coordinator who supports our CHWs across the enterprise.

Next slide.

So the reduction impact.

Patients will no longer receive patients of uh followed by care complex care management will no longer receive individual assessments and ongoing management by the social workers.

Our overall capacity will be reduced, resulting in a higher patient to staff ratio.

Patients with behavioral health needs will be referred to our internal integrated behavioral health unit and externally to the Alliance and Alameda County Behavioral Health for Mental Health Services.

Wait times for ECM and behavioral health within ECM may increase.

Patients, there will be continuing services.

Patients will continue to receive care management services delivered by our end care managers and our community health workers as described and required and contracted by the Medical Benefit Enhanced Care Management.

Core services will include outreach, engagement, assessment, care planning, coordination, health teaching, transitional care and referrals.

So annual financial savings is just over 1.2 million dollars.

Next slide.

So the impacts to the proposed reduction.

It's um, I'm sorry, the proposed reductions to direct services are expected to result in an approximate 25% decrease in our reimbursements.

So the proposed reductions will not impact our current sustainably focused, sustainability focused projects that are already underway.

So as mentioned, uh the annual proposed annual savings will be just over 1.2 million dollars.

Thank you.

Thank you for the opportunity to represent Alameda Health System as the chief medical officer.

My name is Dr.

Lisa Laurent.

Next slide, please.

We will be experiencing a reduction in our plastic surgery service without any compromise to patient care and without our level one trauma center certification being in any jeopardy whatsoever, that was our primary concern.

Our current state is that we have 1.4 physician FTEs, which are costing us approximately $1 million.

We must preserve the 24-7 365 call coverage for our level one trauma certification.

Right now, the non-acute elective oncologic and breast reconstructive surgery cases total between 36 and 40.

Our proposal is to reduce the FTE to 0.6 physicians, which will generate an approximate $350,000 savings.

Again, this will not jeopardize the 24-7 365 call coverage with the understanding that if this particular physician is unavailable because of the 0.6 FTE designation, we will supplement any required call with per diem physician coverage for vacations time off or any other requests.

This will also include two four-hour clinic sessions per month.

And again, this also includes the projected approximate 40 cases to support our surgical oncology program to include breast reconstruction.

This will also allow this physician to increase the amount of patients that he or she sees as a way to generate more volumes and increase productivity as necessary.

Thank you.

Hello, good evening, supervisors.

My name is Patty Esposeff.

I am the chief administrative officer for John George and Behavioral Health Services at Alameda Health System.

So I'm here to share with you about our behavioral health outpatient services at Fairmont and Highland.

So the situation, just a couple of things.

The programs are part of a Medicare benefit.

So 98% of the patients in these programs have Medicare as their primary insurance and Medical as their secondary.

Sometimes we get a few that have private insurance.

So our situation is that the operating revenue right now for the programs, they're bringing in 3,663,000 in change.

But the cost to operate the program is approximately 7,200 in change.

So the operating loss is 3,600.

And if you if you also look at the costs which are provided here, the overhead expenses to cover the allocation for environment facility, engineering, security, HR, payroll, food services, rev cycle compliance quality, epic leadership, all these things, that's what it would look like.

So that's why it shows an overall $8 million loss.

Next slide, please.

They do great work and they support the clients who come to the programs.

Approximately 175 clients were served in 2025.

Next slide, please.

And as far as if the programs are to close, and I hope they don't close, but if if they're to close, for people who are for people who are acute, like who are who are having a hard time currently, like that um aren't as stable with their symptoms.

For that group of people, we would be able to refer them to Herit IOP or Fremont's potentially.

So I I think you're gonna hear actually you'll hear from many lovely people that work at the programs and from the clients there tonight so they can explain to you what the program means to them.

But those other services are available for people who would still be in an acute phase.

However, the majority of the people are in the wellness phase of treatment at these programs, which is they come a couple of days a week and they've come over the years and they have community support.

So what we would be looking at is working with behavioral health care services to um to put together what we can to make sure that they have that safety net.

They currently are um setup is that we do require people in the programs to have an outpatient psychiatrist.

Some of them already have case managers, some of them are affiliated with other um level one clinics or other um uh community centers, but we'd really have to partner to make sure that that could be in place for the clients, um, should we have to close these programs.

So thank you for hearing this report.

Supervisors, in closing, I I do want to express my appreciation to the department leaders that you've just heard from for their thoughtful as well as thorough presentation.

I'd also like to thank you as this board for hearing us and the members of the community for taking the time to listen carefully to what's been shared today and for the feedback that you are going to be receiving from them momentarily.

As you've heard, these proposed changes are not rooted in a lack of commitment or compassion.

They're the result of extraordinary financial pressures that have left us facing decisions that frankly we never wanted to make.

We do not take these decisions lightly.

We feel the weight of what this means for our community as well as for our workforce.

And you've heard our efforts to try to reallocate to the extent possible to create opportunities for people to move elsewhere within the organization.

Our responsibility is to preserve the long-term ability of the Alameda Health System to care for those who rely on us, and that's what we are presenting to you today.

We remain committed to approaching this process with transparency, dignity, and respect, and to continuing to serve our community with the compassion and the excellence that they deserve.

Thank you very much.

Thank you for that presentation and to all your department heads.

So at this time, I'd like to call Maria Bentoncourt from SEIU 10 to 1, the Alameda Health Systems chapter chair.

And Peter Masiac from the SEIU 10 to 1 East Bay.

Um is the mic on?

Okay, there we go.

My name is Peter Maziac.

I'm the East Bay field director for SAU 10 to 1.

Next to me is Maria Bettencourt.

Uh, she is the AHS chapter president and is a specialist clerk who is currently on paid leave and facing layoff.

Um, I want to thank the board first off for allowing us to present today.

It's not often that we're not just relegated to public comments.

We really do appreciate this time.

I plan to use the time to go over some high-level concerns.

There's no ability to get go into everything that we have regarding the layouts before you and how the lack of transparency and collaboration will impact services beyond what is even conceived of in the Beal Intonis.

I'll also attempt to highlight a few key cuts that are emblematic of the problems that exist throughout this layoff effort.

And I will then invite up some.

We also represent about 400 AU physicians in the AHS system.

And I've also would like them as SAU 10 to 1 members to come up to talk a little bit uh of my share time, talk about the perspective from from the physicians.

First, uh, we've provided with you with a quite lengthy sort of a uh uh white paper, it includes a lot of attachments.

I will kind of be using that as like a as a rough guide for my talk today, but I will not be sort of going point by point over it, and I'll have to be skipping around.

I think some of the other details and background was already covered by AHS management.

The first thing I want to talk about is the shifting finances.

Um, so despite um, despite only citing HR one cuts in the war notice, I think you can look.

If you look at the notice that went out, they cited uh the cuts from HR one and potential impact from the state.

Um, AHS has admitted that there are no there are zero HR one cuts in this fiscal year.

Uh, we also know that the disproportionate share hospital DHS cuts uh of 60 million that was supposed to take place in October of 2026, was delayed until 2028.

This is done after the layouts were announced, so that's 60 million dollars that they thought they were losing in October that they're now not.

Also, the limits on the MCO taxes that were originally scheduled to take place in June 2026 were extended to December 2026.

So that's additional money.

Uh and then also recent federal guidance provided to states around implementation of HR1 allows California to document the beneficiaries' hours based on wages, based on wages, not hours.

So as far as work requirements, right?

The federal minimum wage is 725, California's is 1690.

If you base it on wages and not on hours, then the threshold to continue to qualify is much less.

And earlier predictions of how much the work requirements would result in people losing their coverage is way out of line by at least an order of magnitude of two when you look at the difference in hourly wages.

Um, so despite all these changes that have happened since uh the layoff notices were issued, uh management is still continuing to pursue uh these massive layoffs.

The next thing that I want to talk about is union identified savings.

Um, so part of the process uh in the layoff impact bargaining is to seek alternatives.

Over the course of bargaining, uh the union, and it's it's it's laid out in the white paper that we presented has identified at least uh 29 million dollars in cost saving ideas.

Uh AHS has not agreed to further investigate any of these recommendations or take any of those options.

We also had at a board of trustees meeting, uh Port Commissioner Andreas Kluver said, I will let you break your lease for your office base in Jack London Square.

We've heard no follow-up about that.

So a very simple thing, you know, a volunteer, I'll let you break the lease.

Uh no, no, they're not interested.

They're more interested in maintaining an off-site executive suite for themselves.

Um, in addition to, in addition to this identified funding, there's also a belief that we've asked them to look at that there are hundreds of millions of dollars in work queues waiting to be processed for payments.

There's a uh uh the AHS could present to you sort of how long once a payment is submitted, how long they get reimbursed.

But the belief that we've heard from many people is that there are hundreds of millions of dollars that haven't even been submitted to the vendor yet, haven't you submitted to the insurance yet that are waiting?

And we definitely think that this is something that we ought to look into.

We've heard nothing on that front.

Um, and to go, you know, to move on, I think, and perhaps the main point that we want to sort of stress, because it's way too much to get into everything that's incorrect with the Beelandson hearings uh uh with the Beelington notice is way too much to talk about how our team heard more details and analysis about the cuts today than we've ever heard in months of bargaining.

There was more, there was more information in the declarations opposing the union's uh uh application for temporary restraining order.

We got more details from management in that than they're willing to voluntarily give to us uh in bargaining.

And so we're learning some things the same time that you're learning them.

Oh, that's your plan.

We never knew that.

We've been asking for months.

You'll tell the board of supervisors, you'll tell a judge, but you won't tell Maria Bettencourt.

Um, so is that we can't even begin to calculate the impact because we did not engage, AHS did not engage with the subject matter experts in bargaining.

At the beginning of bargaining, uh SCIU asked if we if management consulted with doctors, medical staff, department chairs, and department manager and department managers, they said that they did.

We quickly pointed out to them.

Uh, we actually represent the physicians, and they told us you didn't, and then management quickly abandoned that claim.

Later, after months of ignoring information requests, management finally told us that the people who made the decisions was the executive team.

And you will hear today when we get into public comment from a lot of doctors in this room that not a single doctor was talked to about hey, these are the cuts we're gonna do to your program.

Now, does management have the right to say, hey, look, we're unilaterally making these cuts, we don't care, right?

Do we have the right to do that?

You know, they might have the right to do that, but their obligation is to center patients and the services that are provided.

Uh, they have might have a right to unilaterally make cuts without consulting with doctors, but they have an obligation to consult with the subject matter experts.

Uh, and and and you'll hear more about that later.

Um, this is also further concerning when you look at the language in the Beelinson.

Under the nature of proposed changes, there's five closures, two reductions, and seventy-two right sizing.

And 52 times the document AHA's AHS claims the additional work will be quote, absorbed by existing staff.

How are you gonna claim the work is going to be absorbed by existing staff if you didn't talk to the managers who will tell the staff, hey, you're absorbing someone else's job now, right?

I also think it's quite troubling that a right sizing is a layoff and is a reduction.

When we heard the presentation from management a few moments ago, they focused on the closures and they focused on the reductions.

There is, and you can look through the BL and to notice, there are 72 line items where the reduction is a right sizing.

There's a right sizing of 17.2 housekeeping staff throughout the agency.

But because it's considered right sizing, management does not think it is worthy to talk about in this forum today.

They think it's like a clerical error, seemingly, and a furthermore, right sizing, there are two reasons people get laid off: lack of work and lack of funds.

Right sizing implies wrong sizing is currently the status quo.

Right sizing says that we are overstaffed.

This is something Kim Miranda brought up at the bargaining table with us on talk about the shifting rationale for for layoffs.

After originally only saying that the war note is saying that it was just about HR1 cuts and management's own financial analysis, uh has shown that there's no HR one cuts this year.

Then at bargaining on February 4th, Kim Miranda told us that AHS is overstaffed.

Uh the union asked, where are they overstaffed, what departments, what classifications, and we were told that it doesn't exist at that level uh to say that what is overstaffed and what is not overstaffed.

So I think throughout what we've seen is the union does not have the ability to even effectively bargain over the impacts if they cannot give consistent rationale for the layoffs and they have not incorporated the actual decision makers.

And I think that to be at this hearing, like less than two weeks out from the anticipated cuts, and to be finding out part of management's plans for the first time shows that the proper stakeholders uh were not in were not brought in uh from the beginning.

Um I don't want to talk too much about about bonuses uh because uh I I think that the evidence is quite is quite obvious, and you've been presented with the actual document that we received to an RFI.

I do really quickly want to talk about the timeline.

Um on June 11th, AHS received the presentation about the cash flow concerns, approximately 100 million dollars.

On July 4th, President Trump passed assigned HR one.

And then in August, uh Kim Miranda confirmed that uh John Minut Schwartz, the director of reimbursement and finance strategy, delivered a presentation that talked about the implementation and rollout of HR one.

And that uh in, and then that was in August, and then in September or October, AHS executives decided to give themselves over three million dollars in bonuses.

And then on November 19th, they announced layoffs.

So I think that all the concern about we care about this system, we care about the patients.

It's it's it's it comes across very disingenuous when you've just given when you've just been given a 77,000 bonus.

If you really truly care about the patients and clients, you should say, you know what, I'm good.

Don't give me my bonus.

But I do want to get into some of the specific cuts to highlight, and I I'm definitely not gonna have time to talk about everything.

Um, but what I really want to talk about is uh, and I think it's emblematic of the larger problem that we're seeing, and you'll hear from a lot of these people is the Highland and Fairmont outpatient behavior health force uh closure.

First, just there's a level of inconsistency with this.

Um, the presentation on the, so the Beelinson says 13 positions from Highland will be cut, and 30 positions from Fairmont will be eliminated.

Uh, but then the February 4th Board of Trustees meeting, the presentation on program closures said that 10.1 FTE will be gone from Highland, and 20.5 FTE will be gone from Fairmont, but also note that three of the 10 have resigned from Highland, and two of the 20 in Fairmont took uh early retirement.

And then I was just surprised that the numbers are even slightly different now on what's just been presented to you.

So even on, so from February 4th, February 11th and February 25th, we've gotten three different numbers from Alameda Health System about how many actual workers will be laid off.

Also, we've heard today that they say 211.

If you count up all of the FTEs that are included in the BL2 notice, it's I think it's like a 191.

So that number doesn't even align.

So it's very difficult for us to effectively approach the uh the cuts when management doesn't even seem able to give us consistent and accurate information about who's impacted.

Um, I will let the workers from the impacted program come up later, talk about what it is they do.

I'm a union field director, I don't work in healthcare, so I'd be uh presumptuous of me to stand in a room of healthcare experts and say what healthcare does.

But what I will say is that is that um the claims of the organizations who can take on these patients is just not accurate at all.

And what's even more scary than how inaccurate it is is that the work had to be done by our members in their free time to contact these organizations to find out like what do you do?

What is your program look like?

And on multiple occasions, uh it was our members calling in these programs who was informing Laheim, who was informing Alameda County behavioral health that um, hey, that their program is closing and we're sending all of our people to you.

This was not something uh nobody in the executive leadership team called up Herrick and said, Hey, we're shutting down, you're gonna get all of our patients, right?

This was the first time they ever heard about it.

And so just a couple things.

Um, you know, uh um Laheim does not provide transportation, has no interpreters, has a one-year admission wait list in the past, has restricted number of Medicare patients, and does not have the capacity or program for people suffering from chronic SMI.

Alt debates HERIC, no transportation, no in-person interpreters, only over the phone, which is not good for a diverse community such as Alameda County, limited to a four to six week stay, no milieu therapy, no individual therapy, no case management, mostly higher functioning patients, not the patients that we have at AHS, no expressive arts groups, no TOPS groups, no special messages uh groups, and no wellness program to continue support and stability.

And then Fremont has some transportation, but not for all of Alameda County, only for like central, North Oakland and Berkeley, or maybe it's the inverse.

Uh um uh no interpreters, a four week stay.

Patients of all function levels are mixed together.

Uh, there's no lunch provided, as you can imagine, providing lunch to patients in this situation is very uh important.

Uh no DBT provided, no TOPS group, no special messages group, and no wellness step down program.

So these are all things that are absolutely going to be lost.

And just to say, oh, go to this other program, and we haven't contacted the program, we haven't talked about them really indicates that we're going to have a massive problem when these folks are out there.

And what does it mean then when those folks are out in the community and not getting the support?

One, it's bad for health outcomes.

Two, it's bad financially.

They're gonna end up back re being readmitted, they're gonna end up uh dead, they're gonna end up in Santa Rita, and it's gonna end up costing the county more money.

However, if that if the if the if the Santa Rita cost is not AHS's cost, that's yours.

So it's kind of a cost shifting in a way.

We're saying, hey, now this person who used to get outpatient therapy, we've reduced, we had reduced it by doing something preventative.

Now they're not gonna have that.

The cost is gonna be borne by Santa Rita jail, but that's the county's problem.

It's not on AHS's books anymore.

I can only assume that that's sort of like the logic going on with this.

Um there's also the partnership with the Alameda County behavior uh health department is unrealistic.

Um they say that it's it's one thing that's funny.

Uh uh, it's attachment 34 in the in the document I've given you, um, states that AHS can partner with Alameda County uh if the program's closed.

It's absurd on its face because AHS is seeking to lay off the exact staff that would partner.

So it's like we got rid of the partners, you can partner.

And then also the county assessment is only done through the access helpline phone number.

There's 113 patients, and they all kind of need help making that call.

And we see this on another uh example, too, on the um on the health advocates, where it's just basically the the response in the Bealons and the health advocates is uh um patients can the services are available on the AHS website.

So what we're talking about with the health advocates is that uh these are folks with you know uh um significant you know uh uh language uh uh issues, psychological social ailment, and basically the answer is go to www.alameda health system.org and you're gonna find a number and you're gonna have to call, you're gonna be on hold for all you're gonna have to call back.

These are people who have mental health issues, marginally housed, homeless.

The whole existence for this program is to provide a staff member who is paid by the county who can be your advocate.

You don't have to have a health advocate because the health advocate is necessary.

And I think once again, this goes back to the question of that if this if this service is cut, who bears the cost?

The cost will be borne by the Highland ED.

The cost will be borne by OPD by San Leandro PD, the cost will be born by Santa Rita, and the cost will be born by Alameda County.

So AHS can say their savings because they're only one component of who is going to suffer the cost when we're not doing the preventative care.

Only the the the emergency department in county is their cost.

All the other costs are shifted to cities or counties or other or other organizations that is not their budget.

So it's not really a cost savings, it's a cost dispersal where they're going to be harming Oakland police department budget, Berkeley police department budget, Alameda County behavioral health budget, Alameda County Santa Rita jail budget.

And I think that those things need to be considered.

Because we're gonna hear from a lot more, and I'm definitely remaining willing to sort of talk to other folks about this, um, is but I do want to uh, you know, provide some space for some of our physicians who are also SCIU 10 to 1 members, so they can make their way up here, and I can hand the mic off to them.

Um, I also just want to say there's also several areas in the notices, and you see this especially in the declarations opposing the uh union's application for a TRO, where what management talks about is a desire to return to a historical model.

What's missing in a lot of that conversation is why the model was changed in the first place.

For example, uh Maria Betancourt's position right next to me is being laid off.

They say that we do not need people at the front desk at uh John George to greet people and to send people uh to the right.

That can be done by security guards who are third party contractors now.

What Maria knows because she was a part of this was that in 2017 or 2018, we're looking for the file.

Um the a report by the joint commission issued a what was it a like a a memo of correction?

Yes.

Yeah, a plan of correction that said you have to have AHS staff at this front desk.

So if AHS is not resolving the problem that resulted in this change, but now say we're going back to a historical model, their reason historical models change is because they're inadequate.

We have another example with the um, we have another example with the bed control, where management is saying we are going back to the historical model for bed control, right?

But then we also have a memo that was from Dusty Gilliland in 2023 that states that they need to implement a new plan because their average time for uh for boarding is an hour and 20 minutes, and our goal is 45.

So they made a change because they were not hitting the objectives that they met.

And this is kind of creates the most concerning problem is that you see documents and you see the right sizing plan.

I personally do not believe, I believe that the HR1 cuts are an opportunity to engage in right sizing and layoffs because I believe that AHS fundamentally feels like they don't want to have all these staff here.

And I think that what you see is when you have the flood waters of the Trump administration rising towards you, you're supposed to run to seek higher ground.

And what you have here is AHS management walking towards the water throughout the entire process, SAU 10 to 1 has been very honest.

That look, the Trump administration is an existential threat to public health care everywhere.

There is may not be a way out of this, but what there ought to be and should be is collaboration.

We are all opposed to these cuts by HR one.

There should be collaboration to figure out how do we maybe rack up a credit card bill in the hopes that when we finally get a new administration that it'll be paid off.

How do we borrow more money?

How do we figure out how to do this?

How do we work together to minimize these costs?

What things can we do to adjust this?

Instead, what what we saw from management was an opportunity to engage in right sizing and austerity that was provided by Alameda help that was provided by HR1.

This is particularly concerning in the light of with all of the hand ringing over how difficult things are.

I think the proof is in the pudding that if you're saying we don't want to do this, we don't want to do this, but I'm gonna give myself a 69,000 dollar bonus when I after I've decided I'm gonna do this.

I think all the other things sort of fall apart uh on its face.

So are there doctors here who want to or I do think that they wanted so?

So as part of our presentation, I was because we also we have four, we have we have uh four contracts and two chapters and uh uh SCIU 10 to 1.

We have the uh the RN uh contract, we have the general unit contract, the San Diego contract, those three are under one uh umbrella of um of one chapter, and then we also have a doctor's unit and doctor chapter, and I do want to give them just a couple minutes to talk about their perspective and their feeling of a lack of involvement from the physician's perspective.

Thank you.

Thank you.

Okay, I appreciate the enthusiasm and the applause, but honestly, um, when you do that, I can't hear the speakers very well.

So can you kind of subdued your enthusiasm?

Thank you.

Please.

Hi, so I'm uh Dr.

Benny Liu.

I'm the uh interim division chief of gastroneurology at uh AHS, and I've been there since 2012 and I've seen a lot.

Um, one of the very big concerns that the physicians, the clinical staff, the clinical leaders have is that there has been very little to no engagement with the clinic with the clinical leaders who understand what patient care needs and what goes on when these huge decisions like these RIFs and other things are being made, just virtually kind of very little um input from the clinical leadership.

And so I just wanted to give some examples of things that this has is affecting right now.

And so here's a list.

And so the level one trauma center, which is Alameda Health System, it's the only level one trauma center in the East Bay, lacks the required vascular surgery coverage, and therefore it puts our level one trauma certification at risk from the American College of Surgeons.

Second, there's significant anesthesia shortages throughout the entire hospital system, and this is impacting surgical capacity.

Our cardiac arrest receiving center.

So if you have a heart attack or your heart stops and you're brought here uh to Highland, this is compromised because we have reduced cardiology coverage and there's limited support for invasive cardiac procedures.

And so if you have it, if you need a cardiac catheter because of a big heart attack, sometimes those services may not be available.

Uh the inability to meet ambulance patient offload time requirements under AB 40, which puts at risk the ability for Highland Hospital to receive stroke and cardiac arrest patients due to EMS standards.

And so we can't get patients off the ambulances fast enough because of the emergency room crowding.

And if all this stuff happens, the emergency rooms are gonna get even more and more crowded.

Um there's decline in operating room and procedural capacity from all these decisions, which is gonna result in delays in trauma care.

It's gonna result in delays in emergency procedures.

Uh, it's already resulting in delays in gastroology services, which uh is my division, and there's also delays uh will result in cardiac or cardiology care.

There's also been sharp reductions in women's health services, and so there's been a 50% contraction in prenatal care access, which increases incidence of women presenting in labor without adequate prenatal care.

So these babies are, you know, uh behind the eight ball already, right?

When they're born.

Um, and because of this, there is gonna be a rise in preventable maternal and neonatal complications because of this.

And then lastly, this is a big problem.

There's an inability to fill vacant positions due to a hiring freeze.

Um, this hiring freeze uh for physicians, it's not a formal part of this RIF, but um it's producing equivalent negative um impacts on patient care and access to uh critical services.

And so these are just some of the impacts that um a lot of uh the decisions of the uh executive uh leadership has made um and is impacting vital services um at AHS.

All right.

And the physicians at Alameda Health System, and so 332 physicians and providers have drafted a letter with regards to these reduction in force.

And so I want to read this letter.

And I have some of my colleagues here that are going to help me.

And so first, uh Dr.

Anna Liang, she's a pediatrician at AHS.

Then next, I have Dr.

Christina Cho, who is a gastroenterologist.

And then lastly, uh David Duong, who is an emergency room physician.

All right.

And so they're going to read this letter that was signed by 332 of the physicians and providers at AHS.

Thank you so much.

Representing the physicians of Alameda Health System, we want to express our profound opposition to the proposed reductions in health services and our deep disappointment in the approach put forth by AHS executive leadership.

The proposal before you reflects a long-standing pattern of poor judgment, lack of understanding of clinical care for the underserved, and systemic mismanagement that directly threatens patient safety and undermines the mission of our public health system: caring, healing, teaching, serving all.

The threats facing public health from HR1 are real, and we fully support efforts to build a more resilient healthcare system in response.

But dismantling essential services is not the solution.

Any healthcare system facing a financial crisis should start by protecting its existing sources of revenue, identifying new sources of revenue, and if cuts are needed, taking them first from the top and from systems with no immediate downstream effects on clinical care.

What AHS has put before you is a bottom-up approach, cuts from areas with immediate clinical impact.

This is a dangerous strategic failure.

It is deeply troubling that decisions of this magnitude have been advanced without meaningful engagement with clinical leadership or those who understand the realities of patient care.

We chose to work at AHS over more highly resourced health care systems because we are capable of delivering high-quality health care in the resource-limited environment.

The failure to involve clinicians in high stake restructuring decisions reflects not only poor governance, but a fundamental disconnect between AHS executive leadership and the mission that they are entrusted to uphold.

We urge you to examine how other similar health care systems have approached financial crisis, past and present.

This analysis will show you that AHS systematically under codes and under bills for clinical work.

No matter how many times we raise this issue to AHS leadership, these inefficiencies remain.

Leadership must ensure the system is capturing the revenue it generates.

So let us be clear, these cuts will not save Alameda County money.

They'll shift costs as eloquently already stated and strain emergency services, burden taxpayers, and destabilize an already strained public health care system.

They will result in delays in care and human suffering.

At a time when HR1 already threatens to strip coverage of so many of our people in our community.

This is just what will just compound that harm.

So we urge the Alameda County Board of Supervisors to intervene decisively.

Accountability must be demanded of the board of trustees and the executive leadership.

HS cannot cut its way out of mismanagement.

It must instead pursue a path of responsible, transparent, and competent stewardship, one that prioritizes patient safety, preserves essential services, and fulfills its obligations to serve all residents of Alameda County.

And this was respectfully signed by 332 clinicians at Alameda Alameda Health System within the only the last two days.

Thank you.

Um hello, supervisors and the public.

Uh I'm Dr.

Caitlin Bailey.

I'm the medical director of the Highland Hospital Emergency Department.

Thank you for allowing me some time to speak.

I really want to emphasize that even though there has been a very explicit packet of reduction in force details, it does not encompass what Dr.

Liu referenced, which is that there is a very clear, very public focus on attrition, hiring freeze, and failure to backfill positions that are required to keep our lights on, our trash empty, and our beds available.

If we don't backfill certain positions, positions we are aware are absolutely critical for safe staffing and to literally staff 24 by seven services that are required to be a trauma center, we will not be able to function.

And that's not included in what's been summarized today.

That includes vascular surgery coverage and anesthesia coverage.

One of our anesthesia colleagues just worked 48 hours in a row to ensure we did not go on trauma diversion.

This is a real real threat.

We are not being alarmist.

This is alarming.

I would like to, I know Dr.

Mendoza was operating up until the point where she got put in the overflow room.

So she and I spoke.

She's the trauma services director.

She put it pretty bluntly with me today.

She said we should ask does the county want to have a trauma hospital or does it not?

Do we want a place where babies can be born safely or not?

Do you want a place to go if your heart stops feeding or not?

And do you want a room to be available in the emergency department when that happens or not?

Do you want the department to be clean or not when that happens?

These are this is what is before us.

It's not subtle.

If we don't staff our hospital, we cannot function.

Thank you.

We have one more speaker who's online from SEIU.

Okay, thank you.

And Dr.

Matisse.

So please do that because it helps us hear the speakers.

Thank you.

So we'll go to the TEC room for Dr.

Latize.

The speakers from the TEC room.

So what you're saying?

Okay.

Yes.

Okay, one of the physicians.

Yes.

You can hear me.

Uh yeah, just yeah, just to just to kind of reiterate what all my colleagues have already mentioned.

I just want to make sure everyone knows that in 2023, our trauma center was on probation because it was determined at that time we were critically understaffed.

Um, as we had only one IR physician to cover 365 days a year, just as they're proposing right now for plastic surgery.

Turns out it's too cumbersome to hire locums as needed.

And we missed several days.

And for that reason, we were put on probation.

They also mentioned that we had weaknesses at that time, and they determined, guess what?

We were critically understanded in trauma surgeons, critically understaffed and advanced practice providers.

And this was determined to be a weakness.

And if it was unaddressed, it would be considered a primary deficiency.

So, as everyone mentioned, with a reduction in force and likely mismanagement, we are now critically understaffed, and not only anesthesia, vascular surgery, likely plastic surgery as well.

And each of these are considered critical to maintain verification by Alameda County, which means we'll suppose to lose 50 million dollars from the county if we lose our our um verification status.

Um as it was mentioned with the only level one trauma center that served this county.

We are one of the busiest busiest in the bay, if not the busiest.

We serve 4600 activations every year.

Uh this county doesn't just deserve a trauma center that has a bare minimum.

We deserve to have an excellent trauma center.

And what's being asked is to deliver less than the bare minimum.

So as was mentioned, we serve all from the cyclists in Berkeley to the homeless in Oakland.

Help us make Highland something that we all can be proud of.

Thank you again.

Thank you very much.

At this point, um, because we've been here for over an hour and a half, we're gonna take a five-minute break and then resume with questions from the board.

Please be seated.

Thank you.

We are reconvening from the break.

May I have roll call, please to re-establish quorum.

Supervisor Marquez.

Oh my gosh.

Sorry, sorry.

Sorry, sorry.

Uh, Supervisor Cam.

Present.

Supervisor Miley.

Supervisor Fortunato Bass.

President Halbert, excuse.

Thank you.

Thank you everyone for your presentation and for um the very in-depth information about some of the um materials that we did receive.

We did receive the white paper from SEIU and also the presentation that you saw before you today from AHS.

So I serve on the health committee with uh supervisor Miley, and I just have some overall questions.

I know without a question, this board, this county, AHS, all of you believe that access to quality health care is a critical priority in our county.

And so that's the vein in which I'm asking some of these overall questions based on what was presented today.

When we look at um the patient mix that was discussed, uh you know, I see in the white paper, SEIU talked about 99% on Medicaid, which I assume is Medical.

And Mr.

Jackson talked about 60%, and then in some programs, there's like 90%.

So overall, what is the patient mix and how many unsured do we have that goes through the Alameda Health Systems, and what's the basis for uh some of these some of these uh percentages?

Please come up.

Sure, thank you.

Let me explain.

So currently about 60 percent of our payer mix, which is based on gross charges, services that we charge for are medical.

We have another 20 to 25 percent that are Medicare and have Medica.

So, when you add those together with the uh self-pay, which is what we call uninsured, which is a you know one or two percent.

Uh, we actually get up to about 92 percent government um patients or charges or services provided.

Just the remaining uh eight percent uh uninsured or private insurance, private insurance.

So we have around seven percent commercial um business, which mostly comes from the trauma center.

Okay, and what's the percentage of uninsured?

It's probably about 1.7.

So it's just very small because of the expansion of Medi-Cal.

So most people either qualify for HPAC or Medi-Cal now.

There's very few that don't have any insurance.

Okay, thank you.

That's very helpful.

Um, I'm trying to look through at least uh pages six through 59, uh, the services that were listed in terms of the reductions in force, and trying to get a better understanding of what programs are eliminated, and how does that affect the medical services and patient care or the clients that were served by these programs?

And so some of the programs that were mentioned were at least uh tied to patient care was uh the complex care program, the plastic surgery, um, the outpatient behavioral health, and also there was a clinical lab that had some um reductions as well.

Can you help me understand um in terms of some of these programs, the clients that are being served, focusing on patient care?

How uh is AHS transitioning some of the care?

Uh, because I heard from uh some of the SEIU representatives and in their white paper that when they contacted some alternative options, like in Fremont uh or Herrick, uh, there was not um clear communication that occurred in that transition of care.

Yeah, I can answer that.

So should should the programs close, then we'd have to look at each individual patient with patient to see which resources they have because the the PHP IOPs of their programs, they are short term, and they'll take people if they're acute, some of them, but then they would have to assess the patient at that in real time, like when they're ready to go there.

You can't just cold call in advance and say, will you take patients without presenting a real clinical case for it?

Does that answer your question?

Yes, thank you.

That's helpful.

Um, the last question I had is it's mainly to some of the SEAU represented physicians.

Um, a lot of the concerns that were expressed, the ones that I'm also very worried about is uh the level one trauma center certification.

It sounds like a lot of these issues with the crowding in the emergency room, with the issues on availability of staff, uh has been going, whether it's offloading for ambulances in our EMS service have been going on long before this issue about the reductions in force have occurred.

Is that correct?

And this reduction in force is not necessarily tied to the conditions that you are experiencing.

Very worse.

I'm sorry, can you please come up?

I know we can question the CPHF.

All right, um, my name is Dr.

Othlet.

I'm part of CIR SCIU, so not 10 to 1.

Um, but I am in a resident doctor at the hospital.

Um, and I can say that from just experiencing Highland as a resident, um, a lot of the issues are from like an underoptimized baseline that's then going through additional stressors.

So, yes, there's definitely already been existing pressures and gaps in coverage for vascular surgery IR, which is interventional radiology that are necessary to maintain level one status, and the new laws regarding APOT times, which are those ambulance offloading times, are already very, very strained.

And we actually recently had a case where um this is prior to the RIFs, um, that in ambulance um EMT was just like, I need to leave.

Like this, my patient's been waiting three hours in the ambulance bay.

Like, I can't stay here, and was basically broke unfortunately Mtala regulation by leaving with the patient.

So that's gonna happen more and more if we have these rifts.

So I think that's our concern.

So, yes, definitely already under optimized base baseline.

Uh, can you help me be more specific when when you look through the at least pages six through 59, uh, which particular programs you think would um affect that level of care, and particularly in terms of the patient, uh, what the patient actually sees.

Yeah, like it's gonna be better, but yeah.

Um, so um, I don't have any idea what page it's on, but the phlebotomy and clinical lab reductions.

So our phlebotomists draw blood when the patients are waiting in the waiting room.

And when I sitting in the waiting room, I don't mean for like a minute, I mean for potentially seven hours.

So we have a provider in triage who can get that patient seen, you know, in essentially a public space, like they're not undressed and say, I know that you need lab tests, I'm gonna order those tests.

There's not a nurse assigned to that patient in the waiting room there, but they're previously used to be phlebotomists who could then draw those labs, get results that might be critical and expedite that patient's care with the limited resources we have for a many our bed.

All of those positions were initially cut in the RIF with no consultation with any clinical leadership as to their role.

Um they had been saving the hospital $2 million a year in contaminated blood cultures.

Um they had a they had paid for themselves within 10 months of being hired.

Um, that was well known to me, well known to the chair of pathology, well known to the chair of the department.

All that information was available, they were cut anyway, and now at one point we had no way to draw blood in the lobby after a presentation to the board of trustees, we strongly strongly advocated for a return of these positions, and one of them was brought back in the middle of the day to see at times 40 patients in the waiting room and draw their blood.

So that's an example.

We absolutely were overcrowded prior to reductions in force.

Um, however, if you then reduce services available for an already incredibly strained system, it's gonna break further.

What is now the issue is we are very realistically in danger of not meeting regulatory standards for coverage for for various service lines that need to be available 24 hours a day to be uh a place where you can have uh high-level heart attack, a STEMI, or a trauma, or be receive a cardiac arrest patient.

Those are all kind of scrutinized by the state of California and you need certain services to be able to provide them and without the ability to hire into vacant positions or have phlebotomists and other staff to take care of them, we will not meet those certifications.

Okay, thank you.

Um can one of the AHS uh department heads that spoke about the uh clinical lab reductions um help uh respond to that as well.

I don't think we have a director from my department, but I am from the clinical lab.

My name is Ashley Marin.

I've been a clinical lab scientist there for uh about five years now, uh, going on six.

And I just wanted to add about the lab assistants and what they do.

So, as uh everyone has been saying, uh especially Dr.

Hull referring to being able to draw patients while they're waiting and get a sense of what's going on before they can actually get into a bed.

Um, in addition to that, lab assistants are the ones who respond to level one traumas.

So if there is a level one trauma cult, those are the people who bring a cooler full of blood to the level one trauma.

And if you don't have that blood right there, when a patient is blood bleeding to death, they're gonna die before they can ever get transfused.

Um, I would also like to note that the three lab assistants who were RIFT were all the ED um lab assistants, and in order to reshuffle their responsibilities around due to seniority, they were moved into the lab.

But the people who were sorry, the three people who were lost were on PM shift.

The ED staff were moved back into the lab in order to cover that.

And then when they were asked to provide partial coverage to the ED, that remains um there's still understaffing on the PM shift.

So there's two full-time staff right now.

These are the people who are responding to level one traumas, in addition to answering the phones, processing specimens, um, plating microcultures, uh, basically doing everything to make sure that me, I'm a clinical lab scientist who does the testing to make sure that I can do my job.

Um, but like I said, if you have two lab assistants who are going to the level one traumas, we don't have anyone else to send.

So if we have more than two traumas, we don't have anyone else to send.

The cost according to an analysis performed by Dr.

Valerie Ng in 2024 was 8,000 non-reimbursable dollars each, meaning that it's money that AHS will never get back, even though we're providing treatment.

And as they said, it totals one to two million dollars per year.

And the cost of the FTEs is only a small fraction of that.

Okay.

Thank you.

I was hoping that somebody from AHS can help me understand this statement about how there was a prior model in terms of having the clinicians routinely perform the blood culture collections and then how uh the 2.6 staff reductions has changed that and it's being absorbed by the existing staff.

Um we don't have our lab direct, but I'll take a stab at it, Supervisor Tim.

Um so in 2024, that was a reference or 2023.

We had the model that we're at right now.

About that time, we added the FTEs back, must have been like two years ago.

Um, we're now of course back to the practice that we had prior to the current model.

And the contamination rates are always a concern around quality.

Um, and we're monitoring those very closely right now in the new model, and we'll continue to do so.

Right now, they're they're fine.

Um, and we're gonna continue to monitor them.

I can't tell you the exact number, but um I haven't heard they've been out of line by any means.

Okay, and you have uh data and trending information to show and demonstrate.

Yeah, we do.

Okay.

And we'll keep an eye on it.

Okay, yeah.

Thank you.

Yeah, it'll be like I'm sorry.

So when the pulled from the ED, uh blood culture contamination immediately spiked.

So we were whenever blood cultures are positive.

There's a machine that goes off.

We have to call it as a critical staff around the clock were having to respond to this machine and not focus on their core duties because it was just going off so much.

The people in micro who are the ones figuring out what pathogen is responsible from a sample, because it's contaminated, it's all kinds of different skin bacteria.

It's not just one thing that you can say, this is growing in a place that's supposed to be sterile, that therefore it's the pathogen.

If it's mixed, you have no idea what's going on.

So that delays patient care.

You're starting to give them antibiotics that may not be helping them, it might be hurting them.

It can cause uh C diff if they have it in their bodies to already, if they already have it, and normally their um their normal flora is keeping it under control.

The antibiotics kill the natural flora and then C diff can take over, and that causes colitis, it causes massive diarrhea.

It's another thing that uh is not reimbursable.

I appreciate understanding the level contamination.

Do you also have access to the data that Mr.

Faski was talking about in terms of trending?

Yes.

So I don't have a specific number.

Our micro lead is actually on PTO right now and was not able to give me statistics to present.

I do have the data from 2024, which is what I said earlier, or 2023.

Um, yeah, it's they're still getting a lot of positive blood cultures that are likely not real.

Okay and doctors don't know how to treat it if they don't know what's there, right?

That's the point of the lab.

We need to know what's wrong so that we can treat it.

Thank you.

Hello, I'm Dr.

Alan.

I've been chief of plastic surgery of Highland for the last 27 years.

And I was told that this would be a good time talking about other clinical reductions, and I think you inquired about plastic surgery.

You know, the Baylance and notices stated that plastic surgery, the plastic surgery division does 36 to 40 cases a year.

Now that was a mistake, and we'll discuss that, but if that was true, I would cut plastics too.

The actual volume of the plastic service is 210 cases a year.

Six times greater.

Now, this was an honest mistake, and it's it's collect it's uh corrected in the plastic surgery service reduction handout.

So the 36 to 40 concurrent cases were just ones that I personally did to support surgical oncology with their complex cancer cases and our breast surgical oncology.

But what about the other 174 cases that we do?

And first of all, these are excellent revenue generating cases.

So we're talking about the loss of 210 revenue generating cases per year.

The thing that really compelled me to talk about this was the statement that's made in the upper right corner, which says we believe the current volumes support a partial plastic surgeon FTE.

That's just not the case, and I've reported that to the administration, the data of the operative cases that show that we do 210 cases a year, and that you know, my uh 175 cases is enough to justify 1.0 FTE with 4,000 work RVUs per year.

So the what I want to leave you all with, and this is a completely different talk than I was planning on giving uh tonight, um, because I really feel and my medical colleagues and union leadership all felt that it was important to set this record straight on this data.

The, you know, so you've got 210 cases overall, these 36 complex cases that the administration acknowledges are worth preserving.

What about the other 174 cases?

They're important too.

These cases include most of the skin cancers that we do, all of the complex wounds and exposed bone referrals that come from orthopedics, podiatry, vascular, and our womb centers.

And they don't include, uh they do include hydratinitis separativa, which is an absolutely horrible skin infection that is so severe that it leaves the patients desperate enough to beg me to remove huge blocks of skin from their body and replace it with skin grafts and artificial skin.

So these are the kind of things that we do in plastic surgery clinic.

All of our work is medically necessary, and I fear that if we reduce it, we're going to end up with patient abandonment issues.

Thank you for listening.

Thank you.

At this time, let me turn it over to my colleagues.

ID uh Supervisor Fortunato Bass.

Next, and then we have Supervisor Marquez and Supervisor Miley.

Thank you, Chair Tam.

And thank you, everyone, for being here and sharing all of this information.

Um, I do want to start uh by saying that I am really moved by everything that I have heard, and I do believe health care is a human right, and that everyone should have access to quality affordable health care.

And uh that's partly the lens that I am looking at today.

I have a set of uh questions and comments.

One is around finances, uh, the second is around patient care, and the third is about how can we all work together to improve what's happening with our healthcare system.

So I do feel compelled to um, you know, just underscore why we're here.

You know, certainly it's because of Trump's big ugly bill, HR1, uh, the effects of which uh we will see later this year, and that's a massive wealth transfer from our most vulnerable residents to the super rich.

It's really about stealing our health care away from our residents and giving tax breaks to billionaires.

And while uh we may not be able to do something about that today, I think it's an important part of the context.

Um, in terms of finances, I am interested in hearing from um AHS management about the financial health before HR 1, you know, before that bill was passed, as well as about the $7 million in bonuses, and I understand that's hundreds of employees over a couple years, um, but I do think it's worth um asking about and making sure that we understand.

Secondly, I want to hear about the delays at the federal level of the dish payments and the MCO tax, and specifically could these proposed reductions have weighted because of those delays, and then thirdly, the union mentioned a number of cost saving recommendations that they shared with AHS.

I am interested in hearing um what AHS's response has been to those recommendations, I'll start with help.

So, in regard to timing, um AHS did pass their budget, which was right at break-even, understanding that we were going to max out our NNB.

Our board of trustees came back and asked the leadership team to come up with a plan to get us back on course, and we felt we would be able to do that internally during the year.

Then HR1 passed in July, and we started looking at the longer term situation with cuts that are beginning now in January.

You're right, most of them will hit next fiscal year, but there are undocumented impacts now, and we are seeing, and we had heard from the Alameda Alliance their projections on the reduction of uh Medi-Cal lives.

So it is happening now.

Um so that's the timeline for that.

And I want to add, we have been in this situation before and found ways to get the NNB down and work internally to do it.

So this would not be the first time we would have been able to accomplish that task.

But definitely when HR1 passed in July, it's like, oh my gosh, these are unprecedented cuts, right?

Um, and then the next question you asked on the dish delays and the MCO tax, none of that was in any of our projections anyway.

Um, yes, it was a risk in the slides that we presented because we wanted to make sure our board of trustees were informed, but we did not have those reductions in any of our numbers.

And even the numbers I'm sharing with you today are based on our actual cash flows.

You know, our um our payroll is about 40 million a pay period, and that's why on my graph you can kind of see the jumps because it depends upon how many pay periods are in the month, and the proposed uh reductions now are about 4% of our workforce, which um if you uh look across the country, you're seeing most healthcare systems doing something similar.

We are just proportionately hit because 92% of our payer mix is government pay.

I think the rest I need to leave up to you.

Very good.

The bonuses was the other question.

Thank you.

And so the bonuses are a roll-up.

And so if I can if I can speak, um the bonuses were something that were one, it was built on there was a trigger, which was did we meet our EBITDA target for the last year?

And we did.

And then there were other um gates, if you will, that opened by virtue of our financial performance.

And so the bonuses were driven by the performance of the prior fiscal year.

And so the idea that they were given with full knowledge of what was happening with HR1, I think is dubious, and they had been promised based on performance for the prior fiscal year.

And so that's why they were paid out.

Um so I, you know, the numbers are what they are, but it wasn't based on this year's performance, it was based on the prior fiscal year, which ended in June of last year.

And going forward, given that the state um of health care is pretty dire right now under this administration.

Is that policy going to stay in place?

Well, we have we built to the same gates and the same targets in the budget.

My suspicion, and I would defer to the CFO.

I'm guessing we're not going to hit it.

You heard the financial performance thus far halfway through the year, and so it would be uh a non-issue simply because our performance would not warrant any payout of the bonuses.

Thank you.

Certainly.

And the last question was about uh your response to the union cost saving recommendations.

We're open to it.

Um, I recall when that um individual mentioned the ability to get out of the lease, and my direction to the team was let's explore that.

Because if we obviously leases have poison pills, they have clauses that punish you if you break a lease early.

And if that individual who said that, that's a pretty um grand offer.

And if he can help us execute and leave that contract without having to pay an onerous burden, we would be very open to that.

So um, that is what the team has been looking into.

And so the suggestion that we that fell on deaf ears, I think is incorrect.

Thank you.

And um, the cost savings uh in terms of the recommendations are 39 million.

So that certainly seems worth looking into.

Is there a timeline to look into those recommendations given the amount of cost savings?

Well, we we actually have started, I can't tell you a date certain when we would.

We have something called the Center for Organizational Transformation, and those ideas along with all of the others that we've received have gone to that organization, that aspect of our organization for vetting to really determine is there something tangible there that we can take advantage of?

And so we are grateful for that kind of feedback and certainly looking for more.

Okay, thank you.

Yes, thank you.

Um the second area I wanted to uh ask about is around patient care.

And I want to especially thank um a number of the advocates as well as the health care workers who've talked with me individually to help me understand things, and as I also shared with some of you, uh my dad was a doctor and was always getting called off into the emergency room, and so hearing some of the comments today is um it just really resonates in terms of my commitment to work collaboratively with all of you to improve the system.

Um, so in terms of the health advocate program, I am here interested in hearing more about the what the alternatives are.

Um, what I saw was calling 211, and I'm really concerned about that as an alternative.

Um my office had an opportunity to support one of our constituents who knew he who needed a lot of support.

This person uh used the health advocates program when they were at Wilmachan Highland Hospital, and those advocates helped him get onto Medi-Cal and disability.

And knowing the severity of the surgery that he underwent and knowing that he had some compounding issues in terms of his um overall well-being and economic security, it was really life-changing.

And so um, it's hard to imagine that 211 would provide that same level of care.

So I do want to hear a little bit more around what those alternatives are, and maybe I'll just go through my questions before hearing the responses, um, in the interest of time.

The second concern is around the intensive outpatient mental health programs.

And thank you to the folks who came to my office hours over the weekend to help me understand this program better.

I want to hear a little bit more about what the alternative would be.

I did hear that this would be more of a one-on-one alternative when and if these reductions go into place, and knowing that there's about 100 patients right now, how would that work given that March 9th is the date when these reductions are possibly taking effect?

I want to hear a little bit more about how all of that works.

And then I am also concerned about the complex care coordination, but maybe I'll leave my questions at those two.

Thank you for the opportunity to respond to your question.

And I'm concerned as well.

And I'm appreciate hearing the feedback about uh the health advocates program because they do really strong work.

Um, in terms of replacement for the health advocates, as I mentioned in my presentation, there is not an even replacement for the for the work that they do.

And so when I mentioned 211, find help and um other sort of embedded um ways that we provide services to patients kind of within clinics and services, um, it there will be a gap.

Um, so I want to be really transparent about that.

Thank you.

I'm concerned too, but I I want you to know that we also have members in revenue cycle that help to get people on Medi-Cal or on HPAC.

It's not just this one group that does that work.

Oh, it's sorry.

Okay, I've got one more set of comments.

Oh, I am a collage.

Can you hear me?

I'm a primary care provider in our Highland outpatient clinics, and I I'm compelled to speak because these are not just small lapses in care with IOP.

What about the future patients?

I hear we can make plans for the patients that are in the program today, but what about my future referrals?

How are we going to get into them into care?

Secondly, without the health advocates and the complex care workers, I don't have anybody to help me do that.

And that falls on me as the primary care provider, taking care of very complex patients who speak a different language.

I'm there with an interpreter, working with them, trying to get them services.

Our health advocates do more than get people onto Medica.

They help with housing, they help with food, they help patients fill out their IHSS paperwork.

They do so much, they link people to legal care.

I already feel we do not have enough of those services for our patients, and so to hear that there are other places in the community that are going to take our patients is unbelievable to me because I already struggle to get my patients the care they need from everything.

All of these people who speak up, we interface with them as primary care.

And the patients I share with Dr.

Allen in plastic surgery are some of the more most complex patients in this county that he takes care of.

And we share those patients.

It's not just about the trauma center.

People have gunshot wounds that then become chronic wounds, and Dr.

Allen and I manage them and take care of them and help their families.

So I just I feel compelled around this one piece to step out of turns, pardon me, but thank you.

Thank you.

Um, I do appreciate hearing uh hearing that comment and the IOP program is of particular concern to me personally, um, in addition to the complex care and the health advocates.

Uh, but moving on, um, I do think that this is not a problem that the county can solve on our own.

And so just going back to what are the root problems and the longer term solutions.

You know, at the federal level, obviously we know that the elections really matter.

Um I personally support Medicare for all on the statewide level.

I think we need to close the Prop 13 loophole.

And I do want to note uh this has not yet come up at our PAL, our legislation committee, uh, but I did hear the California Association of Public Hospitals is asking the legislature for budget relief.

So uh when we have a chance to have discussion after public comment, I think we have to also make sure we're advocating statewide.

And then um for us locally, I think myself and my colleagues probably have a number of um ideas about how we can partner together.

Excuse me, um, but I do want to ask about potential changes to the NNB to AHS.

What could that potentially look like so that we um are in a better situation as it relates to patient care.

Thank you very much for asking that question.

And the NB for those who don't know is is essentially a line of credit that we carry with the county, and that was um something that was done when we were spun off and it kind of has iterated over the years.

So back from 1998 and forward, and as CFO Miranda showed, it it moves based on when we receive funds.

So we have an obligation to pay back five million dollars a year to drive it down, and we have been successful in driving it down significantly every year by virtue of paying it back, and the projection so that this year will be different because of the pressures that um we have been discussing.

And so what we've talked about on a very preliminary basis is the what can we do to modify the NNB.

And so those conversations, frankly, have been put on the back burner to some extent because of what we're talking about this evening.

But I have had a number of conversations with our county administrator about the idea of revisiting how the NNB is currently structured to create more room.

What you've heard this evening, we are pulling the levers that we can.

We're doing the things that we believe are within our control to try to change our overall cost structure.

There are other opportunities that the county could be of assistance to us and um I am looking forward to having more of those conversations.

But again, I think that because of the urgency of the Belinson process, the reduction force process, the N and B conversations have been um set back a little bit, but I'm very eager and looking forward to having those conversations with the county administrator.

Of course, thank you.

Oh, thank you.

Um, just a couple questions on revenue, then I'll yield to my colleagues.

Um, in terms of collections, um, while you're here, Mr.

Jackson, can you review sort of what the traject trajectory of collections has been?

And in particular, I've heard that other hospitals are able to collect up to 25%.

So I will, but the subject matter expert is our CFO, and so I'm just gonna have her keep me honest and make sure.

But our trend has actually been pretty positive because before Epic was implemented, we were probably anywhere from 16%, 15 and a half, 16%, and we have been every year trending up to where we're at about 19.5% this in a current state.

Um I think it's correct that the the most successful successful organizations are in the low to mid-20s in terms of their collection percentages, but we have consistently been improving.

And so thank you, uh Kim.

So 22, we were at 17 um.6%.

Increased our collections.

Oh, sorry, increase.

Yeah, the change.

Thank you.

The change was 17.6%, and then we increased it by 10% in 23%, 7.1% in 24, and 13.4% in 25.

And the annualization right now is looking at about 3.6.

So this year will not be as successful as the prior years, but it's still trending up.

And so again, the idea that our collections um are not good, I think is factually incorrect.

And the cash collections do continue to outpace the government fee schedules.

Kim, anything you'd add?

Yeah, because 92% of our payer mix is government payers off of fee schedules, we do negotiate with the alliance, but the percentages that are in increases in those fee schedules are usually one in two percent.

We have like way out that.

So I think we're doing a good job.

We don't have the commercial payer mix that's gonna pay 50% of charges.

We have six percent.

We do have some good contracts, we've gotten contracts, we've we're holding those percent charge on trauma, and I I think um that we're doing a very good job.

Okay, while I've got our the CFO here, one more question and then I'll be done.

Um you had mentioned the um VHS payments and potentially restructuring them or expediting them.

Could you talk a little bit about that to help us understand what that could look like and how it might help the budget situation?

Is this the the John George payments from the county?

Yeah, so um uh what I think the withhold at 20% is too much, but I'm not seeing the cash collections that the county is getting.

I'm not seeing the denials that we might be getting, and we fight every denial, and I want to fight every denial that we might be getting for John George to get paid.

And so right now I'm in the blind.

So I would like a rudder, I'd like to make sure that we're collecting everything that we can collect for John George, and that comes, you know, through the county.

So um I mentioned that we were at about uh 72 million back in 23 before Cal A.

Our costs have gone up much more than the contract, which is like 83 million this year.

Um we are losing, I mean, just on our own financial statements at John George, about 15 million a year.

I don't have it with me today, but I can provide those financial statements to you.

Okay, and I would just add to that that um Dr.

Chaudhry and I have been having conversations about that 20% holdback, and so I I don't want to leave it as though the county has been um unwilling to have a conversation about that, and so I would simply say that while we don't fully understand why it's a 20%, I believe that our partners at the county have been open to the idea of having a conversation around that, and so I I just want to acknowledge the collaboration thus far, and that we're hopeful that that can be adjusted um in the near future.

Thank you.

Thank you, Supervisor Marquez.

Um, this opportunity to welcome President Halbert back from a long flight from Washington, D.C.

Um, but we'll start with Supervisor Marquez, then we'll go to Supervisor Miley, and if Supervisor Halbert has questions, I'll yield to him.

Okay, um thank you everyone for being here.

I know it's been a long day, but truly appreciate everyone's um deep engagement and sharing specifically the personal testimonies and how these decisions are directly impacting patients um in Alameda County.

Just for a quick background, um, I've only been in this position for three years.

Um, my number one assignment when I was appointed was to ensure that St.

Rose Hospital did not close.

I care deeply about the entire healthcare ecosystem.

And now Lameda Health System stepped up and they partnered, and now St.

Rose is an independent hospital, an affiliate St.

Rose Hospital of Alameda Health System.

They have um unique provisions regarding SB 1100.

They can draw down federal dollars.

So for me, this conversation, although I'm not too excited about the process, I know this hearing could have potentially happened earlier.

And I feel strongly about good governance, but I do I'm gonna choose to focus on the silver lining here, which is this is a tough conversation we need to have collectively.

So a lot of information has been shared, and I'm confident that we will be able to figure out a path forward.

Also, want to thank my two colleagues.

They asked many questions that I also had on my list of questions.

So I will do my best to bring up questions that have not been asked just to uh streamline the discussion.

Um I believe I heard in the presentation that there were 114 full-time positions added last year.

If that is correct, and if we could just kind of have a rationale of what those positions were and kind of what the thought process was at the time, and fully acknowledging this is pre-HR1.

Yes, we are um running that many more paid FTE year to date this year over last year.

I don't have where those specific um uh increases are tonight.

Um the way it works in a hospital is depending upon um the volume that you have, you're allowed a certain amount of FTE.

So in some cases, we have grown in some areas, and we needed more FTE to provide the care to patients.

So every uh department that sees patients has a unit of service, and that they did that determines how they stab.

We're not perfect.

You know, people may have called somebody in, and then it we may be off of it, but um that's how a hospital works, and in most hospitals, when your volumes go down, you can flex down.

We struggle with that because some of our MOUs don't allow us to do that.

Um so we struggle on that end.

Um, but we do we are working on this right sizing where we have actually um hired consultants, we've looked at how other staff, we know that in total we are overstaffed, but we have not done the work to go in department by department and see wow, what can we do different here?

What can we do different here?

How do we schedule different?

You know, that that's a it's complicated, and we need our union part to do that.

We can't do that on our own.

Okay, um who could speak to the current vacancy rate?

What is that number currently?

HR.

And are any positions currently?

Off and on.

So my question is the vacancy rate and if there are any uh current if there are currently any positions frozen.

There um I don't know what the exact vacancy rate is, Supervisor Marquez, but what I can share with you is we have about 114 positions that we are looking at filling because of critical need and operational need.

Those are currently on hold because of the budget.

We're still looking at the budget.

We also are looking at impacted employees to see if we can fit some of those impacted employees into those positions.

So I don't have the actual number for the vacancy rate, but I'm happy to get that to you.

And then the 211 layoff notices, how many of those positions are represented and how many are unrepresented?

There are approximately 55 to 58 that were unrepresented, and the remaining are represented between the unions that we mentioned earlier.

Okay, and um, trying to see if I have any more questions for you rather than having people go up and down.

Can you elaborate on you had mentioned there have been meetings with um the unions back in November?

Can you kind of elaborate on those discussions?

I know post that meeting, they've uh presented proposals and cost savings.

Did any of that come up in November?

So that did not come up in November.

What happened in November is we realized that the HR1 bill was happening and what our budget was looking like.

And so we thought it was really important to actually meet with the unions to talk to them about the impact and what we were anticipating was going to happen.

And those meetings were held uh November 13th and 14th.

And it was the same meeting, but it was held two different days in order to allow all of our 19 unions to participate.

And we shared information on finances, we shared information on the possible reductions that were going to happen, and we shared information that our uh HR team was dedicated to, making sure that we followed each of the contracts the way they were supposed to be followed, in terms of layoffs and impacts.

Okay, but it was no no discussion about.

We did ask them to partner with us in any cost savings they had to come to us and have a conversation.

We are in impact bargaining right now.

They have brought up some cost-saving measures, which I think um Mark, our COO mentioned that you know have been submitted to the COT team for review.

Okay, and then can you briefly describe?

I'm hearing that there was um some issues with sending layoff notices and putting people on administrative leave and then resending that.

Can you just describe to us what occurred?

So there were so layoff notices were issued December 19th, um, and they were placed on paid leave.

Okay, unrepresented staff were issued layoff notices December 19th, represented originally were scheduled for December 23rd.

However, after we heard from our board of supervisors and our board of trustees and other public officials, we delayed that to January 6th.

There were no layoff notices that were issued December 23rd.

Okay, and can you speak to people being paid put on administrative leave?

So we placed uh there was a decision made to place um our employees on paid leave to allow them time to kind of reset, figure out uh what was next, um, review whatever you know decisions they needed to make or whatever adjustments they needed to make.

That was the reason for placing them on paid leave.

They were placed on paid leave based on the warrant notice for 60 days, and at the end of the 60-day period, that's when the layoffs would become effective because we had uh issued the paid leave notices to our unrepresented December 19th, and we delayed those notices for represented staff to um issue them January 6.

We um made the date effective for everyone, which is March 9th.

Okay, and then when those notices were given out, what was the coordination with the specific departments being impacted in terms of um patient care?

All of the decisions that were made were based off of um our executive leadership team making decisions on how the classifications were going to be done as well as um making sure that the continuity of operations would continue, and so there was a con there were conversations that were had.

I can't tell you specifically which uh, you know, which of our chiefs had conversations with whom, but there was um conversation about workload issues, workload distribution, and continuity of operations continuing.

Okay, thank you.

Um thank you so much.

My next questions are related to behavioral health services.

Um I appreciate the data in terms of how many people are being serviced and what type of care and treatment they need.

But are you able to tell me um how long these patients have been in care?

What's the average?

Is it three months, three years?

I want to have a better understanding of their relationship to the providers, having established rapport.

I know this is very complex population, so if you can just elaborate on the patients that are in the the PHP and an IOP are typically there three to six months and then get stepped down to the wellness program, but many of the patients in the wellness program have been coming on and off for years.

Like if somebody decompensates and gets hospitalized, then we'll catch them if they're at John George and bring them back to the program.

So it's it's been a long-term program.

There are some patients who've been there over 10 years in the wellness program.

Okay.

And it's no secret, this county is grappling with cuts for Prop One.

So we have independent from this tough conversation.

We have many more in the pipeline.

So has there been a conversation with Dr.

Tribble in terms of coordination and coordinating services?

Has there been any touchdown?

That conversation has been started, but it but it hasn't gotten specific yet in terms of uh what we will do for the individual patients.

And it's it's safe to say that if the programs move forward with closing, we'll need to look at that March 9th date because we're going to need to collaborate with the psychiatrists and the clinicians that treat the patients to come up with a reasonable amount of time to refer them to psychiatrists and whatever clinics they work with, etc.

Okay.

Thank you.

I think my last question for now is related to the enhanced care manage uh case management care management.

Um my question is I believe I heard in the presentation that we're not fully maximizing our reimbursement rates.

I just want to have a better understanding.

Can this draw down more Medi-Cal dollars?

We're in the process of optimizing our program so that we can draw down more medical dollars.

Um we provide a very intensive version of ECM, much more intensive than other programs that you might find in the county.

Um we often serve people who might not be able to engage with some of the community clinic uh clinic programs, but I think we're facing a time that we need to optimize and shift.

Do you share a little bit more of a kind of vignettes um personal testimonies to our patients?

Give us a sense of like how long does it take to establish rapport?

Is it three months, six months, two years?

What is medication and treatment compliance look like?

And I know obviously it's it's broad, but it just think of a couple of examples.

Well, I first want to just acknowledge the goal is really the patient's goal, so it's not necessarily medication compliance.

Um so we really center the patient and what what they're interested, so it could be stable housing.

So Michael, okay, uh, could be stable housing or you know, access to repaired familial relationships.

Um, so it I think it ranges in terms of establishing rapport.

Sometimes it takes a long time to establish trust and to have someone, you know, call you back and um trust you enough to engage with their primary care physician or um access services.

Sometimes it's really you know fast.

I think um, you know, we employ strategies like we provide a very, like I mentioned, intensive services where our staff see patients in person.

So we prioritize seeing people at the bedside, so like I can imagine um like one you know situation, someone being in the hospital and feeling really vulnerable because they're really sick, they are symptomatic.

Um, so we really try to strategize and have someone see them in that moment to be able to strategize with them, um a plan for when they discharge from the hospital.

Um I think it's hard for me to think about examples, specific examples.

I know people here can because many members of the team are here tonight, but um we have people who really range um in terms of the the struggles they're experiencing, people who are living, you know, on the street, um, and our staff go out and see them, um, you know, where they're staying, um, which is on the street or in a shelter.

Uh we have people who are so symptomatic uh with their medical symptoms that it's hard for them to leave their houses.

And so we do home visits, um, sometimes people who have serious mental illness, and so those those symptoms are preventing them from connecting with the services that they need because they're scared, they're um paranoid, worried.

So those are just some like general kind of examples.

And I would say that some of the strengths of the team is being able to partner with other folks in the system to build a comprehensive plan.

I'm not sure if that's what you're looking for.

That's very helpful.

Thank you.

And does the patient have the ability to ask for a change and uh care manager, case manager if it's not a good fit?

Does that happen frequently?

Okay, thank you.

I need to make a logistical announcements for those that are parked in the alcal parking lot.

You have 10 minutes to move your car because the alcohol parking lot closes at seven o'clock.

Are those, is there anyone here parked in the alcohol parking lot?

Okay.

Looks like you're all safe.

Supervisor Miley.

I think I have a time.

I'm sorry.

I appreciate that.

Can you do it?

Can you do it during your public comment?

Thank you.

Yes, I'll try to be uh brief and uh succinct uh because we have about 300 people still online and folks in the audience, and we haven't heard public uh testimony yet, and my three colleagues have answered or asked some great questions.

Um, and uh we've gotten a lot on the record, and it's helped to clarify various matters.

Um, having you know, chaired the health committee.

I've heard some of this through the health committee, and I've had some meetings with folks uh over the course of the last uh month or so as well.

Um, but even today I've gotten new information and further clarification because I do think um there seems to be a disconnect uh between what AHS uh executive team uh uh has decided to do and what we're hearing from uh the folks who are on the front lines delivering the services of the ranking five.

And I want to pick up on something that Supervisor uh Bass and Marquez mentioned, the whole need, and it came up too today, the whole need for uh collaboration around these um tough challenges uh that we're facing, and I don't think there's been the need, I don't think there's been the type of collaboration uh that is required.

Um we're here today with this villains and hearing so we can hear all these matters and the the five of us can figure out what we want to do.

So I don't want to prolong because I we've heard a lot, but I do want to say just one thing.

Uh it it I know folks who are on the board of trustees.

Uh some of them actually work for the county in the past, and then I also know people know that Alameda County is Labor County, so we need to get this right.

That's all I need to say for now.

Uh we'll have deliberations, but I want to hear from the speaker from the audience.

Okay.

President Halbert, do you have any burning comments?

We've got about 30 minutes of uh dialogue and comments.

Before I open public comment.

No, I don't.

I do want to apologize for arriving late.

I was up at five o'clock DC time to catch an early flight that was delayed by five hours.

I was listening in on the BART ride from SFO, the BART ride is wonderful experience, but it does have some spots where you can't quite hear as well.

But I did get a lot, uh, starting with the presentation from uh uh AHS and then the presentation from SEIU and the the speakers that have already spoken.

I want to thank my colleagues for the questions they've asked um because they were very good ones.

It's very clear this is these are complex issues.

Complex.

They're not easy.

We have very passionate people to serve those in need.

Passionate people that serve those in need all day, every day.

I see them in the purple shirts, but passionate people here that are leading AHS, they do care about people.

And I know that it's a matter of coming together and collaborating.

Supervisor Miley, I think you're right.

It's a yes, there is, no, there isn't.

Yes, there is, no, there isn't.

We're getting conflict there.

We have to continue to collaborate together.

And I don't think we're going to solve this tonight, but we will get very close to doing that.

I will say what I believe in.

And I'll echo comments from my colleagues earlier today.

Health care is a human right.

No doubt about that.

Cuts to health care hurt people, and people will suffer if there are cuts.

And then suffering also costs money.

People deteriorate, pay me now or pay it later.

And so I'd rather alleviate the suffering, help people before they deteriorate.

And I was really interested to hear the only question that I have that hasn't been asked, and again, my colleagues did a great job.

I heard, and it's never really occurred to me, people that are in our hospitals are helping refer clients to legal assistance, refer clients to filling out forms for IHSS.

Who spoke about that?

And can you come back up?

And I do want to understand that better.

And I I want to understand it from a better system-wide perspective.

Because if there are ways where we can maybe continue to do more of that, but fund it and take the funding that we do elsewhere and bring it in here.

So help me understand that.

And I put that information into my patient's chart for them to take home and talk with their family members to help them apply for IHSS.

I do not have social workers in my clinic to support with that work.

So if that is not done by me, it is not done.

I have patients who do not speak English and are not able to complete that form on their own.

Actually, I think some of our interpreters were here earlier.

One of our interpreters personally helped a patient get on to IHSS because I implored her to help me with that.

So our patients uh don't always have the capacity to be given a website and information to do that.

Same with legal services.

People are often facing eviction.

They are facing uh immigration issues.

They are facing domestic violence concerns and all of those concerns.

Um they do not know how to access care.

I spend time Googling to find the right language, the right resource for patients.

Um, I do utilize the county resources that are available.

Alameda Alliance has has good resources.

I utilize our our we have a healthy elders program that I utilize those nurses as well.

Um, so this isn't just an island.

We have primary care clinics that span across the county, right?

We have Hayward, Eastmont, and um, what's the other?

Newer, thank you.

And the it's similar in all of these clinics in terms of the resources that the providers are giving to the patients to help support them in their care because we recognize that without help at home, people cannot take their medications regularly.

Without help at home, they cannot get to their appointments on time, they cannot eat, they don't have food.

Food is another issue.

I spent with just just this week, I spent time with my team trying to locate food for a hungry patient in clinic.

That's what I did with my time.

Do you feel connected to those services that we have that also do that?

Um, we have many, many, many sources of food.

If you don't know what they are, we need to connect you to them.

So, yes, I mean, I am aware through 211.

I am aware through our our Find Me app.

Somebody applied to uh referred to going online and getting that information.

What I find is that my patients are not able to utilize those resources.

It's not that I don't know about the resources, I do know about them.

Food banks in their local neighborhood, they often know about, but then beyond that, how to get on to CalFresh, for example, they don't necessarily have that information.

No, very good.

I appreciate that.

Um and I I ask these questions because um healthcare is at the center of a holistic system, and there are breakdowns outside of AHS that are happening that we need to find a way to fix.

Um I'll stop by just saying I don't think this is going to be solved tonight.

I think I heard from AHS, you're open to continued collaboration, you're open to continued dialogue.

We will um find the solutions for uh our that will best fit us together.

Uh, when we do, I hope that we based on what I heard earlier that we maximize revenues.

I heard that we're in the process of let's get that done, maximize revenue, streamline operations, i.e.

reduce costs, but I think we're gonna have to we should be prioritizing cuts that keep away as much as possible from people's jobs, people have to work, people need to make a living, they need to serve our community.

That doesn't mean we won't have any.

Sometimes it has to happen.

I hope we never have to lay anybody off, but we're gonna do it by after maximizing revenues, reducing costs.

We'll do it together, and um I that's all I have to say.

Thank you.

Thank you.

So at this point, I have 115 speakers, 10 online, seven in the overflow room.

We have some 11 online.

We have some clients that outpatient side services.

Uh are um we're waiting to speak actually.

That would okay.

Can you identify them and and have them uh all online?

Online.

Okay, let's um, supervisor miley.

Yes, madam chair.

Seeing as it's seven o'clock, we've got over 100 speakers.

I know you said earlier they get two minutes.

Can we reduce it to a minute?

Is that okay?

Yes.

Let's can we have a maximum of an hour?

We're gonna have a lot of comments, but well, I I've got a seven o'clock hard stop.

I can stay longer, but how long are we gonna stay here?

You're at seven o'clock now.

I know I'm gonna go after, but my hard stops gonna be an up yard.

How I guess there should be a time limit, I think, by which we would.

Right.

We we allocated uh an hour and a half in the beginning, and we had allocated two minutes, but we encourage people, they didn't have to use the entire two minutes.

But at this point, given the lateness of the hour, let's try to have the comments concluded in one minute and in with a hard stop of 8 30.

Let's get started.

Okay, we are not completely I have to call you.

I have to call you first.

I will need to talk.

So, you know, you're not okay.

Uh, I'm just saying it's not in focus.

Um, so we will continue because uh of the lateness of the hour.

Um I want to be mindful of the fact that we had uh set out um some parameters in which the speakers will be speaking, and I think we need to respect that because that was the expectation at the beginning.

So let's start with the speaker slips that were submitted, and then let's have five speakers in house, and then we'll go five online and then alternate until we are completed.

What about the clients here?

We're just at the mic.

They're gonna they're online.

So we'll call the first five speakers.

We'll call the first five five speakers in chambers.

Once you hear your name, please approach the podium in the order in which your name is called.

Please state your name for the record.

You'll have one minute to speak.

Maria Bentoncourt, Ina Davis, Doug Jones, Sochil Henninger, and Sue Chan.

Please line up.

As your name is called, please just come to the middle of the aisle so that we can move through some of the speakers and be helpful in trying to make sure everyone is heard.

Maria Bentoncourt.

Let's go out of order.

Ina Davis.

Good evening, uh Board of Supervisors.

My name is Ina Davis.

I am a nighttime bed controller at Highland Hospital.

Also a member of SEIU 1021.

And I just wanted to say that Highland is an adult level one trauma center in the East Bay.

This designation is not symbolic.

It presents a commitment and responsibility to our community.

Every night patients arrive in critical conditions, often during the most vulnerable moments of their lives.

The system that supports their care must be fully operational at all hours.

Eliminating bed control at night does not alliance with the line of urgency, coordination, and compassion of our patients.

Bed control is not simply an administration function, it is central to patient flow and safety.

Throughout the night, we maintain continuous communication with the emergency department and unit charge nurses often every 10 minutes to ensure patients are placed as quickly and safely as possible.

Thank you.

Hello, my name is Sochi Haninger, and I am a nurse with the complex care program.

There's been many questions related to our program.

Um our program actually falls under the umbrella of community health, which includes health advocates.

Our patients, our team, excuse me, supports some of the highest medical and social needs individuals living with serious mental illness, substance use disorders, cognitive impairment, and homelessness.

These are patients who cannot safely navigate the health care system on their own.

We provide intensive hands-on care coordination, and I mean by hands-on, we go to patients' homes, we go to encampments, we find them where they are at, we connect patients to medications, primary and specialty care, behavioral health service, and essential support social supports as you heard.

Oh no, for money, I think we's your maintainment.

Sorry.

Doug Jones and Sue Chan.

Uh Doug Jones organizer, SCIU United Healthcare Workers.

We represent hundreds of workers at Alameda Hospital in the HS system, and we oppose any cuts at any of the uh AHS hospitals.

Uh, in order to address the revenue losses, AHS current current directly projects in federal revenue.

We've asked AHS to partner with us on two campaigns.

The biggest one is the Billionaire Tax Act, our SEIU locals ballot initiative, which proposes to create a 5% wealth tax on the state's 215 billionaires, which would bring in the 100 billion dollars in revenue over the next five years that would alleviate the federal cuts.

This would preclude the need to massively cut jobs and services at AHS.

We've asked AHS management to bring a resolution to their trustees meeting in March so that the system could establish official support for the Billionaires Tax Act as the Eden Health District has already done.

And we hope that the Board of Supervisors can also consider a resolution now that four of the five supervisors are endorsers of the Billionaire Tax Act.

So these things would show management is working in true good faith to solve the budgetary challenges that we agree existing.

Thank you for your comment.

Your time's up.

And we um developed a uh county community coalition that pushed back against the services that were being cut.

The county said I couldn't afford it.

Thank you for your time, your comment.

Thank you.

Hello, my name is Maria Beck.

I'm sorry.

Maria.

She was called earlier.

She was called.

Hello, my name is Maria Betancourt.

I'm a specialist clerk at John George Psychiatric Hospital.

On January 6th, like hundreds of other employees, I received a notice from AHS stating that they intended to eliminate my position and lay me off.

As a specialist clerk at the front lobby of John George, I often help to greet and comfort families who are seeking information about loved ones with serious psychological issues.

I received calls asking about daughters and sons experience experiencing psychiatric breaks, chemical dependency, severe depression, and some who are suicidal.

I'm proud to place a small part in our safety net system, but since both of the front desks at John George receive layoff notices, that places us that placed us on an immediate paid leave.

Patients' family seeking help have been abandoned.

Little things like having someone to greet you at the front desk and answer your questions are the sorts of things that patients on private insurances would expect without question.

But for some reason, AHS feels comfortable abandoning patients in our public health system.

AHS does not believe poor people deserve to be treated with compassion.

In addition to being a specialist clerk, I was recently elected to president of SCIU Alameda Health Systems.

I'm proud to take this leadership role at a difficult time.

While we are busy supporting patients, we expect AHS management to support us, but instead, these boos have failed to do the very thing that they should do to help us with these.

Thank you for your comment.

Thank you.

And Shane Peter, anybody who showed up today to tell the board to stop these cuts.

Yes.

Go ahead, Greg.

Tell me.

Caller, you're on the line.

Ray, you have one minute to speed.

Yes, my name is uh Raymond.

Uh I've been to the uh Fairmont Alpatian Psychiatric program.

Probably went on 22 years.

I've suffered from bipolar illness, uh, which is basically a lifetime war to deal with um it's an illness that's I've found that the structure immense the beneficial groups that provide much needed coping skills and overall safety of this top notch program are excellent.

I have stayed out of the psychiatric hospital because of it.

Friendships here, I have made clients with clients, staff, therapists, something you cannot receive elsewhere.

Short, if you close this institution of mental health learning, and yes, it's like a school, you'll put people in psychiatric hospital.

Shannon, you're on the line.

You have one minute.

Hi, my name is Shannon Hinden.

I am a long-term client of the Fairmont Behavioral Health System.

Um I have been with the Fairmont program for going on 20 something years.

And for me, this is a lifeline.

Um without Fairmont, uh it gives me structure.

Uh, it gives me purpose.

Uh, it has given me the um self-esteem and and you know the things that I need to be able to go on and share my message with other people, you know.

It Fairmont has brought me to the outside world where I can be of good use to someone else.

Um I think you're putting a lot of people in serious risk if we close this program.

Um I've heard a number of people say that this program has saved their life.

Um I've heard people say that it has made them a better person.

So I I strongly believe that we'd be at risk if it closes.

Thank you for your comments.

Alicia, you're on the line.

You have one minute.

Please unmute your mic.

Lisa Hobson, you're on the line, you have one minute.

My name is Alicia Koenig from Paramount PHP IOP program.

As someone with bipolar disorder, this program helps me get through day-to-day life, provides a safe, supportive, and genuinely caring community of amazing therapists and clients that have rooted for my growth and therapeutic healing and stability for the last two years that I've been here.

The group therapy has helped me process grief, work through trauma, develop spiritually, taught me coping tools, um, and set boundaries with abusive family members.

Most of all this program has helped me stay.

Thank you for your comment.

Alicia, well, you're on the line.

You have one minute.

Please unmute the last speaker is still speaking.

Can you hear me and can you hear her, please?

We can hear you, Alicia.

I think I think you heard the last speaker up until the last 20 seconds or so.

Would it be possible for her to finish her last 20 seconds, please?

This community shares in tears of struggle and enjoys a breakthrough as we lift each other up every day like family.

This place is fundamental, essential, and central to my livelihood and many others.

This is about care and healing through community that is irreplaceable.

Please consider this before you take it away.

Thank you very much.

Thank you.

Thank you.

Um can you please hear me?

Yes, we can hear you.

Okay, thank you for um working with us.

We've been working with a lot of technological issues.

I appreciate it.

And yeah, in all honesty, I had something completely written down to begin with.

And then as I've just been hearing the speakers, I just can't help but to notice that administrator, administrator, says essentially that you know there's no problem.

Um you can slash our budgets or close our programs, and get an equal or perfectly health care.

And then at the same time, I hear the physicians saying pretty much the opposite thing.

And so why is it that people who work in the same department experience such opposite realities and predict such opposite outcomes?

And you know, clearly it's because there's two different roles.

Um physicians have the role to save lives.

They're time's up.

Thank you for your comments.

Well now go to the TEC room.

Five speakers from the TCO reflect room.

Casey Kettering, Michael Martinez, Alison Renroe, Sanite Saleh, out by Agos.

Alison Monroe here with FASME.

I had a daughter with serious mental illness who overdosed a couple years ago.

I oppose cuts to programs that serve the seriously mentally ill.

Um I start out opposing them because the people who need these programs the most are not effectively placed to advocate for.

So many misunderstandings and boo-boos can be made with that.

You don't have to try and come back tomorrow with your loved one because you may never come back.

And I oppose cuts at John George for people who answer questions because I used to go there.

My daughter was there 15 or 20 times, and I would bug the crap out of them with questions.

Is she here?

Where is she?

Can I see her today?

Can I see her tonight?

Can I talk to a nurse?

Did the doctor get my fax?

Where are you gonna discharge her to?

Is that a safe place?

I'm here and she's not here.

Where did she go?

Who said she should go?

Why is she not here?

Blah blah blah.

You know, it would be good to have a person at the desk to answer these questions.

It's very important.

Thank you very much.

Hi, good afternoon.

My name is Sanait.

And as an interpreter, I have work.

What?

Okay.

Hi, my name is Sennai, and uh I'm interpreter.

Uh as an interpreter, I have worked with the old departments and the I'm speaking in behalf of the our community, the Eritrean and Ethiopian community, and the services that they're about to be cut is they're very essential for our community, uh, especially the health advocate and the uh complex care, our community, especially our seniors.

They totally rely on them.

And uh I'm very very concerned and to uh really to continue get the services, advocate interpreter, and transportation, and uh resources and on social aspects.

Thank you.

Hi, my name is Michael Martinez.

I am a complex care case manager, SAN, which means I'm not benefited, so in a way that's good because that means I wasn't laid off.

But um, you know, I'm walking around with a broken crown and need an EKG and can't get that done, unlike everybody from the supervisor sitting there to everyone in the C-suite and so forth and so on.

Um, even though I work for complex care as a case manager, I'm gonna have to hit three different triangles here.

I cannot believe for a moment that the health advocate department is being shut down.

How well are the people who are supposed to be the bean counters supposed to be when half of the people that work there are future doctors working for free that I buy snacks for so that they don't faint.

We helped over 3,000 people.

These are people that might not be able to go into the ED.

I don't understand what's going on here at all.

Maybe the thing that happened in 1998 where the trustees were given power, maybe that needs to go back to the supervisors now.

Casey Kettering, um by August.

Okay.

Next two will be Diana Lawton and Jody Huang.

I'm Diana Lawton.

I'm a licensed marriage family therapist at uh Fairmont.

In the Intensive Outpatient Program.

Um I'm actually gonna quote from an article, an op-ed that came out yesterday by a former journalist who's now a mental health person, who was one of our colleagues not long ago.

Um I'm quoting just a tiny bit of this.

The intensive outpatient programs at Highland and Fairmont hospitals serve a vital need in our community.

They ensure that individuals with chronic mental health conditions who require consistent treatment receive the necessary support they need to maintain stability.

Access to consistent treatment greatly reduces their likelihood of inpatient hospitalization, homelessness, and incarceration.

For individuals struggling with chronic acute mental illness, the consequences of closing these programs would be devastating, they would find themselves suddenly without the consistent support of a therapy team to get your time.

Adriana Martinez.

Buenas noches a todos.

My nombre Rosael Bia Soto Estrada.

Estoy aquí para pedirles que nos lleven el grupo del hospital Highlander.

Hello, my name is Maria.

I'm here to ask you to not close the group program at Highland in the psychiatric program.

I and my other call.

Patients really need the service.

I really need the service.

I am survivor of human trafficking.

My son was killed.

When I arrived to the group, I arrived with my soul and my life in pieces.

I came with a broken heart, and the people that work, they they helped me.

They helped me regain my life and live differently.

A respect that means so much to me.

But I am asking you in your hands it is the future of all of us, and my future.

Back in 2020, the Board of Supervisors asked the Board of Trustees to turn in their resignations.

And because I've been to several four or five board of trustees meetings, and the doctors are crying, pleading, begging, and they just sit there stoic, like they got hearts stone, and it's just to me it's hard to see, hard to watch.

So let's go back to 2020 and do it again.

I'd like to speak freely.

Uh the way I the way I figure it.

Do you have to seize your word of seizures?

There's gonna be some sacrifices.

Jesus sacrificed his life.

We have to help the middle class that is been destroyed already and they they know how to work.

Suicide is the psychiatrist is the highest percentage of suicides in the professions.

I've been suicidal.

We're select group.

And I pray that uh the providentialism has some say so in the matters of salvation of our souls.

Veronica Perez.

Craig Metz.

I'm sorry, I guess speak in English as second language, and I'm very nervous, and I'm gonna let my colleague finish her statement from earlier.

All I wanted to say was that the closure of C, well, the reduction of CCM and the closure of health advocates is an an inequity to our patients.

Our program provides so many support services, and we help with transportation, and I just feel like it's a disservice to our community to not only get rid of health advocates completely, but to reduce our program and of a complex care.

The only thing necessary for the triumph of evil is for good men to do nothing, for the humans to do nothing, for good supervisors to do nothing.

Today you have to respond to Trump's dastardly deeds.

Dastardly with a D.

Look it up if you don't know it.

I've been providing case management at Hayward Wellness Center for the past eight and a half years to the top three to five percent utilizers of who you don't who spend 50 to 60 percent of health resources.

I was ready for a two-minute speech, and I was gonna think your time is up.

Hi, my name is Craig Metz.

I'm the clinical manager at outpatient behavioral health at Vermont Hospital.

Um I had a lot to say, but I'll just focus on that.

There really isn't good places for our clients to go, and they're sort of acknowledging that.

Um we've talked with the IOP programs at Herrick, Lahaim, and Fremont, they mostly don't take Medicare clients, which is all of our clients.

Um they don't have the capacity, they're short-term, they don't do transportation, they don't do lunch.

Um the county is closing five out of its six wellness centers, which aren't treatment centers and aren't appropriate for um high acuity clients anyway, but they're closing services that um just trying to think, and then and then the other only other thing the county offers is case management, which is great, but it's not treatment.

There really isn't a place for our clients to go.

Um so thank you very much.

Call you on the line, Jordan, you have one minute.

Uh yeah, uh one minute.

My name is Jordan.

I have been working in community mental health for 15 years.

I've been working at the Fairmont IOP program for nine years.

Uh real briefly to touch on the finances.

When we found out in November that our program might be on the chopping block, uh prior to that, we were told that we should never worry about our finances, that mental health always loses money, so just don't focus on it, even though we had ideas to make sure that we were actually in the black and we've been in the black before.

Once we've learned that we have a document, hopefully you should all see uh somewhere that shows that with recent inflammation implementations, we changed the 2.1 million deficit for our program to only 600,000 just with our current population, and we anticipate that actually going into the black with this submoder increase in seeing people, but the most important thing is this is a community.

These people have been in treatment in and out of treatment for years, and this is their community and their home.

Thank you.

Your time is up, Jordan.

Tanya, you're on the line.

Yes, my name is Tanya.

I'm a lab assistant too at Highland Hospital.

I just want to say that what the CLO Mark stated about the blood cultures.

He has no clue what he's talking about.

He does not specialize in the laboratory.

He does not specialize in being a scientist or running them tests.

He doesn't understand how serious that is.

And for him to make that statement and then shake his head when one of the scientists came back up to explain it.

This just shows the lack of the just compassion for the patients, for the staff, just the hospital overall.

And I please ask the board of supervisors to talk to these uh CEOs and everything.

And it's time for you guys to take over and have them retire because they clearly don't know what they're doing.

Please stop the layoffs.

Peter, you're on the line.

You have one minute.

Oh, hello.

Can you hear me?

Yes.

Okay, great.

Hi, this is Dr.

Freed.

I'm the manager of the outpatient behavioral health at Fairmont.

Just want to make a few points.

Uh I really agree with the president, the Board of Supervisors and saying that we need to take a uh a closer look, step back, and look at some of this information.

There's been a lot of disagreements about our budget and where our patients are going.

And we have been actually asking our department leadership for a meeting to talk about this for months and have not been able to sit down to go over the specifics of our budget, which we disagree with.

Never had a budget in the red, um, in the in the 20 years that I've been involved in in budgets, and our patients that they've already mentioned can't go any place in the community.

So, you know, we would like to sit down and work out a way to support our patients and support our staff and avoid layoffs.

Thank you.

Brianna, you're on the line.

You have one minute.

Um, um, thank you, Board of Supervisors, um, and everyone who has spoken.

My name is Brianna Wallace.

I am a parent living in District 3.

I am also a Medi-Cal recipient.

Um, I'm speaking as a mother today.

Um, these these cuts to Alameda Health System are not just numbers on a page, they actually impact uh my son and families like mine in real immediate ways.

So when over 250 health care workers are being laid off, it actually means longer weights, fewer services, and more uncertainty for parents who are already carrying so much, like myself and just other individuals as well.

Um, so Board of Supervisors, I'm asking you to lead with both responsibility and heart.

Please stop these cuts and restore the resources.

Without them, we will see more harm and more loss in the very communities you were elected to protect.

So these decisions um are clearly being made without the meaningful input of the frontline workers.

So please just stop the cuts.

Um, and protect our families.

Thank you.

You're on the line.

You have one minute.

Thank you.

Hello, Board of Supervisors.

My name is Peggy Raman.

I'm speaking as the president of the National Alliance of Mental Illness Alamana County affiliate.

We serve West Alameda County, Oakland through Fremont.

Nami Alameda County has been proudly endorsed the care for and jail slash initiative.

These cuts at the to the AHAs will severely impact Alameda County well beyond Alameda Healthcare.

The corollary to Benjamin Franklin's announcement prevention is worth a pound of cure.

Could be take too many pounds of flesh and the loss will be irreparable.

The proposed cuts to Alameda County Health System will impact the county budget and local budgets, will cost more in the long run.

The Board of Supervisors was elected to take fiscal responsibility to the citizens of Alameda County, so you must help manage its crisis.

Please engage in fiscal responsibility and work with AHS and the employees to manage the impact of the big beautiful bill is having on mental health care in our community.

Thank you.

Your time is up.

Well now go to the TEC for the next five speakers.

Nicholas Flores, Alberto Para, Marcus Garcia, Greg Lee, Gregory Mosley, and C.

Landry Landry.

Hola, my number is Alberto Parra, so resident of District 3, member of ASE.

StoyPorke System de la MEDA no is solo ungasto presupuestario, sino sustenta de nuestras familias y vecinos.

No solo is equilibrando un presupuestario, sino que está haciendo un agujero in la red securidad to protege a nuestras familias hispanas e the classes trabajador vulnerables.

Hola, my name is Nicolas Flores.

Stoy again.

Sanaran nos mandemos unidos para maintenir el sistema de salud de Alameda Abierto Con personal y listo para servir.

Gracias.

Hello, my name is Marcus, and I reside in District 5, and I'm an organizer with A.

I am here today as a microphone for the neighbors I've spoken with over the last few weeks.

I've sat with seniors in East Oakland who are terrified that a budget adjustment means that they'll lose the care that keeps them alive.

These aren't just statistics, these are human lives.

We are already seeing the safety net fray with overflowing ERs and unstopped shifts.

To management, these are efficiencies to our working class families, these are death sentences.

AHS management must understand these cuts will not heal.

They will bleed this community dry.

I'm here demanding that you postpone these day layoffs immediately.

Stop treating our health care like a luxury and start treating it like the lifeline it is.

Work with us, work with labor, and solve the budget crisis crisis without sacrificing our people.

We are ready to fight to keep Alameda Healthcare system open and fully stopped.

Thank you.

Um good um good evening.

Uh my name is Cynthia Landry.

Um I'm the Vice President of Services for Alameda County Social Services, a sister organization that uh utilizes the services at um Alameda Health System.

Um I'm a social worker three who works primarily with the general assistance, unhoused uh population, assessing for employability and barriers to uh employment, which includes physical and mental health um issues.

Many of my clients utilize the services at Alameda Health Systems, and I also request medical verifications from their providers so clients can continue to receive their uh general assistance um benefits.

I asked the board to consider the impacts of cuts both to staff and the communities we serve in Alameda County, and once a system is broken.

Thank you for your comments and time, Chip Freen, Drew Scott, Chelsea DeMarte, Lydia Apple, and Parisa Farrol.

Please come to the podium.

My name is Drew Scott.

I'm a full-time therapist at the Fairmont Intensive Outpatient Program.

I'm here because on March 9th, HS plans to close our program.

And our program's a lifeline.

It provides consistent structured treatment to clients who are severely mentally ill, keeping them out of overcrowded psychiatric units, homelessness in Santa Rita jail.

Many of our clients tell us plainly that this program saved their life.

For many of our clients, it's a place they feel safe, valued, and understood.

For many, it's where they go to celebrate the holidays because they don't have anywhere else to go.

One of my clients said it that she said that if the program were to close, then I won't have anywhere to go.

And if I don't have anywhere to go, I'll be at home in my board and care all day.

If I'm at home all day, I'll be in bed all day.

And if I'm in bed all day, I'll be isolating my symptoms will get worse and worse, and I'll end up back in the psychiatric hospital.

This isn't care, this is abandonment.

And so we're urging the board to do the right thing.

Work with us to find real solutions and protect our Fairmont IOP program.

Cuts don't heal care does.

Thank you.

My name is Charles CD Marty.

I've been with outpatient behavioral health for 16 years as a therapist.

So the referral sources that AHS proposed for our patients are really unrealistic because in reality our patients will face significant barriers to even accessing them.

And because of their poverty and their disease severity.

So we've already talked about the transportation issue to other IOP programs.

That's a barrier for them.

Let's say they're given the phone number to call Alameda County Behavioral Health Access Line.

Many of them don't have telephones to call.

Others cannot make that phone call because of their symptoms, and they have no one to help them.

And if they ask to be referred out to an IOP PHP program, they will be told the county does not refer out to IOP PHP, and that all any of the wellness centers left in the county only have peer-led groups.

They do not have clinicians running the groups like we do at our program.

This cannot compare to the way that we recruit people from John George, transport them to us and keep them for years stable in our program.

Please stop these cuts.

There is a better way.

Please work with us.

Hello, my name is Lydia Apple.

I'm a therapist at Fairmont Outpatient Services.

I've been working in the community, providing direct service to folks for the last 20 years in different capacities.

And I want to speak specifically to what's been said about where patients, our patients and other patients with mental health issues will go once they once the program closes.

So in my experience, when I was a direct service case manager at lifelong medical care, I worked with chronically homeless people in Berkeley.

We tried to connect them with mental health services continuously, people who are high utilizers of the system, and often we wouldn't be able to find anything.

Saucil Creek, various island would provide services, but not enough.

I also worked at um Fremont Hospital, and I want to say we did not accept people who had um medical and Barely Medicare that we were prioritizing people with high time is uh insurance.

Hello, thank you for hearing us.

My name is Parisa Farrohe.

I also work at the outpatient psychiatric services, and I've been there for 24 years.

One of the reasons that I've been there because it's a job that I don't get burned out at because I see folks coming out of the hospital and they get um their coping skills, they have a community, so they don't go back.

We help a lot of folks that are coming out of the hospital and we keep them out of the hospital.

And we um uh I just want to say that as um with my coworkers, we um have been problem solving throughout the years these years to get the needs of our clients met during COVID.

We went to everybody's houses and we gave them tablets because they were isolated.

So we know how to problem solve as frontline workers.

If the management was talking to us, we would we would be able to tell them how to meet meet the needs of the community that the most uh vulnerable people.

So please we want to green, chip freen, Sandra Marshall.

Maria Hopper.

Lucy Cole.

Hello, my name is Marie Hupper, and I am one of the intensive outpatient program therapists, and I'm here to say that we want to help.

We don't want to just um stay the way we are and say this is the only way we can provide services.

If Alameda Health System will work with us, we will work with them.

We want to make sure that we are meeting the needs of the community first and foremost, and if there is something um information that uh they can provide us with that will help us do a better job, we want to listen.

We would also like to be heard about all the ways that we can contribute to solving the the needs uh and the problems for mental health in Alameda Health System.

We have already added groups we are extending to try and cover more substance use needs.

We have other ideas about how to market our programs, how to reach more people.

We have been trying to network more in the communities.

We only need Alameda Health System to work with us, instead of close us.

Thank you.

Um rich deep program that can serve people with schizophrenia all the way to people with a major depression, uh PTSD.

They have very different needs, but we have come up with these amazing different treatment modalities, and not only that, they have come together as the most amazing human healing community, and this healing community.

You were talking about attachment issues, will be heartbroken, completely heartbroken to not have the resources here.

Tribble, we can't work with Triple because the people that work for her refer to us, the caseworkers, the psychiatrists, the wellness centers, the full service, they refer to us and we partner with them.

Um young, one man who came in with us.

We have time is up with them for your comments.

Okay, but thank you.

Please keep us open, essential continuum.

You're on the line, you have one minute.

Caller, you're on the line.

Please unmute.

If you're on the line, you have one minute.

Good evening, supervisors.

My name is Navjot Tatla.

I'm here because these proposed cuts at Alameda Health System are not just program reductions, they are the quite erasing of the people who depend on us the most.

These cuts target patients who are already fighting every day to stay stable, safe, and connected to care.

And the consequences won't just be human.

They will be financial.

Medicare won't reimburse for bed sores or hospital-acquired infections.

Early discharges lead to readmissions.

Also not reimbursed.

Lawsuits will rise.

These cuts don't even make fiscal sense.

We live in one of the richest counties in nation.

If we, a progressive community, cannot protect our most vulnerable, we set a dangerous precedent that others will follow.

This is not the time to take the easy route.

It's the time to use every tool and every partnership to solve budget challenges without abandoning the people who rely on us.

People look to us for leadership.

What you do here becomes the example the rest will follow.

This is the moment to leave.

Thank you.

Jack Lingwist, Chris Middle, Kim Clark, Donna Savio, Michael McAdu.

Hello everyone.

My name is Jack Linquist, and I'm a full-time therapist at the Fairmont Iope Clinic.

I've had many clients tell me that this program has saved their lives, which I believe to be true.

I also believe that the elimination of this program would have the opposite effect.

It would cause unnecessary death and suffering to many of our most vulnerable patients that have nowhere else to go.

Many of the patients consider this program their family.

Having to look at each patient in the eyes and tell them that they're on their own is an incredibly cruel and unethical prospect.

At the Board of Trustees meeting where closing our program were discussed.

It was stated repeatedly how valuable this program is for the Kennedy.

I urge you to reconsider these cuts.

They are both morally and financially wrong.

You have the ability to do the right thing.

My peers couldn't be here tonight because some of them don't function like as well as I do.

I want you to really consider what you're gonna do because I've been at Cream and they do not have the program that PHP has an IOP.

And Elsa Marquez, if you want to meet later and ask me some questions personally that we can ask, I'd be willing to happily answer them.

That was real powerful.

Um hello, supervisors.

My name is Michael McAdoo.

I am the manager of outpatient psychic services at Highland Hospital.

And I'm gonna go off script a little bit, but um I want to say both Fairmont as well as Highland has been a beacon of light for the patients who have severe and um moderate mental health issues in Albany County for over 30 years.

Um we are the only comprehensive program uh in the county, and we should not close it.

Um all we're asking for you us is to work with I'm gonna talk about finances and I'm speaking to Alvieta as well for the board of supervisors.

Say finances, both programs were terrified with a 4.5 million dollar uh overhead.

Thank you.

Donna Thebrew.

Thank you.

You're not here.

Cynthia Harris, Greg Denny, Donna Thibou, Valentine Ilior, Patrick Topastio.

Hello, my name is Cynthia Harris.

I am a registered nurse at Highland Hospital and a proud member of SCIU 1021.

I would like to say, as a person who's been at the bargaining table with AHS, I we do understand the HR1 cuts.

The problem is AHS is not managing this well at all.

We have told them since December that they can get rid of the C-suites, and they're saying they're taking it under consideration.

How long does it take to break a lease?

Seriously.

If it could save five jobs, it's worth it.

They're not managing this well, they're not doing it well, and that's why the people are suffering.

These cuts won't heal.

My name is Patrick DePassian on this program.

It's been my man.

And if you causes, I'm gonna be to be state.

I need this to keep me calling me.

You gonna cause a bad thing that cuts my hurting so bad.

That's all I gotta be said.

My name is Valentine.

In the month of thought, I'm asking you to consider our program.

Outpatient services at Highland Hospital.

I have been attending Highland for now 11 years and have not been in the hospital for bipolar one.

I also have been refrained from being called a battered woman by being a part of peers.

Well, I learned how to advocate for myself.

How to advocate and avoid stigma.

Our program is a program of the heart.

It helps us to realize there are much more options than hospitalization and being in jail, because that's what it is.

When you cannot escape and come out of a door outside, you're in jail.

No one likes that.

Your time is up.

Thank you for your comments.

Neil Liebort, Tim Drebby, Benny Lu, Anna Long, Christina Chow.

Hi, good evening.

My name is Neil Liebert.

I'm a licensed marriage and family therapist at Highlands Hospital's Intensive Outpatient Behavioral Program for over 16 years.

As previously mentioned, not long ago, this board of supervisors stood before the public strongly endorsed these outpatient programs as necessities for our community safety and well-being.

You recognize then what is still true now.

Mental health care is a fundamental right.

Yet, despite that endorsement, we've watched the current hospital administration systematically shrink this program instead of strengthening it.

We've experiencing a death by a thousand cuts that ignores the board's own state of priorities.

We're betraying the trust because vulnerable residents rely on these services now, nowhere else to go.

Please stop these cuts and help us.

Thank you.

I'm Anna Leeing, but I'm using my time to Dr.

Nevin.

Hi, my name is Simon Borble.

One of two doctors getting weighed off of my position has not been brought up yet because it's just me, no redundancy.

I'm the only rehab and sports medicine physician in our system and the only non-surgeon in our orthopedic department.

I'm the only physician who performs ultrasound guided injections for joint, muscle, tendon, and nerve conditions.

When I started four years ago, there was a growing backlog of these procedures that awaited me.

If my position is eliminated, these injections will again not be done.

AHS states there will be no delay in care and that others can perform these procedures.

This is not true.

In my last few days, the ortho department is rushing to schedule patients with me for these injections, and no one else does.

No plan.

The other physicians trained to perform these injections are pain doctors and are only spine surgeon.

They use x-ray guidance requiring an OR room, which uses their already limited OR time.

I'm the only physician trained to do these in clinic, avoiding additional appointments and OR utilization.

Thanks.

Hello, my name is Tim Dreeby.

I'm a licensed marriage and family therapist who's been working at Highland Hospital Outpatient Psychiatric for 24 years.

I wanted to say that we can be more lucrative than we've been if we open up an IOP, which um has higher reimbursement rates for years.

We've not been permitted to do this, although many of our participants could use the higher level of care.

Worse, we've had to refer IOP patients out of the community in Oakland to Fairmont Hospital, and many didn't go.

Currently we have three therapists employed, two of which are part-time.

We need more coverage to conduct more individual therapy for IOP reimbursement.

We have no admissions coordinator.

Our manager has been doing that job in addition to all the other duties that he does, including help us deal with the fact we have no clinical manager.

Our community is therapeutic and magical, but we could easily make more money if we weren't forced to work with such a skeleton staff.

This closing has been coordinated, or if at least it's felt that way.

Your time is up.

Carl Calhoun, Lisa Reyes, Joe Fox, Collette Cooper, Niven Forwal.

I guess I can see how we're sorry.

I'm Carl Calhoun.

I'm a member of uh uh uh I have a the Highland program outpatient psychiatry and services.

I've been out of the mental hospital since the year 2000.

I've been in this program since 2010.

It's been proven to keep me out of John George, out of the mental hospital.

That closed this program.

Thank you.

Hello, my name is Joe Fox.

I'm a physical therapist at Highland Hospital.

I um reside in District 5.

And um, I've been attending the Board of Trustees meetings, and I hope that you've been listening to the Board of Trustees meetings lately.

Um the executive team has not been bringing the numbers as tonight.

It's it's mathematics.

We're not getting the information.

It wasn't brought to the um health and housing committee.

There was it's just there's a lot of lacking numbers.

And um my concern is also with the board of trustees comparing us to Contra Costa County and the services they provide.

They're not a level one trauma.

There's just some very disconnect going on in the Board of Trustees and the executive team.

And also um, as a physical therapist, Nibben has been highly beneficial in helping prevent patients from having to have surgeries, and he is the orthopedist.

Thank you.

Hello, my name is Colette Cooper.

I'm a member of SIEU 1021, and I'm also a physical therapist at Highland Hospital, and I am a professor at Samuel Merritt University as well.

I care deeply for this community and for the patients that I serve, and I strongly believe in the commission of the Alameda Health System to provide care for the most vulnerable to ensure access and to protect the health of this community.

The Board of Trustees has accepted responsibility to further this mission, and that responsibility carries legal obligations as well.

Public health systems have a duty to protect patients from foreseeable harm once care has been established.

Under California law, terminating care without ensuring continuity constitutes patient abandonment.

And right now, there is no care planned.

You have heard that.

The current board of trustees is moving forward with cuts that undermine the mission of the health system while prioritizing leadership bonuses.

We are asking you to step in.

Please ensure that this system fulfill its mission as well as its legal and moral obligations.

Please rescind these cuts.

Thank you.

Benjamin Fisher, Christian Haas.

I'm taking Niven's spot.

We just went.

These ideas have been suggested since the beginning of these negotiations back in December, and we are now two weeks out of people's termination dates.

These programs are life-saving.

I've worked in a psychiatric hospital and seen people with severe mental illnesses.

Um in a revolving door, never, no end in sight.

Going to the NAP, like state hospitals to live out the rest of their lives there.

It is beautiful to see these people turn their lives around thanks to this program.

Please reconsider these cuts.

Thank you.

Hi, my name is Vanetta Vita.

I've been working in healthcare for over a decade.

I've been a medical cleric, a phlebotomist and ER tech, the nurse assistant, and now I'm a respiratory therapist.

I work in a local hospital.

I am a resident of district two, Oakland resident.

And I think these cuts are very important.

We should be taxing the rich.

I know this is an issue with uh the cuts to health care, but our funding should not be to working people that are trying to serve the community that are saving lives.

I think that when people are asking for you all to collaborate, it's to collaborate working people with working people because the telehealth that that was a mistake.

Robots should not be taking care of our patients, watching patients and whether they're gonna fall if they have dementia in a bed.

It should be a physical person actually there to assist them, a nurse assistant there to see if they need something, if they need water, if they need to go to the bathroom and not sitting in their own shit and you're their member.

This is our family members, these are our parents, these are old elders.

Hello, my name's Loretta Smith, and I'm here because I have uh an adult son who has schizophrenia, and he is currently living with me, and there is no other place for him to live unless I want to consider him homeless, and then he'll get help.

By definition, anyone with SMI, whether they're living with their parents, wherever, should be considered at risk of homelessness.

Major W.

Prop one, they shouldn't have to be on the street to get help.

You're the mental health system is broken, and you need to look at the Trieste model and you need to look at the county of LA and what they're doing with Heart Forward.

It's ridiculous.

These people are helping, and you're gonna cut them, and the mental system is broken, and you're gonna break it more.

You really need to stop these cuts.

My son just came back from John George.

He was hospitalized for the second time in three years.

He lives with me, and I have to live in fear of him hurting me if he goes off his medication because there's no other place because what?

I want to take him to Santa Maria, he doesn't need to be there.

Let's get real.

Okay, y'all try to cut therapy for those that got mental illness.

I suffer from mental illness.

Okay, I got fit to John George.

That's not a place for me.

Y'all try to cut this program for people that got real life shit going on.

For what?

Y'all, y'all don't got shit going on with y'all.

I got real life shit going on with me.

For what?

Y'all trying to cut their jobs.

Y'all feel bad.

These people.

These people got kids.

Hi, thank you for me.

Allowing me to speak tonight, supervisors.

My name is Ben Fisher.

I'm an activity therapist over at John George.

I'm also a resident in district two.

I want to mention two words.

I keep hearing tonight, um, both from AHS and the supervisors have mentioned collaboration and transparency.

As you can see tonight, there is not a whole lot of transparency.

We're getting different numbers and different presentations from AHS's people having sitting in the impact bargaining table.

I can confirm that this is exactly what's happening.

It's extremely frustrating, and day in and day out.

I have people asking me what's going on, and I throw my hands up in frustration.

And I don't have a good answer for them.

It's extremely difficult.

There is an extreme disconnect between the people at the bargaining table and what you all are hearing tonight.

We are not being collaborated with.

Millions of dollars getting out of a lease.

There is no action that is coming out of this team other than saying they want to set layoff notes for your home.

And then we thank you.

Hi, my name is Christian Paz.

I mean with the H is for the last 24 years.

I work at Fermo Hospital.

I also co-membered delegate.

I'm here because my cafeteria is gonna get close.

And I would like for you guys to also, I live in district.

We love for you to come to that cafeteria to check it out.

That way we can work together to keep that cafe open.

That's the only cafe we have in the area that people's gonna work one mile to get a lunch when they have half an hour break.

I would love for any of you to come to check the cafeteria out.

Thank you very much.

Bertha Hernandez, LaShawn Molin, Lana Walton, Nina Villa, Antoinette Washington.

My name is Berta Hernandez from EPS of San Leandro.

I'm here to raise my voice.

I want to make clear that we are not on necessarily expense.

We are an essential part of patient care.

In EBS department, for example, we ensure the cleanness, this infection and safety for every room for our patients.

Without us, there's no infection prevention.

Without superstitions, um, the quality of service is affected.

The remaining employees are working double shave all over times, working on the days off, uh, with non-stop.

I don't think this is fair for them.

I don't think this is fair for the patients.

We ask you to consider laid off to explore alternative and open transparent and honest.

Yeah, look at thank you.

Real quick, my name is Antoinette Washington.

I work at Highlands Outpatient Psyche program.

Growing up in a household of faith, you hear this.

If the head is not right, the body is not right.

We know that Trump is not right, but who is willing to put in and get in some good trouble, like the late John Lewis said.

Here we are.

I we we spend more time at work than we do with our families, and we're here late now, sacrificing time.

I have a granddaughter who has been accepted into four S HBCUs thus far.

And I told her, if you do it, baby girl, Nana got you.

She hears what's going on.

So she said, Nana, are we still good?

I said, Nana, gonna keep her word.

So am I closing?

I turned to you, Mr.

Jackson and Mr.

Fretzki.

You came on the unit with the the Becky made his exit and you made your entrance.

You came, you told management to leave the cafeteria that we serve our clients every day.

And you told us to look at your eyes.

You said this department is essential.

It's needed.

I give you my word.

Look at me.

This is what you told us.

I thank you for your comments.

Your time is up.

Yes.

Wait.

A reminder we have a hard stop at 8 30.

This will help if we help.

Making sure we hear the speakers.

Una stod, Denise Trin, Christina McGuire, Ashley Marr, Carlos Vasquez.

If your name has been called, please approach the podium.

Adriana Martinez, Nicholas Flores, Alberto Parra, Sydney Loggins, Donna Griggs Murphy.

Denise had to leave, so Laura will be taking response.

Laura Cocus, clinician at Fairmont PHP IOP, tenured professor of neuroscience at Santa Clara University, District 2 resident.

Give our program the opportunity to become financially sustainable.

Our entire staff was laid off, and trustees voted to close the program before a single meeting was held to right size our budget, before any meaningful effort was made to work with us to cut costs, increase revenue or restructure operations to make this clearly essential program sustainable.

As soon as we heard we might be cut, we began to make changes.

We added a fourth treatment group daily increasing revenue by 25% in the past month.

We have a new admissions coordinator, have increased admissions, and with new legislation like Prop 1 and CalAim, we can now begin accepting Medi-Cal only, a major new revenue or source that was previously unavailable.

We are not asking you to preserve this program without change.

We are asking for the opportunity to work with leadership to make the necessary changes to keep PHP IOP programs open for Alameda County to keep them effective and financially viable.

Give us the chance to do that work before eliminating the program.

So I want to make sure that we're fair to all the speakers.

But you had a replacement speak for her.

So are you speaking for uh a replacement?

Are you speaking for yourself?

Christina, Denise, and I were going to give a free part speech.

I already gave a lot of it.

I'm just going to stay home.

Okay.

I'm sorry.

Right.

She responded to a question on the laboratory.

So I've already told you about the positions that were riffed, the significance of the ED lab assistance.

I just wanted to highlight the second part of her question that I did not fully answer that there was no coordination between leadership and lab to mitigate the effects of the layoffs.

Right now there are only two full-time lab assistants left on PM shifts and SANs, services as needed employees have been called in to help with the workload, but they're not trained all over the benches.

So Bernie and Cherice are holding down the fort, doing the work of three to four people, and they're quickly burning out.

Both are single mothers who are responsible for their families.

Charisse meets well over an hour each way and is still experiencing pain from a medical procedure and the loss of her husband.

Bernie works over 60 hours a week at two jobs to make ends meet.

This is not sustainable.

Furthermore, they can't work every day of the week, so the other shifts are racking up over time in order to make sure that our operational needs are met.

This is a higher cost for a lower quality of care.

Thank you for allowing me to speak.

Barley Anastumos, Maria Insogna, Dr.

Disney.

Riley Jardine.

Ansel.

Any of these speakers here?

Not all keep going.

Hello, my name is Riley Gardine.

I'm a dietitian at Highland Hospital.

Um, I'm a part of a collective of frontline workers from across the Alameda Health System, standing multiple departments and multiple facilities.

These layoffs are threatening every part of the hospital, regardless of if we're experiencing layoffs or not.

We were already understaffed before these layoffs.

And although the executive team might make you think otherwise, we are the backbone of Alameda Health System.

Some of our layouts have been rescanded.

Guess what?

We're still here.

When run roll disappears, patient care breaks down.

Let me show you what that looks like through one patient we're gonna call James Fratsky.

He's a fictional name, but he's a story we see every day.

James is a medical patient with heart disease, diabetes, and he has not have stable housing.

It takes him over an hour on the bus to reach an appointment.

Because of layoffs, his January visit to cardiology was canceled.

The next available slot is not until May.

In case you guys don't know, your heart is really important.

He develops chest pain and he goes to the emergency department.

The ED is backed up, and more people are gonna finish this story for you.

My name is Martin Sony.

I'm an orthopedic PA working as a services is needed provider at the Newark Wellness Center.

I'm the only orthopedic provider for the entire South Bay service by AHS.

I was told by the orthopedic department that because of the workforce reduction, I would only be allowed to see patients until the end of January.

Since February 1st, my template has been closed and my patients removed from my schedule.

You will not see the Newark Orthopedic Service included in AHS's list of proposed program reductions because I have not been given a formal layoff notice.

However, closing all future orthopedic appointments at Newark is a backdoor way of laying me off and is indeed an elimination of our orthopedic service from Newark and our South Bay patients.

I care a great deal about my patients.

Please restore or pediatric to the Newark Wellness Center so we can provide the orthopedic care so needed in the South Bay.

Hi there, my name is Christy Fees, and I'm kicking up the story of James Fratsky.

I'm an SLP over at Paramount Outpatient.

Our patient James Fratzky develops chest pain.

He goes to the emergency department and the ED is backed up with fewer nurses, fewer lab staff, and slower turnover of rooms because of EVS or housekeeping, has been cut and cannot clean their rooms fast enough.

We've been told that residents are cleaning up blood themselves, even though this is not their job and they are not trained on how to clean like EVSs.

Trash cans are overflowing.

Bodily fluids remain on the ground for too long, becoming a slipping hazard.

Case management is short, so patients are not discharging and rooms are not opening up.

The ED is overflowing with ICU patients waiting in ED rooms, ED patients waiting in hallways, and our friend James waiting in the waiting room for hours.

This is not an exceptional day.

It's a typical Friday.

James continues to wait and dietary is understaffed, so there are not enough kitchen workers to make sure all meals are well prepared and sent to patient rooms.

Dinner does not arrive on time.

James is diabetic and his blood sugar drops.

Next patient.

I'm an occupational therapist at Fairmont.

So James has just had his blood sugar drop and he becomes dizzy and disoriented.

He is passing out and falling because he may be having another head injury.

If he falls, he will get a CT.

He won't get a CT fast enough because although we have two CTs at Highland, and we do not have staff both for both of them at the same time.

Cutting staff is already costing people their lives, and it will only get worse.

James next gets his blood drawn.

Lab is delayed because staffing was cut.

A sample is contaminated and has to be redrawn.

Cutting lab workers means cutting the experts who sent ensure timely and accurate tests.

Completing contaminated sample results with thousands of dollars wasted.

It is results in these delays and in care.

Infectious have time to spread without accurate testing and informed treatment.

James continues to wait.

James next gets his sorry, James's daughter is with him, and she is hungry, and she tries to go to the cafeteria.

It's midday on a Saturday, so it's closed.

It's ridiculous that the Highland cafeteria is not open on a weekend when visitors are most likely to visit their family and friends.

Next speaker, please.

Please come up if I've if I've called your name.

What's the next name?

What's the next name?

No, I just go ahead and speak.

Okay.

So James could have been treated in a cardiology clinic months ago.

Now he needs to be admitted.

This was a preventable mission.

He may even end up in ICU.

These cuts are costing patients their valuable time, health, and costing our county more money in the long run.

My name is Iman Khalil.

I've uh worked at San Leandro Hospital as a respiratory therapist for over 18 years.

These cuts cost our community.

Um I've been around long enough to see the consequences.

Across the ICU, ER, and health supervisor departments were consolidated.

All decision-making capabilities to out of state hires.

Anyone black or brown in leadership was let go or demoted while their white counterparts were ushered into administration or upper management.

There was no oversight and prejudicial decisions were made based on race towards patients and staff.

These results were devastating and people died.

In 2019, the consolidated racist management.

We had a patient commit suicide due to lack of sitters.

That's right sizing for you.

In 2026, AHS decided to replace several black and brown leaders who had decades of community experience with one white woman who doesn't know what our community needs during Black History Month.

It seems that AHS is doing its own DEI elimination.

These layoffs devalue them.

They send the message that if you don't make money for AHS, your health matters less.

Your ECT for all committee focuses on the following how balance and guidance work.

Effective coordination and sharing amongst county, community, and government agencies, protection of access to critical health programs and social services, establishment of a fund.

Your time has been up.

How did these cuts support your initiatives?

So how do you convince your fellow board members to do the same?

Thank you.

You are our last speaker.

The time is 8 30.

You are.

That was our last speaker.

Thank you very much.

We need to take a five-minute break for now.

Before we come back for board deliberations.

Lean at Tam.

Um I would be willing if the rest of the board is willing to extend public comment for another 15 minutes, but that's it.

Fifteen minutes.

Nobody else, 15 minutes.

If the board's comfortable with that, extending it, we don't see time.

We don't see time to folks.

If you haven't signed up to speak, you can't speak.

15 more minutes of public comment at the board's comfortable with that.

Do I have concurrence from my colleagues?

Yeah.

Respectfully asking since we only have 15 minutes if you guys can decide amongst yourself who we need to prioritize because we're not going to get to everyone, unfortunately.

Hold on a second.

We're still on a slight break right now.

Um we will come back after this five-minute break because some of us really need to take.

Supervisor Portugal Bath.

President Halbert.

Thank you.

We will resume public comment.

Uh 15 minutes for the remaining speakers.

Thank you.

Okay, hello.

We are the officers of the medical executive committee at HS.

We're responsible for the delivery of quality care uh to the patients at AHS.

We have a letter from the medical executive committee that we would like to read to you.

Um we'll briefly introduce ourselves and we're going to collate our time and give our time to Dr.

Robbie, who's going to read the letter.

Um, Dr.

Bernie Saprez, I'm an emergency physician, and I'm the uh chief of staff.

I'm Mona Lee.

I am the chair of the obstetrics, my referee and gynecology department.

Charles Wills, I'm an emergency physician at Highland Hospital.

I'm chair of the Department of Emergency Medicine.

My name is Brett Lash.

I'm a primary care physician and the medical director for our Highland Wellness Clinics.

Thank you for letting us speak tonight.

I'm gonna read a letter that we wrote on behalf of the medical executive committee, as Dr.

Perez said, the Alameda Health System Medical Executive Committee is a committee of physician leaders that is tasked with upholding patient safety and quality of care, as written by uh into the Alameda Health System bylaws.

On behalf of the Alameda Health System MEC, we write to express our urgent concern about the current direction of Malameda Health System AHS and the growing risks to safe and quality patient care.

For years, the executive team has made major clinical and operational decisions without meaningful engagement of the medical staff and without transparency, resulting in reduced services, loss of revenue, and avoidable disruptions in patient care.

These patterns include reduced surgical access at Highland Hospital, San Leandro, and Alameda hospitals, prolonged freezing of vacant physician positions, and investment in operational initiatives that have failed to demonstrate meaningful clinical or financial benefit.

Until now, frontline physicians, nurses, and staff have worked to buffer patients from the effects of these decisions.

However, the recent reduction in force has created a level of instability that can no longer be mitigated by frontline staff.

We respectfully request prompt and decisive action by the Board of Supervisors to strengthen oversight of Alameda Health System.

Our asks include, as appointing authorities, we request that you engage regularly with your appointed trustees to better understand the performance of the executive management team and ensure alignment with community expectations.

We request that the medical executive committee chief of staff provide a standing report to the Board of Supervisors that encompasses quality and safe delivery of health care at AHS, as we are tasked to do by the bylaws.

Regular reporting would support informed oversight and improve transparency around safe patient care.

And thirdly, to ensure responsible planning of the upcoming fiscal year, we respectfully request that the board direct a comprehensive and rigorous financial and managerial assessment of AHS prior to finalization of the fiscal year county budget.

The MEC remains steadfast in its commitment to the mission of AHS and to serving the diverse communities of Alameda County.

Many of us have dedicated our professional lives to caring for our community, and we will continue to advocate vigorously to preserve and strengthen our safety net system.

We will not support efforts that undermine, destabilize, or dismantle this essential public health infrastructure.

Any individual or action that threatens the integrity of this system, must be challenged by the MEC to protect its mission, the patients it serves, and its long-term viability.

The reason for our asks are as follows.

There's been a profound failure of governance at AHS.

Under AHS bylaws, the organization functions effectively only when it's three core bodies.

The Board of Trustees, the Medical Executive Committee, and the executive leadership team operate collaboratively in an alignment.

The Board of Trustees provides direction and oversight.

The MEC has clinical expertise and responsibility to assess and recommend measures to safeguard clinical quality and patient safety, and the ELT is responsible for operational execution aligned with our community needs.

Although the BOT has strengthened its partnership with the MEC in recent months, operational decisions by the ELT continue to compromise patient care and jeopardize the system's ability to meet its safety and obligations.

We've heard many people speak about the failures of patient access to care.

I won't go through all of these, only to say that again, the level one trauma center, the STEMI Center, Cardiac Arrest Receiving Center, as well as birthing center are at risk.

There's been a communication failure from the executive team.

Their communication has been inadequate and has undermined the medical staff's abilities to fulfill its responsibility for patient safety.

There's been a persistent lack of transparency with critical information not proactively shared and questions left unanswered.

On multiple occasions, physicians have explicitly requested inclusion in important operational strategic discussions that affect clinical care, and we're told that union status precluded their participation.

This rationale is inconsistent with the memorandum of understanding, which clearly states that medical staff bylaws supersede the MOU and affirm the medical staff's duty to oversee and ensure patient safety.

Physicians cannot effectively carry out this responsibility when essential information is withheld or when they are excluded from decision making, which directly impacts patient care, clinical workflows, and safety conditions.

This communication gap erodes trust, impairs collaborative problem solving, and creates unacceptable risk for both patients and the organization.

We appreciate your attention, especially so late into the evening, and are available to provide further information at your request.

Thank you very much.

Thank you.

We have copies for the public.

Thank you.

So that closes our public hearing.

I mean, excuse me, our public comment period.

Let's see.

She he took more than five minutes, right?

Each of the five speakers would that be.

Through the chair to the chair.

I do have eight minutes and thirty-four seconds left for this 15 minute period.

Okay, thank you.

Next speaker, please.

Claire.

Christy Thaez, Mondara Granados, Correiro, and Barbara K.

My name's Claire.

Um, I'm an ICU nurse at Highland Hospital.

I've worked there for nine years.

Um, I first want to know if this still meets the legal definition and the spirit of the law of a public hearing as required by state law.

Considering services are being cut to the most vulnerable people in the public, and you open the actual public comment four hours into the meeting.

Immediately cut our time in half and tell us you'll cut off the whole group in 90 minutes.

I did want to say I can tell by your faces that you find the comments of the patients of the mental health system here as moving as I do.

How am I supposed to feel when I see these same patients in the Highland ICU for a mental health crisis?

And I find out that they had previously been maintained for years in outpatient mental health.

Do you know what a mental health crisis looks like in a trauma ICU?

I'll just let you think about what that looks like because this is how those people die.

Hi again, my name is Christy Peace.

I spoke earlier.

I believe you called um Iris earlier and she was not able to come up.

I went in her set.

I'm gonna see my time to her.

Hi, I'm sorry, did you uh submit a speaker's list?

Yes, okay.

Okay, can you please restart my time?

Okay, go.

Hi, supervisors.

You were elected to serve a Lamira County.

Our job is to care for a patient, your job is to find the resources as a patient service representative.

We absorb the pressure and frustration caused by decisions we didn't make.

We are expected to carry more while being given less.

We are not sponges.

So when patients ask why care is delayed service that reduced that should uh what should we tell them?

Your health is not profitable enough.

You are gene dedicated workers as dispossibles.

Remember this positions are temporary, accountability is permanent, and you are not less less represent replaceable than workers you treat as dispossibles.

If this is your decision, congratulations.

You will be remembered as the leaders who failed the community.

You were elected to serve, and each of you is replaceable.

Thank you.

Good evening, my name is Isaac Robinson, and I'm the hearing coordinator at Highland Hospital.

I have dedicated the past 10 years of my life to serving this hospital, its staff, and its community.

What you didn't see in the FN FNS slides in the beginning, where they forgot to mention the FTEs that are affected at Highland.

Today I stand before because the company I have worked for so faithfully is trying to eliminate my position as part of what they describe as a financial deficit.

When faced with budget challenges, the first solution should not be cutting the very people who keep this institute running.

Yet that's what's happening.

Workers should not be the first sacrifice where executives continue to receive bonuses and benefits.

Thank you.

David Padilla.

David Padilla, Daniel Allen.

It's in person.

Do you want?

No, go ahead.

Um hi, Supervisors.

Debbie by the uh political organizer with SCAU 1021.

Um, I just wanted to uh re-emphasize a couple points.

These cuts here really reflect the kind of uh politics of abandonment and punishment that we see from the federal government.

Um, but the stop the buck stops here with you.

Um, and I just want to talk a little bit about some of the deeper effects that will uh we'll see with these cuts.

Um of the things that we haven't mentioned is the likely impacts that this will have on undocumented people being able to access care.

You all were brave and bold in passing a ice-free zones policy just a just a little bit over a month ago, and these cuts here will jeopardize the well-being of undocumented folks, uh, families and neighbors in our community.

Um, I also want to make sure that you all know that uh these these effects continue to compound in equities that we see in our community.

Daniel Allen, Kip Waldo, Joanne Barray.

Hi board.

So I just want to respond to uh David there.

He said you won't be able to solve this tonight.

I agree with you, but there is something you could do tonight.

This whole proposal by the so-called leadership team is a bunch of bullshit because they pretend that they did an impact assessment.

You can't do an impact assessment that has every single line that says the work will be absorbed by existing staff.

Or we it's come to our conclusion that AHS has determined that there will be no impacts to patient care.

They can't say that.

You can't cut an understaffed facility, the understaffed hospital without impacts of patient care.

They didn't do the assessment.

None of what they're saying is is an assessment.

This is we shouldn't have to come up here to have the public comment to explain to them that every single line of their cuts is inaccurate and is a lie.

That's not public comment.

We're not the public.

This is the people who run the hospitals, these are the people who do the work.

So you have the capacity to recognize that this entire uh proposal that they have doesn't meet the doesn't meet the terms that it stands on, right?

Every single cut they're proposing is gonna impact the patients.

Do the chair, we do have one minute and 10 seconds left.

We have time for one more speaker.

Chair, actually, I know that we are allowed to call up somebody if we would like them to continue.

And I think that Mr.

Padilla had more to say, and I'd like to hear it.

I know that he's had his minutes, but we are allowed to continue, speaker.

Okay.

There's some great numbers that want to say, too.

Okay, thank you.

John Garay.

Marina Stat Co.

Nurse, over 12 years, labor and delivery.

This is one of the only countries where medical debt can leave you bankrupt, and that's fucked.

Complying with these health care cuts in advance is sadistic.

Detention centers are the current U.S.

administration's answer to the potential medical debt medical bankruptcy that could be experienced by our community members.

Why are we okay funding surveillance tech for clan members and not health care for our community?

On my unit, labor and delivery.

The day that these cuts rolled out, we were unable to transfer a critically ill pregnant patient to the ICU because on that day, these nurses got noticed through email that they were no longer a part of the ICU team that they should leave mid-ships.

We had nowhere to send this patient.

I spent 12 hours in the ED with another pregnant patient.

Then she spent a whole other day because there was also no ICU beds.

We were waiting for an emergency section for a woman that could not get labs drawn so that she could have her blood type um verified before she could, then her baby's heart rate was dropping, and we couldn't get those results because there was no.

Thank you all for your comments and your patience as we get through this.

We have heard you, we've seen you, we know very clearly that we have to use every tool that you've talked about, some collaborations and partnerships, but we also are hearing conflicting information that we need to reconcile.

So at this point, I will turn it over to the chair of the health committee to for a motion to close the public comment and to um move forward on further deliberations.

Yes.

Can I have a motion first?

Yes, I that's what I plan on doing.

Yes.

Give me a give me a give me a moment.

But I'd like to make a motion to close public comment on this agenda item and continue to the board of supervisors for discussion and deliberation on this matter at our next regular meeting on Tuesday, March 3rd as a set item at 2 p.m.

And if I get a second to that motion, I'd like to speak to it.

So I've got a motion from Supervisor Miley and a second from Supervisor Fortunato Bass to close the public comment on this item and continue for the purpose.

So the chair, we said public comment, but we should be closing the public hearing through the chair.

No public comment.

Okay.

So we're closing the public comment on this agenda item.

This is the motion from Supervisor Miley and to continue the for board deliberations and discussion on this matter at its meeting on Tuesday, March the 3rd, as a STEP matter at 2 p.m.

And I have a second from Supervisor Marquez.

Oh, I'm sorry.

I keep looking right.

Can I speak to the motion?

Yes, please.

Thank you.

Sorry to get a little annoyed there.

Uh, first of all, I want to thank everyone for coming out and speaking.

Those are still here, those who've left, those who are online, etc.

We have heard you.

Um obviously folks are very emotional about this, very charged up about it, and rightfully so.

I think the board feels your your um your emotion, your pain, your concern.

Um, a couple of my colleagues have already mentioned we want to look at how we can uh come up with a collaborative approach to addressing this concern or these concerns because we do feel that they're major and they need to be addressed.

Now I'm not here um because I've been here for a while as a supervisor.

So I've seen Board of Trustees, I've seen hospital administrations, and I've worked with labor over the years as well.

So I want to see how we can produce a win-win situation here.

So when we deliberate on March the 3rd at two o'clock, I really would like to see us do the following.

One, have the county come back with at least 10 million dollars to um provide some type of reprieve so that these layoffs are curtailed.

That's the first thing.

10 million dollars.

Secondly, I'd like to have the board consider putting together a working group made up of two supervisors, representatives from Alameda Health Systems, and labor, so that we can look at this and so we can collaboratively come up with addressing it for the coming fiscal year and even the fiscal year thereafter, 2026, 27, 27, 28.

So two fiscal years coming up with an approach to address this.

Thirdly, I think between the net negative balance, um withholdings from behavioral health, between the items laborers identified potentially as savings, there are options that we have both for the 10 million as well as looking at how we might address this uh in the future.

And that's just some of my thoughts on this.

So I'm not having us deliberate on it now, but I wanted to telegraph at least what I thought might be a possible uh direction on this when we deliberate this coming Tuesday.

And if the board in its deliberations um moves in that direction to do this, then hopefully that would give enough assurance to the board of trustees and the um the executive team to stop the layoffs to give us all a chance to look at this for the next two fiscal years and figure it out.

So I just wanted to kind of telegraph that without deliberating.

So I hope I stayed within uh the confines of appropriateness.

Thank you, madam chair.

Thank you, Supervisor Miley, for speaking for all of us on this issue.

Um, may I have roll call vote?

There's oh, I'm sorry.

There's a cue.

Okay, it's a new system.

It's a new system, yeah.

Okay, uh you control the mics now, right?

Got it.

But you have to call and okay supervisor fortunato bass.

Thank you, Chair Tam, and thank you, Supervisor Miley, for the motion.

Um, I am supportive of the motion and coming back on Tuesday to discuss uh some very specific options as you described.

Um I wanted to also say that in addition to the county for our part, uh, potentially renegotiating the net negative balance and restructuring the behavioral health services payments.

I do want us to also discuss next Tuesday lobbying for state relief together with the California Association of Public Hospitals.

Um I am also interested in getting feedback from AC Health on uh the reductions.

I think that would really help me make some decisions.

I'm very concerned about the IOP and some of the other programs, and when we are also looking at Prop One, as Supervisor Marquez said, as well as reduce funding for homelessness from our state, possibly our state partners and certainly our federal partners, you know.

We're looking at more than what we've discussed tonight.

We're looking at a number of complex systems, and so I would appreciate feedback from AC Health on the reductions, and then finally, while we can't direct AHS, I do think um it's important to reiterate the collaboration that was discussed today, especially with the uh medical and clinical staff, as well as exploring um the union revenue recommend recommendations.

Thank you.

Okay, I'm still still getting used to this microphone.

Um, Supervisor Marquez, then Supervisor Halbert.

Okay, thank you all for your patience.

This is our first time with this new technology.

Um, so again, thank you, everyone, especially the patients that were extremely vulnerable.

It was really powerful to hear from all of you.

So thank you for hanging in there.

And what I'm gonna say is gonna sound very cheesy, but I mean it.

We are all in this together.

This is a collective fight.

This is against the clown in the White House, the federal administration.

And I mean it that we need to brainstorm come together.

We learned a lot of new information tonight, and I just want to be explicitly clear as the chair of public protection.

It is one of my number one priorities to reduce the number of people in Santa Rita jail, full stop.

And we need to make sure we're appropriately meeting the needs of people outside of the jail.

And so I appreciate everyone raising that.

Um it's also liability.

We don't want people to pass away in our care.

So we have a responsibility, we have a moral imperative to figure this out.

So to everyone who spoke, just know that um I'm in it for the long haul, and I'm I'm confident we will uh figure this out.

Uh with respect to some of the ideas, the motion, I'm in support of it and just hope that I'm just gonna flag the analysis that was done in terms of the reductions, the closures.

This is what we need to do, as I mentioned earlier.

Not for this just this critical decision, but also prop one.

We need to look at measure W.

We have so many critical decisions to make.

So just thank you all for elevating uh your concerns because we need to have the full picture because it's really the same person.

It's not a limited health system patient, it's not behavior health, it's the same individual we're talking about, and we have a responsibility to make sure that we do everything we can to protect their well-being.

Thank you, Supervisor Halbert.

Yes, thank you.

Indeed, I see that we I see the wisdom in the motion that was made from our wise elder, because indeed we're not going to solve this tonight.

I don't think this forum of one minute speaking and us trying to absorb something that professionals have been dealing with day in and day out for a long time.

So we're it's going to take some time, and I think a working group is highly in order.

I think the money to tie it over and delay the cuts that have been proposed is in order to stabilize where we go from here though, still needs to be determined.

It will be determined as we've said all along collaboratively.

I heard that from management, I heard that from labor.

We have to bring that together.

I love the idea of bringing in our health team, where's the Nika?

Right there.

We we have to bring in help.

And I just realized that we have experts that we're going to listen to.

It's not necessarily our expertise.

We have to listen to the experts and make wise decisions.

Um, but we're we're not going to be able to do that uh tonight.

Um gosh.

I don't think we would have gotten here without everybody in the room.

So thank you all.

You were critical to getting us to this point.

We'll see you all next Tuesday.

Now, just to be clear, we're gonna have a set matter at 2 p.m.

Okay.

Public comment has been closed.

The public hearing is still open, meaning we will deliberate, meaning we will be able to, if we need to call somebody to speak, we can do that at our discretion.

But public comment is over.

Is that your expectation, Supervisor Miley?

Uh yes, that's my expectation.

And the reason I want to telegraph it is so that the public knows this, but also the county administrator knows it.

So she has a sense of where we might want to go with this to come prepared with uh the funding options.

Agreed.

Excellent.

Well, with that said, um, I am also supportive of the motion.

Thank you.

Thanks.

Thank you.

I fully support the motion.

I think we need to use every tool, every option we have, um, because our health care system is extremely critical, whether it's measure A, whether it's measure C, some version of it, or whether it's measure W, whether it's looking at uh different options in collaboration with our uh health care.

So at the next meeting when we meet on Tuesday, I would also like to get that feedback from AHS because as we we respect your expertise, and I know you heard a lot this evening, and I would like an opportunity to hear uh what are what's feasible in terms of social options as well.

Thank you.

So at this point, let me ask for a roll call vote if I have no further comments.

Supervisor Marquez.

Hi, C advisor Jan.

Aye, supervisor mining, supervisor fortunately bath.

Hi, President Halbert.

All right, motion carries, thank you.

So I need to ask County Council to do a correction on the report out from our closed session today.

We previously announced that there was nothing to report, but in fact, we do need to report that in the matter of Trump v.

Barbara, Supreme Court of the United States case number 25365 on a vote of 4-0 with Supervisor Halbert excused.

The board authorized County Council and the County to join into an amicus brief supporting the on the issue of birthright citizenship for children of non citizens supporting the public um rights projects brief to support the right of birthright citizenship to exist.

Seeing none, this meeting is adjourned.

Thank you for your time.