A modestly sized conference room tucked away on the seventh story of Zuckerberg San Francisco General Hospital this afternoon became the safest place to be in all San Francisco, as perhaps 100 to 150 nurses marched in, overwhelming a regularly scheduled Health Commission meeting.

If one were to hyperventilate in here — and, with this many bodies in this small a space, it was a possibility — a battalion of medical personnel was on hand.

The nurses’ complaint is that the same can’t be said for the hospital writ large. Contract negotiations between the hospital and the nurses broke down on Friday, and a potential strike looms on July 1. Per the aggrieved nurses, the sticking point has been staffing levels.

“We are chronically understaffed,” shouted cardiac catheterization lab nurse  Aaron Cramer, who would make the first — and only — public comment of the meeting. “I hold in my hands a petition of no confidence with the Department of Public Health, signed by more than 1,300 nurses.”

And, with that, he began to read the names of the signatories, as his colleagues raucously chanted, “safe staffing now!” At a pace of 12 names per minute, this figured to be a one-hour, 48-minute endeavor. But, after around a quarter of an hour, the health commissioners quietly gathered up their folders and coffee cups and filed out.

“I was prepared to go the whole way,” Cramer said moments later. “Today was about giving the Department of Public Health executives a glimpse of what a strike or work stoppage would look like.”

The nurses complained about greater demand placed on a staff that is holding steady or contracting, and is relying to an alarming degree on “per diems” — temporary workers who do not earn benefits or pensions. The union claims a full 40 percent of nursing hours are assigned to per diems. 

“I work in psychiatry, and when the cops do their sweeps, they come to us,” says 32-year nurse Meg Brizzolara. “There are just not enough of us. People are working to the point where they’re jeopardizing their licenses. And even when we get patients glued together and discharged there’s not enough outpatient treatment so they come right back.”

Brent Andrew, a hospital spokesman, confirmed that talks between the union and the Department of Public Health indeed adjourned on Friday without a conclusion. “We’d very much like to continue negotiating,” he said. But “the city is satisfied with its offer.”

Memo From Roland Pickens to SFHN 5 27 19 (1) by Joe Eskenazi on Scribd

Andrew said that staffing levels are adequate and safe and comply with relevant codes. He could not speak to the claim that 40 percent of nursing hours are currently assigned to per diem workers.

Staffing statistics obtained by Mission Local, however, reveal a years-long pattern of busting budgets when it comes to per diem nurses. In fiscal year 2016-17, the Department of Public Health budgeted $16.9 million toward temp nurses. It paid out $58.4 million. In fiscal year 2017-18, it budgeted $17.3 million and paid out $62.3 million. And, through seven months of fiscalyear 2018-19, it has already spent $34.3 million, despite budgeting only $17.8 million.

These budget overruns dwarf the costs associated with increased staffing currently dividing the union and management — leading to charges from the unionized workforce that, in its refusal to add full-time employees, the Department of Public Health is being pennywise and pound-foolish.

Psychiatric nurse Jennifer Esteen compared the hospital’s heavy reliance on temp workers to Google.  “Nobody’s going to die if Google crashes tomorrow,” she said. “But here? A Level-One trauma center should be run in a reliable manner.”

Unlike many San Francisco employees, there is no provision forbidding nurses to go out on strike. There are around 2,100 unionized nurses in this city. But, should it come to pass, this strike could have larger ramifications: “Sympathy strikes” of other workers who come into contact with the hospital or the Department of Public Health could vastly augment that number.

It is not certain when negotiations will reconvene.