proposed training project details critical … hospital proposal (with att)..pdf · proposed...

PROPOSED TRAINING PROJECT DETAILS

Training Proposal for Riverside Healthcare System, LP dba Riverside Community Hospital of 6

CRITICAL PROPOSAL FOR

Riverside Healthcare System, LP dba Riverside Community Hospital

17-0795

Panel Meeting Date: 8/25/2017

Regional Office: San Diego Regional Office

Analyst Name: Ray, Maria

Type of Proposal: Single Employer Contract (SE)

Funding Source: Special Employment Training (SET)

FUNDING OVERVIEW

Provided here is a summary of the funding for the proposed Training Project.

TOTAL ETP FUNDING: $715,170

Program & Admin Cost Support Cost Substantial Contribution

($ / %) Total In-Kind

$715,170 N/A $0 $1,350,600

APPLICANT PROFILE

Company Summary

Riverside Healthcare Systems, LP dba Riverside Community Hospital (RCH) (www.riversidecommunityhospital.com), founded in 1901, provides intensive care services such as Level II Trauma/Emergency Services, Medical and Surgical/Trauma Intensive Care, ambulance services with air capabilities, STEMI center services (cardiac emergencies), and cardiac catheterization and electrophysiology laboratory. The Hospital is a Center of Excellence for Metabolic and Bariatric Surgery (designated in December 2013) and certified as a Primary Stroke Center (designated in January 2014). RCH serves individuals throughout Riverside County and its surrounding areas.

Industry Sector(s) Healthcare

Priority Industry Yes

No. of Employees (Applicant) State: 6,159 US: 173,357 World Wide: 241,000

Turnover Rate (Applicant) 10.70%

Repeat Contractor Yes

http://www.riversidecommunityhospital.com/



High Unemployment Area No

Unions

SEIU Local 121RN – Service Employees International Union;

SEIU Healthcare UHW – United Healthcare Workers West

UHW

TRAINING PROFILE

Training Objective

This proposal for RCH is designated as a “Critical Proposal”, as defined in Title 22, California Code of Regulations (CCR) 4402.2, by the Governor’s Office of Business and Economic Development (Go-BIZ). The Hospital is adding a 7-story tower to its current location to add new functions and expand services. The Hospital will be adding 155 new jobs as a result.

RCH’s primary focus for its education and training centers is evidence-based practice, new technology/equipment, new science, and changes in legislative regulations or standards of practice. The goal is to ensure excellence is attained and maintained in both clinical and non-clinical areas, specifically for newly-hired employees and current employees transitioning to a different specialty department.

Training is summarized below. Additional details are provided in Attachment 1 - Group and Job Title Details of this Panel Proposal.

# Group Characteristics # of Trainees

Reimbursement Rate

Avg. Hours

Cost Per Trainee

Min – Max Hour

1 Retrainees, Job Creation 155 $20.00 129 $2,580 8 – 200

2 Retrainees 155 $18.00 113 $2,034 8 – 200



Provided here are the details on the proposed Training Project.

1. Company Background

This will be the fourth Agreement between RCH and ETP within the last five years (and sixth overall). Located in the City of Riverside, the 373-bed Hospital provides minimally invasive robotic surgery; transplant services; orthopedic/spine surgery; and neurological surgery (brain/spine) including stereotactic and image-guided surgery, deep brain stimulation, and vagus nerve stimulation. The Hospital also provides patient care services (through its Cancer Center, Birthing Center, pediatric care, couplet care, and neonatal intensive care services), physical therapy, occupational therapy, and speech therapy. RCH’s parent company is Hospital Corporation of America (HCA), a private, for-profit organization headquartered in Nashville, Tennessee. Under HCA, there are a total of 171 hospitals and 118 freestanding surgical centers throughout the United States and Great Britain. HCA has five autonomously-operated hospitals in California (Good Samaritan Hospital, Los Robles Regional Medical Center, Regional Medical Center of San Jose, West Hills Hospital and Medical Center, and Riverside Community Hospital). This proposal is only for RCH. RCH is eligible for ETP funding under Special Employment Training (SET) provisions for frontline workers. (Title 22, California Code of Regulations, Section 4409.) The Company qualifies for ETP’s Priority Industry fixed-fee reimbursement rate as a healthcare employer.

2. Current Training Project Details

Provided here are details on the purpose of the training, a summary of the marketing plan and support costs.

Purpose of Training

RCH is in the midst of expansion. In September 2017, the Hospital will open a new 7-story patient tower. The tower will house an additional 105 licensed beds, 12 neuro intensive care unit beds, 4 operating suites, and 3 trauma suites (to be fully operational by Q1 2019). The new facility will also house a new cafeteria and kitchen; laboratory; and plant operations.

Training in this proposal is heavily driven by the following business and strategic plans as a result of the aforementioned Hospital’s expansion:

Add and Expand Services – RCH is moving towards becoming a comprehensive stroke center and tertiary care center. All stroke services are currently functioning as a comprehensive program and will proceed towards certification by The Joint Commission in Q2 2018. The Hospital is also moving towards accreditation by the American College of Surgeons (ACS), planned for Q3 2018.

Hire and Train Healthcare Workers – To fully support the Hospital’s overall growth, RCH plans to hire and train new healthcare employees on a quarterly basis. The Company’s core staffing is built upon census over time and adjusts as patient volume increases and sustains. The Hospital plans to hire 100 Registered Nurses (RNs), 25 Technicians, 15 Environmental Services (EVS) Staff, 10 Certified Nursing Assistants (CNAs), and 5 Food and Nutritional Service (FNS) Staff. A significant amount of training will be provided to new employees in hospital and unit-specific education and training. Initial training will be provided during the introductory period and will incorporate expected objectives, department-specific equipment, standards of care and practice, and



knowledge and skills needed to meet the Hospital’s standards.

Ease the transition of transferring workers - Extensive training will be provided to existing workers who are expected to transition to another specialty department.

Medical Skills Training Program

This program provides funding for nurses and allied healthcare occupations with a Reimbursement Rate of $22 for clinical didactic training and clinical preceptor model. Trainees will be provided core Medical Skills training to acclimate to the clinical environment and to acquire the skills sets necessary to be immersed in solid clinical practice. On average, trainees will receive 4 to 16 weeks of combined didactic and one-on-one Clinical with a Preceptor training. All nurses, technicians, and CNAs will receive one or more modules of MS Didactic training (classroom) in advanced medical care to ensure competency. Didactic training will be provided in conjunction with Clinical Preceptor training to enhance the learning environment. Fundamentals are required to provide the framework to support the clinical "hands-on" training. Together, these training environments will enhance learning opportunity and allow trainees to better understand clinical processes to better prepare them for work in specialty departments of the Hospital such Inpatient Nursing, Perioperative Services, as well as procedural areas such as Interventional Radiology, Cardiac Catheterization Laboratory, Endoscopy Laboratory, and Imaging. These trainees will also receive MS Clinical Preceptor training. Nurses will receive the majority of Medical Skills training and will be assigned to a specific hospital unit where they will complete Clinical Preceptor Skills training under an assigned "preceptor." Clinical Preceptor training is an essential component of RN training to ensure nurses have critical hands-on skills prior to being assigned their own patients.

Training Infrastructure and Administrative Plan

RCH designated its Director of Education to oversee the overall implementation and administration of ETP-funded training. The Hospital also designated an administrative staff who will be responsible for enrolling trainees, collecting and maintaining training rosters, and tracking training hours in the ETP online systems. Both staff are knowledgeable with ETP procedures and were involved in the administration of the Hospital’s previous Agreement.

Marketing Plan

(MEC Only)

N/A

Support Cost Description

(MEC Only)

N/A

Substantial Contribution Description

In accordance with Panel regulations, a Substantial Contribution shall apply to a repeat contractor with prior incumbent earnings in excess of $250,000 at the same facility. (Title 22, CCR, Section 4410(a)) RCH is a repeat contractor with payment earned in excess of $250,000, at its Riverside facility, within the past five years. The Hospital had a 50% Substantial Contribution applied on its previous ETP Agreement. However, there is an exception in regulations for a Critical proposal (Title 22, CCR, Section 4402(b)) The Panel may waive the Substantial Contribution requirement where a California business currently proposes to expand an existing facility and has been designated as a Critical Proposal as with RCH. Staff recommends that the Panel waive the Substantial Contribution requirement. ETP



funds will assist RCH in enhancing patient care services as well as meeting its hiring and training goals in order to successfully support the Hospital’s growth.

3. Sample Curriculum

Provided below is a summary of all methods by which training will be delivered including a sample of the courses that will be offered.

Each of the Trainee groups will be able to take courses under the various delivery methods.

Delivery Method/Level Classroom/Simulated Laboratory

Computer Skills Sample Classes

ConnectRx Application Skills

MediTech Application Skills

Electronic Medical Records Application Skills

Continuous Improvement Sample Classes

Communication Skills

Critical Thinking Skills

Preceptor Skills

Medical Skills Sample Classes

Critical Care Nursing Skills

Care of the Stroke Patient

Electronic Fetal Monitoring

Delivery Method/Level Clinical with Preceptor

Medical Skills Sample Classes

Emergency Room Nursing Skills

Telemetry Nursing Skills

Triage Nursing Skills

Delivery Method/Level Computer-Based Training (CBT)

Continuous Improvement Sample Classes Standard Hours

Infection Control 3.50

Care of the Stroke Patient 3.0

Care of the Diabetic Patient 1.0

CBT Details

Up to 18 CBT Hours will be delivered to trainees

4. Additional Company or Training Project Details

Provided here is additional information relative to the proposed Training Project.

4.1 Program Waivers

The next table lists other waivers and supporting justifications for this proposal.



Waivers/Justification Type Summary

SET Priority Industry Wage Modification

For trainees employed in a priority industry, the Panel may modify the SET wage up to 25% below the statewide average hourly wage from $29.38 to $22.04 (Group 2). This wage modification is intended to train entry-level healthcare workers in lower wage occupations to provide opportunities for wage increases and long-term job security. Staff recommends this modification.

4.2 Subcontractor Summary

The applicant has retained the services of the following Subcontractor(s).

Subcontractor Type Subcontractor Name City Service Cost

Development N/A

Administrative N/A

Training To Be Determined

4.3 Previous ETP Project Summary

This table summarizes Contractor's performance under prior contract(s) completed within the last five years.

Past Contract Activity

Agreement Number

Location(s) Term Approved Amount Project Earnings

Performance %

ET15-0447 Riverside 6/1/15 – 5/31/17 $272,750

(50% SC applied)

$272,750 100%*

ET13-0181 Riverside 10/22/12 – 10/21/14 $424,488

(50% HER applied)

$424,488 100%

ET11-0346 Riverside 6/30/11 – 6/29/13 $212,316

15% SC applied)

$212,316 100%

Notes *ET15-0447: The last day of ETP training was 2/28/17. RCH documented a total of 22,729 eligible

training hours, equivalent to 100% of the Agreement amount ($272,750), for 142 trainees who completed retention. The final invoice closeout was submitted on 6/27/17 and is currently being processed by ETP.

4.4 Supporting Panel Proposal Documentation

Provided in Attachments 1, 2, and 3 are additional application details on the intended training population, the detailed curriculum, and associated program characteristics that are related to this proposed Training Project.

Attachment 1 – Group and Job Title Details

Training Proposal for Riverside Healthcare System, L.P.: 17-0795 Attachment 1: Page 1 of 1

The proposed Training Project includes training for the following Trainees, organized by training group.

Group #: 1 – <Job Creation>

County ETP Minimum Wage

Riverside County (Job Creation) $13.22

Job Title Estimated Number of Trainees

Base Wage Range Health Benefits Applied

Post-Retention Wage

Riverside County

Job Creation: Certified Nursing Assistant 10 $19.78 - $22.94 $0.00 $19.78

Job Creation: Environmental Services Staff 15 $17.36 - $21.13 $0.00 $17.36

Job Creation: Food and Nutritional Service Staff 5 $16.64 - $19.30 $0.00 $16.64

Job Creation: Registered Nurse 100 $40.62 - $56.62 $0.00 $40.62

Job Creation: Technician 25 $20.68 - $41.43 $0.00 $20.68

Group #: 2 – <Retrainees>

County ETP Minimum Wage

SET Wage $29.38

SET Priority Industry Wage $22.04

Job Title Estimated Number of Trainees

Base Wage Range Health Benefits Applied

Post-Retention Wage

Riverside County

Certified Nursing Assistant 30 $19.78 - $22.94 $2.26 $22.04

Environmental Services Staff 130 $17.36 - $21.13 $4.68 $22.04

Food and Nutritional Service Staff 18 $16.64 - $19.30 $5.40 $22.04

Registered Nurse 16 $40.62 - $56.62 $0.00 $40.62

Technician 38 $20.68 - $41.43 $1.36 $22.04

Attachment 2 – Training Delivery and Curriculum Listing

Training Proposal Riverside Healthcare, L.P..: 17-0795 Attachment 2: Page 1 of 9

Provided below are details on the types of training planned for this proposed Training Project.


Training Type/Level Planned Course Offerings

Computer Skills

Centricity (PACS)

ConnectRx

Electronic Medical Records Application Skills

ER-T

Konica RIS

Medcomm

MediTech Application Skills

Pyxis

Continuous Improvement Skills

Care of Stigmatized Populations

Charge Nurse Training

Communications Skills

Conflict Resolution Skills

CORE Measures

Crisis Prevention Intervention (CPI)

Critical Thinking Skills

Culturally Appropriate Care

Customer Service Skills/AIDET

Documentation Skills/EBCD

EBOLA training

Educating the Patient and Family

FNS Equipment

Food Handling

Organization and Time Management Skills

Patient and Family Centered Care Skills

Preceptor Skills

Purchasing Skills

Scope of Practice

Team Building Skills

Workflow

Medical Skills (didactic)

7 Step Cleaning

Acute Ischemic Stroke: Neuro Intervention

Acute Myocardial Infarction





ALARA

Application of Immobilizers, Ace Wraps

Application of Splints

Arterial Blood Gas (ABG) Interpretation

Automated Dispensing Medication System Skills

Basic cardiac anatomy and physiology

Bed Management-Tracker

Beds

Body Mechanics

Body Mechanics, lift equipment

C2 Safe Primer

Cardiac Monitoring

Cardiac Monitoring Responsibilities

Care of Bariatric Patient

Care of Pediatric Patients /ENPC

Care of the Burn Patient

Care of the Cardiac Patient

Care of the Neurosurgical Patient

Care of the patient on remote cardiac monitoring

Care of the Sepsis Patient


C-Arm

Central Lines Management

Characteristics of ECG rhythms

Chemical Hazard

Chest Tube Care & Management

CHG bathing

Code Blue Response & Procedures

Code Stroke Procedure

Consults Primer

Controlled Substance Patient Orders


CSP/USP797 Primer

Decontamination Procedures

Diabetes Care & Management

Dysrhythmia Recognition & Interpretation

ED Throughput Process





ED Triage Process

ED/OR and STAT procedures

EKG & Cardiac Monitoring

Electronic Fetal Monitoring

Emergency Care of the Burn Patient


EMS Process/Helicopter Safety

Equipment cleaning

Equipment Skills

Equipment Use

Evidence Based Practices

Eye Wash Process

Fluoroscopy check C-Arms in OR

Fluoroscopy check Cysto room

Fluoroscopy check Imaging rooms

Gastrointestinal Assessment and Management

Germicide Use

Hazardous Waste Disposal

Hazmat Decontamination

Hemodynamic Monitoring

I/O, feeding

Incontinence, Foley care, peri care, HS, oral care

Infection Control

Infection prevention-hand hygiene

Infectious Waste Disposal

Intra-Aortic Balloon Pump Therapy (IABP)

Intra-Cranial Pressure Monitoring

Intravenous (IV) Insertion & Therapy

Isolation practices

IV Medication Skills

Kinetic Therapy

Labor, Delivery and Postpartum Nursing Skills

Lead placement of lead wires in a 5 lead system

Management of the Transplant Surgical Patient

Medical/Surgical Nursing Skills

Medication Administration & Management

Medication Management Skills





Medication Safety

Medication/Supplies

Meditech Primer

Meditech/EBCD documentation

Medrad Mark V Injector

Mental Health Patient 5150

Moderate Sedation

Neonatal Intensive Care Unit (NICU) Nursing Skills

Neonatal Nursing Skills

Neonatal/Infant Pain Scale (NIPS)

Neuro Interventional Radiology Nursing Skills

New Graduate Nursing Skills

NIH Stroke Scale

Normal ECG waveforms an intervals

Nurse Orientation Training

Nursing Diagnosis Skills

Nursing Process Skills

OB PACU Training Skills

OB Trauma

Oncology Nursing Skills

Oral/Bulk Medication Packaging

Orthopedic Nursing Skills

Ostomy & Continence Care

Pain Management (Acute & Chronic)

Patient Assessment & Care

Patient Fall Prevention

Patient profiling and documentation

Patient safety

Perinatal Orientation Education Program

Peri-operative Nursing Skills

Portable X-Ray procedure

Post mortem care

PPE-donn-doff

Pre and Post Operative Care

Proper use and maintenance of imaging equipment

Psychotropic Medications

Pyxis Primer





Rapid Response Skills

Renal Assessment & Management

Respiratory Assessment & Care

Restraints

Sensitive Area Cleaning

Sepsis Management

Sitter responsibilities

Skin alterations-RN reporting

Spinal Precaution Patient

Subarachnoid Hemorrhage: Neuro Intervention

Surgical Nursing Skills

TED hose, SCD pumps


Therapeutic Hypothermia

Total Parenteral Nutrition (TPN)

Transfer Techniques

Trauma Nursing Skills/TNCC


Ventilator and Tracheotomy Care

Vigilanz Primer

VS, MEWS, Spot monitor

Waste/Sharps Handling and Disposal

Weights

Wound & Skin Care

Wound Care

Wound/Skin care, linen usage

Delivery Method/Level Electronic Learning/Computer Based Training (CBT)

Training Type/Level Planned Course Offerings Standard Hours

Continuous Improvement Skills

Age and Culturally Appropriate Care 1

Care of the Diabetic Patient 1

Care of the Stroke Patient: NIH Stroke Scale 3

CPN 4

E Centricity 4



Delivery Method/Level Electronic Learning/Computer Based Training (CBT)

Training Type/Level Planned Course Offerings Standard Hours

Infection Control 3.5

Patient Safety; Safe patient lifting and moving 1.5

CBT Details

Percentage of Curriculum that is CBT Hours 2%

Delivery Method/Level Productive Lab (PL)


Medical Skills (preceptor)

7A3:A67 Step Cleaning

ALARA

Antepartum, Labor, Delivery and Postpartum Ski

Automated Dispensing Medication System Skills

Bed Management-Tracker

Body Mechanics

Body mechanics, use of lift equipment

C2 Safe Primer

Care of Antepartum, Labor, Delivery & Postpartum

Care of Deceased Patient

Care of patient - portable X-Ray procedure

Care of Patient Hazardous Decontamination

Care of Patient in Cardiopulmonary Arrest

Care of Patient in ED Triage

Care of Patient in isolation

Care of Patient received from EMS/helicopter

Care of patient requiring imaging in OR/ED

Care of patient requiring STAT procedures

Care of patient undergoing fluoroscopy procedures

Care of Pediatric Patients

Care of Pediatric patients/ENPC skills

Care of Pregnant Patient

Care of the Burn Patient

Care of the Cardiac Patient

Care of the Mental Health Patient 5150

Care of the Neurosurgical Patient

Care of the Oncology Patient

Care of the Orthopedic Patient





Care of the Patient at Risk for Falls or Injury

Care of the Patient with Spinal Precaution

Care of the Patient with Wounds

Care of the Percutaneous Coronary Intervention

Care of the Post-Neurological Injury Patient

Care of the Post-Open Heart Patient


Care of the Transplant Surgical Patient

Care of Trauma Patient

C-Arm procedure

Code Stroke Procedure

Commonly used Emergency Department equipment

Consults Primer

Continuous Renal Replacement Therapy (CRRT)

Controlled Substance Patient Orders


CSP/USP797 Primer

Dysrhythmia Interpretation Skills

Dysrhythmia Recognition and Treatment

EKG & Cardiac Monitoring Equipment

EKG & Cardiac Monitoring Skills

Emergency Care of the Acute Stroke Patient

Emergency Care of the Burn Patient

Emergency Care of the Sepsis Patient

Emergency Care of the STEMI Patient


Equipment Cleaning

Equipment cleaning process

Equipment Operation

Equipment Use

External Pacemaker Management

Fluoroscopy check procedure

Geriatric Nursing Skills

Germicide Use

Hazardous Waste Disposal

he Transvenous Lead Extraction Patient

Hemodynamic Monitoring Skills





Impella (Left Ventricular Assist Device Therapy)

Infection prevention-hand hygiene

Infectious Waste Disposal

Intermediate Electronic Fetal Monitoring

Intra-Aortic Balloon Pump (IABP)Therapy

Intracranial Pressure Monitoring

Intravenous (IV) Therapy Skills

Isolation practices

IV Room/ IV Medication Skills

Management of patient - Subarachnoid Hemorrhage

Management of patient with Acute Ischemic Stroke

Management of Renal Transplant Surgical Patient

Management of the Transplant Surgical Patient

Medical/Surgical Nursing Skills

Medication Management Skills

Medication/Supplies

Meditech Primer

Medrad Mark V injector process

Neonatal Advanced Life Support

Neonatal Intensive Care Unit (NICU) Nursing Skills

Neonatal Nursing Skills

Neonatal Resuscitation Provider (NRP)

Neonatal/Infant Pain Scale (NIPS)

NIH Stroke Assessment Scale Training

OB PACU Skills

OB Trauma

Oncology Nursing Skills

Oral/Bulk Medication Packaging

Orthopedic Nursing Skills

Pacemaker Operation and Troubleshooting

Palliative Care

Palliative Care Skills

Patient Assessment & Care

Peri-operative Nursing Skills

Post-Neurological Injury Nursing Skills

Post-Orthopedic Surgery Nursing Skills

Post-Trauma Injury Nursing Skills





PPE-donn-doff

Pre & Post Operative Care

Pre and Post Operative Care

Pre and Post -Operative Care

Pre and Post-Operative Care

Proper maintenance of imaging equipment

Proper use of imaging equipment

Pyxis Primer

Remote EKG & Cardiac Monitoring

RN notification process

Role & Responsibility in Code Blue

S.T.A.B.L.E.

Sepsis Management


Therapeutic Hypothermia

Total Parenteral Nutrition

Total Parenteral Nutrition Skills

Trauma Nursing Skills

Trauma Nursing Skills/TNCC Skills


Ventilator & Tracheotomy Care

Vigilanz Primer

Waste/Sharps Handling and Disposal

PL Justification and Details

Explain the need for productive laboratory (PL) training.

New employees receive both Hospital Orientation and Unit/Department Specific education and training. The Unit/Department Specific training is designed and varies in content and level of intensity based on the unit/department. Registered Nurses receive the majority of the training.

Describe the Equipment/Processes to be used in delivering PL training

Individuals will be assigned a preceptor who will teach, mentor and develop skills individuals need to complete the competencies, expected objectives and standards of care and practice required for the unit/department assigned.

Describe Trainer Qualifications:

The ultimate goal of education and training at RCH is to prepare clinical staff to provide quality, patient-centered care in a competent manner. Initially, clinical staff are provided with core skills to acclimate to the clinical environment. Over time they will become competent in the required skill set for solid clinical practices. On average, clinicians will receive 4 to 16 weeks of combined didactic and one-to-one preceptor clinical orientation.

Attachment 3 - Training Project Characteristics Details

Training Proposal for Riverside Healthcare System, L.P. 17-0795 Attachment 3: Page 1 of 1

Provided in the table are details on the training characteristics.

Characteristic Program Summary

Retrainee - Job Creation Retrainee Program

The Panel incentivizes job creation. Training for newly-hired employees is reimbursed at a higher rate, and trainees are subject to a lower post-retention wage. The date of hire for trainees is within the three-month period before contract approval, or within the term of the contract. Trainees are hired into “net new jobs” as a condition of contract. Substantial Contribution and Turnover Rate penalty requirements do not apply.

Employer must demonstrate expanded or new facilities, new equipment or machinery, expanded business capacity or other measureable investment in hiring workers and expanding their California workforce.

5480 Ferguson Drive Phone: (323)‐236‐0534

Los Angeles, Ca. 90022 Fax: (323)‐721‐3538

RETURN RECEIPT REQUESTED U.S. CERTIFIED MAIL July 7, 2017 Employment Training Panel 1100 J Street – 4th Floor Sacramento, California 95814 Sir/Madam: I’m writing on behalf of SEIU United Healthcare Workers-West. Our Union represents employees at Riverside Community Hospital. We support the application for training funding being submitted to the Employment Training Panel by Riverside Community Hospital. We fully expect hospital to use the funds on relevant trainings that will assist our members in upgrading their skills which are critical to maintaining quality patient care. Please contact me if you any further questions. Respectfully,

Ferdinand Silerio Coordinator II Hospital Division Cell: (213) 716-6734 Fax: (323) 721-3538 E-mail: [email protected] Cc: Alejandra Aguilera, Union Representative Ferdinand Silerio, Coordinator Noemi Beas , Assistant Director

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