DPH seeks $1.5M amendment to cover past Trifecta registry invoices; committee refers to full board without recommendation

The Department of Public Health on April 24 asked the Budget and Finance Committee to approve Amendment No. 3 to the Trifecta nursing registry contract, increasing the not‑to‑exceed amount by $1.5 million to $11.4 million to cover invoices incurred in March–May 2023.

Troy Williams, DPH’s new chief nursing officer, said extraordinary pandemic surges and Laguna Honda recertification training required registry nurses to backfill positions while permanent staff completed thousands of hours of training. Williams described four primary drivers for registry usage—long‑term leave backfill, temporary vacancies, patient surges, and onboarding time for new hires—and said registry represented roughly 4% of nursing staffing for FY23–24, below typical national averages.

DPH outlined hiring progress and new oversight measures: 135 RN positions added since 2019, a goal of reducing RN vacancy to no more than 5% by the end of the fiscal year, daily tracking of registry use at Laguna Honda and ZSFG, a registry review committee and biweekly HR‑nursing leadership meetings to accelerate hiring. DPH said it intends to exhaust the increased authorization and close the contract after paying the owed invoices.

The Budget and Legislative Analyst flagged two issues: high hourly billing rates on the contract (noted at $150/hr in earlier years, higher than comparable cross‑country registry rates and top civil‑service rates) and lack of granular performance metrics tracked against this contract. BLA also noted the late submission of the amendment to the Board and recommended the Board treat the amendment as a policy matter.

Supervisors pressed DPH on whether the amendment was truly retroactive and asked for clearer guarantees that the payment is to settle past invoices rather than an open extension. DPH and the controller said the current amendment request removes retroactive language because the contract term was still active; they said Board approval would raise the not‑to‑exceed to allow settlement of final invoices and that no further authority to spend would remain under the Trifecta contract after the amendment is approved and paid.

Given the fiscal concerns and the magnitude of nursing overtime and registry spending discussed in recent meetings, Chair Connie Chan moved to forward the item to the full Board without a recommendation. The committee approved that motion.