75,000 U.S. healthcare workers of the Coalition of Kaiser Permanente Unions protest claims of unfair labor practices

By Isaac Reese, 617 Media Group

10/4/23 7:00 P.M. UPDATE: “Frontline healthcare workers are awaiting a meaningful response from Kaiser executives regarding some of our key priorities including safe staffing, outsourcing protections for incumbent healthcare workers, and fair wages to reduce turnover. Healthcare workers within the coalition remain ready to meet at any time. Currently, the strike continues, and there are no sessions scheduled at this hour,” said Caroline Lucas, spokesperson, Coalition of Kaiser Permanente Unions.

More than 75,000 Kaiser Permanente workers in multiple states are now on strike to protest unfair labor practices and Kaiser executives’ failure to bargain in good faith over unsafe staffing levels at hundreds of Kaiser hospitals and facilities across the United States. 

Over the course of just three hours, the strike at Kaiser facilities expanded from coast to coast, following months of bad faith bargaining activity by Kaiser executives and repeated appeals by frontline healthcare workers for Kaiser executives to make the kinds of investments in staffing that could help stem employee turnover and reduce growing patient wait times.  

The strike began in DC and VA at 6AM ET this morning, expanded to CO at 6AM MT, then culminated with tens of thousands of workers striking in CA, OR, and WA at 6AM PT.

In the vast majority of locations, barring an agreement, the strike is expected to last for three days. It is already the largest healthcare worker strike in U.S. history. 

Healthcare workers are taking the work action to protest Kaiser executives’ bad faith bargaining, which is getting in the way of finding solutions to solve the Kaiser short-staffing crisis by investing in its workforce.

In recent days, Kaiser executives maintaining aggressive threats of outsourcing became a sticking point in negotiations, especially at a time when the company is failing to retain key employees. 

“Kaiser executives are refusing to listen to us and are bargaining in bad faith over the solutions we need to end the Kaiser short-staffing crisis,” said Jessica Cruz, a licensed vocational nurse at Kaiser Los Angeles Medical Center. “I see my patients’ frustrations when I have to rush them and hurry on to my next patient. That’s not the care I want to give. We’re burning ourselves out trying to do the jobs of two or three people, and our patients suffer when they can’t get the care they need due to Kaiser’s short-staffing.”

Strike lines are set up at Kaiser Permanente hospitals and medical office buildings across the country, including California, Colorado, Washington, Oregon, Virginia and Washington, D.C. 

Workers on strike include those employed as licensed vocational nurses, emergency department technicians, radiology technicians, ultrasound sonographers, teleservice representatives,  respiratory therapists, x-ray technicians, optometrists, certified nursing assistants, dietary services, behavioral health workers, surgical technicians, pharmacists and pharmacy technicians, transporters, home health aides, phlebotomists, medical assistants, dental assistants, call center representatives, and housekeepers, among hundreds of other positions.

BACKGROUND

The Coalition of Kaiser Permanente Unions represents 85,000 Kaiser healthcare workers in seven states and the District of Columbia. In April, the Coalition began its national bargaining process ahead of the September 30th contract expiration. On Sept. 22, Coalition unions representing 75,000 Kaiser healthcare workers gave Kaiser executives 10-day notices for an unfair labor practice strike beginning Oct. 4. The Coalition and Kaiser Permanente last negotiated a contract in 2019, before healthcare workers found themselves on the frontlines of the COVID pandemic that has worsened working conditions and exacerbated a healthcare staffing crisis.

At issue, healthcare workers say, are a series of unfair labor practices related to bargaining in bad faith, along with simmering staff concerns related to unsafe staffing levels that can lead to dangerously long wait times, mistaken diagnosis, and neglect. After years of the COVID pandemic and chronic understaffing, Kaiser healthcare workers are calling on management to provide safe staffing levels.

Workers say that Kaiser is committing unfair labor practices and also that understaffing is boosting Kaiser’s profits but hurting patients. In a recent survey of 33,000 employees, 2/3 of workers said they’d seen care delayed or denied due to short staffing. After three years of the COVID pandemic and chronic understaffing, healthcare workers at Kaiser Permanente are calling on management to provide safe staffing levels.

Kaiser has reported ​​$3 billion in profits in just the first six months of this year. Despite being a non-profit organization – which means it pays no income taxes on its earnings and extremely limited property taxes – Kaiser has reported more than $24 billion in profit over the last five years. Kaiser’s CEO was compensated more than $16 million in 2021, and forty-nine executives at Kaiser are compensated more than $1 million annually. Kaiser Permanente has investments of $113 billion in the US and abroad, including in fossil fuels, casinos, for-profit prisons, alcohol companies, military weapons and more.

The Coalition of Kaiser Permanente Unions unites more than 85,000 healthcare workers at Kaiser Permanente facilities in California, Colorado, Oregon, the District of Columbia, Hawaii, Maryland, Virginia, and Washington

Kaiser issued a statement last month responding to the then-threatened strike.

Allen D. Payton contributed to this report.

By Antonia Ehlers, PR & Media Relations, Kaiser Permanente Northern California

Kaiser Permanente is the largest union-represented health care employer in the U.S. – with nearly 75 percent of our employees represented by unions. We are currently bargaining with the Coalition of Kaiser Permanente Unions, which represents about 88,000 employees in a variety of roles. The Coalition is part of our historic, 26-year-long Labor Management Partnership, the longest-lasting partnership of its kind in the country.

Kaiser Permanente is fully committed to reaching an agreement with the unions affiliated with the Coalition just as we have done in every national bargaining since 1999. Our priority is to reach an agreement that is mutually beneficial and ensures we can continue to offer our people market-competitive pay and outstanding benefits. We are confident that we will reach an agreement that achieves that goal, before the contract expires on September 30. And we are confident that our new agreement will strengthen our position as a best place to work and ensure the high-quality care our members expect from us remains affordable and easy to access.

Strike Authorization Vote

Strike authorizations are a common bargaining pressure tactic that give union leaders the ability to call for a strike in the future. Throughout our negotiations we have seen Coalition leaders attempt to rally their unions’ members to threaten a strike despite important progress made through negotiations.

This tactic does not reflect any breakdown in bargaining, nor does it indicate a strike is imminent or will happen at all. It is a disappointing action considering our progress at the bargaining table. It does not reflect our commitment to reaching an agreement that ensures we can continue to provide market-competitive pay and outstanding benefits.

We urge our employees to reject any call for a strike and continue to focus on providing care and service to the patients who need them. We take any threat to disrupt care for our members seriously and have plans to ensure continued access to health care by our members, patients, and the communities we serve, should any union call for a strike. Our members, patients, and our communities need us to be there for them.

Allegations of Unfair Labor Practices

From the start, we have bargained in good faith to come to an agreement, working diligently in partnership to address the many complex issues at the table. This week, over the course of our sixth formal negotiation session since national bargaining began in April, we offered proposals on important issues including improvements to the performance sharing bonus plan (PSP) and an enterprise-wide guaranteed minimum wage for our Coalition-represented employees. In addition, committees met on staffing, operational savings, and local bargaining agreements.

As always, one of the key issues in this bargaining involves compensation and Kaiser Permanente has made clear we are standing by our proven commitment to provide market-competitive wages and excellent benefits. In fact, as a leading employer, our philosophy is to pay our employees above the local market, to attract and retain the best employees.

Bargaining is dynamic and involves give-and-take. Accusations from union leaders that Kaiser Permanente has not bargained in good faith are unfounded and counterproductive.

We take bargaining seriously and believe that our employees deserve market competitive wages and excellent benefits. We are hopeful union leaders will set aside the counterproductive tactics of this week, so we can focus on working together to deliver an agreement. We remain committed to bargaining with our Coalition unions in good faith and in the spirit of partnership. We will focus our energy on frank and productive discussions that lead to an agreement, and to doing our part to ensure there are no disruptions to the high-quality care we provide.

Staffing

We, like all health care organizations, have experienced staffing challenges driven by the pandemic and its lasting effects. For healthcare systems this has been made worse by the backlog in care and the increase in needs and acuity we’re seeing across the country.

While Kaiser Permanente has experienced the same pressures, through diligent work and an unwavering commitment to our people, we have weathered these staffing challenges better than most health care organizations. Kaiser Permanente’s average employee turnover rate of 8.5 percent, as of June 2023, is significantly lower than the rate of 21.4 percent across health care. Talented people who recognize the value of our current wage and benefit offerings want to work at Kaiser Permanente, which is why about 96 percent of candidates for Coalition-represented positions accept our employment offers—significantly above the industry average.

Kaiser Permanente and the Coalition have agreed to work together to accelerate hiring, and we set a joint goal in bargaining of hiring 10,000 new people for Coalition-represented jobs in 2023. Kaiser Permanente’s efforts to date have resulted in more than 6,500 positions filled, and we are aggressively recruiting to fill more.

Our staffing approach reflects our shared commitment to ensure every Kaiser Permanente patient receives extraordinary care, every time and in every place.

Wages and Benefits

We are leaders in employee wages and benefits, and we have reiterated our commitment in bargaining to continuing to provide market-competitive wages and outstanding benefits. In fact, our philosophy is to deliver compensation that provides wages above the local market (up to 10 percent above market) to attract and retain the best employees.

Kaiser Permanente also offers employees opportunities to learn new skills and grow their careers, and we’re committed to providing a safe and equitable work environment. In addition, we want to ensure that we help our employees build long-term economic security with low-cost health insurance, industry-leading retirement plans, and other benefit programs to support their health and well-being.

It’s also worth remembering that during the pandemic, we took extraordinary steps to support and protect our workforce, and to support their mental as well as physical health. We provided $800 million in employee assistance to ensure that front-line employees had access to alternate housing options, special child care grants, and additional paid leave for COVID-19 illness and exposure.

The unions’ current negotiating position is that wage increases should not be market-based. This prevents us from addressing wage disparities that exist in in many of Kaiser Permanente’s markets where, for some jobs, wages are significantly higher than our targeted wage level, and in other cases our employees’ wages are below other competitors in the market, impacting our ability to attract and retain the best people.

While being a best-in-class employer is a fundamental part of who we are, we cannot continue a national approach for determining wages and ignore local market conditions. We also have a responsibility to make health care more affordable for our patients, members, and customers, including government agencies. For many families and businesses, health care costs are increasingly unaffordable, and growing. Wages and benefits make up about half the cost of health care, across the country. We must work together with unions on the critical goal of ensuring that health care remains affordable.

We are committed to our philosophy of providing market-competitive pay and excellent benefits, and we’ve made that clear in bargaining. We are committed to addressing areas where staffing is challenging, and we are making great progress. And we are committed to doing all this while striving to help health care be more affordable.

85,000 Kaiser Permanente healthcare workers to hold strike authorization vote Monday over what they claim are unfair labor practices, say chronic under-staffing is driving a growing patient care crisis

By Renée Saldaña, Press Secretary, SEUI – United Healthcare Workers West

A strike may be looming at one of the nation’s largest employers.

On Monday August 28, Kaiser workers in California, including Antioch, will start to vote to authorize a strike over unfair labor practices. The voting ends September 12th.   The unions will strike dates soon after we get the results of the vote. The contract expires for a large bulk of the Kaiser workers in the coalition (58,000) on September 30th, so a strike could potentially start as early as October 1.

We are expecting a majority of the workers to vote in favor of a strike. We will keep you posted on any other developments.

On Thursday, August 24, healthcare workers employed by Kaiser Permanente announced details of a potential strike authorization vote at a hybrid in-person and virtual press conference.

Following the UPS labor settlement with the Teamsters, the labor negotiations covering 85,000 Kaiser healthcare workers – represented by the Coalition of Kaiser Permanente Unions – have now become the largest single-employer labor negotiations occurring in the United States. The Coalition unites healthcare workers at Kaiser Permanente facilities in California, Colorado, Oregon, the District of Columbia, Hawaii, Maryland, Virginia, and Washington.

At issue, healthcare workers say, are a series of unfair labor practices related to contract bargaining, along with simmering staff concerns related to unsafe staffing levels that can lead to dangerously long wait times, mistaken diagnosis, and neglect.

If Kaiser executives don’t take swift action to rectify the unfair labor practices that detailed at the press conference, workers say they’ll have no choice but to strike. Workers also say the company needs to immediately and substantively address the growing care crisis at its hospitals and clinics.

Barring a breakthrough in the ongoing negotiations including a resolution of the unfair labor practices in question, the healthcare workers announced the strike authorization vote date and plans.

“Kaiser cannot keep bargaining in bad faith and committing unfair labor practices. Kaiser is facing chronic under-staffing because workers can’t afford to live in LA on the low wages they pay us,” said Miriam de la Paz, a unit secretary at Kaiser Permanente in Downey, California. “If Kaiser’s millionaire executives won’t work with us on a plan to hire more people so we can give every patient the attention they deserve, we’re prepared to vote for an unfair labor practice strike.”

“We want Kaiser to stop committing unfair labor practices, and bargain in good faith. It’s heartbreaking to see our patients suffer from long wait times for the care they need, all because Kaiser won’t put patient and worker safety first,” said Paula Coleman, a clinical laboratory assistant at Kaiser Permanente in Englewood, Colorado. “We will have no choice but to vote to strike if Kaiser won’t let us give patients the quality care they deserve.”

“Our patients expect more from a healthcare system that reported $3 billion in profits in the first half of this year alone, and so do we,” said Nahid Bokaee, a Pharmacist in Sterling, Virginia. “Kaiser can afford to end this dangerous understaffing, but they choose not to. For the sake of our patients and our colleagues, we’re prepared to authorize a strike because Kaiser cannot keep bargaining in bad faith and committing unfair labor practices.”

BACKGROUND

The Kaiser healthcare workers are members of the Coalition of Kaiser Permanente Unions, which represents more than 85,000 healthcare workers in seven states and the District of Columbia. In April, the Coalition began its national bargaining process. The Coalition and Kaiser Permanente last negotiated a contract in 2019, before healthcare workers found themselves on the frontlines of the COVID pandemic that has worsened working conditions and exacerbated a healthcare staffing crisis.

Tensions have been rising as the workers’ contract expiration looms. Earlier this month tens of thousands of healthcare workers picketed Kaiser hospitals across the U.S. to protest the company’s growing care crisis.

Workers say that Kaiser is committing unfair labor practices and also that under-staffing is boosting Kaiser’s profits but hurting patients. In a recent survey of 33,000 employees, two-thirds of workers said they’d seen care delayed or denied due to short staffing. After three years of the COVID pandemic and chronic understaffing, healthcare workers at Kaiser Permanente are calling on management to provide safe staffing levels.

Even as some frontline healthcare heroes live in their cars and patients wait longer for care, Kaiser released new financials this month indicating they made ​​$3 billion in profit in just the first six months of this year. Despite being a non-profit organization – which means it pays no income taxes on its earnings and extremely limited property taxes – Kaiser has reported more than $24 billion in profit over the last five years. Kaiser’s CEO was compensated more than $16 million in 2021, and forty-nine executives at Kaiser are compensated more than $1 million annually. Kaiser Permanente has investments of $113 billion in the US and abroad, including in fossil fuels, casinos, for-profit prisons, alcohol companies, military weapons and more.

At Antioch and other locations in California; Fresenius says they’re “committed to bargaining in good faith”

By Renée Saldaña, SEIU-United Healthcare Workers West (SEIU-UHW)

Fresenius and Satellite Healthcare dialysis caregivers across California are the latest round of healthcare workers to join statewide protests over the short-staffing crisis in the state’s healthcare system. Protests will be held on August 9th and 10th at 21 locations, including Antioch, San Francisco, San Jose, San Diego, Riverside, and Orange.

“We are severely understaffed and stretched so thin. We used to have a one to three patient ratio, but over the years it’s become one to eight, and if someone calls out sick it becomes one to twelve. It happens a lot,” says Jose Manuel Gonzalez, a certified hemodialysis technician preceptor III at Fresenius Kidney Care for over 25 years. “We have to rush, to work as fast as we can, and the quality of service really suffers. I’m considering patient care, regardless of how the company treats us. The company should care more.”

In response to caregivers’ attempts to improve care and safety for dialysis patients, management has violated United States labor law. Both employers have threatened and intimidated caregivers, including firing caregivers for leading the organizing efforts and speaking out to improve patient care. The union has filed unfair labor practice charges with the National Labor Relations Board against both companies for these illegal acts, including one against Satellite Healthcare for canceling all bargaining sessions scheduled for July and August. 

Legislators are also lending their support to the struggle of dialysis caregivers to improve conditions. In a letter of support, U.S. Representative Robert Garcia (D-CA-42), wrote:

“Across the industry, I understand that dialysis clinic caregivers continue to struggle with low wages, inadequate training, and chronically low staffing levels. These working conditions often lead to high turnover as caregivers leave the industry because of burnout or transfer to another healthcare sector where pay is higher. These factors deprive patients of experienced and consistent support.”

The ongoing protests by dialysis and other healthcare workers are part of a larger movement of workers across the country who are taking a stand against poor working conditions, low wages, exorbitant corporate profits, and excessive executive pay. Dialysis workers are joining over 85,000 Kaiser Permanente, Prime, and other healthcare workers who launched protests in July to improve patient care and staffing.

The chronic short-staffing in dialysis care has allowed for-profit dialysis corporations to make hundreds of millions in profits. Fresenius medical care made nearly $720 million in profits and paid its CEO nearly $5 million in compensation in 2022. Satellite Healthcare made $16.7 million in profits and paid its CEO $1.5 million in compensation in 2021.

In contrast, many dialysis caregivers make as little as $20 an hour and routinely hold two or more jobs just to make ends meet.

SEIU-UHW represents more than 600 dialysis caregivers at Fresenius and Satellite Healthcare in various job classes including registered nurses, patient care technicians, licensed vocational nurses, certified clinical hemodialysis technicians, dietitians, social workers, clinical administrative coordinators, and receptionists.

SEIU-United Healthcare Workers West (SEIU-UHW) is a healthcare justice union of more than 100,000 healthcare workers, patients, and healthcare activists united to ensure affordable, accessible, high-quality care for all Californians, provided by valued and respected healthcare workers. Learn more at www.seiu-uhw.org.

Fresenius Kidney Care Responds

In response, Fresenius issued the following statement: “There is nothing more important than the safety of our patients and our team members. In fact, in 2022, for the seventh consecutive year, Fresenius Kidney Care led the industry with 99.63% of our facilities, achieving 5-Diamond Patient Safety status, a program endorsed by the American Nephrology Nurses’ Association (ANNA) and several other organizations in the industry.  

We use a staffing tool to align staffing needs with patient care requirements in order to provide safe and effective care. We constantly monitor census and staffing fluctuations and redeploy staff accordingly to maintain safe staffing levels. We maintain staff float pools and use both internal and external agency support to fill gaps.

Healthcare as an industry in general continues to face staffing challenges. We continue to address the recruitment needs where we provide care and are actively hiring for clinical care roles. 

We recently began negotiations with SEIU-UHW and are committed to bargaining in good faith to reach agreements that are fair to team members and enable Fresenius Kidney Care to continue its mission of providing life-sustaining care to patients. 

We fully believe that the dedication and passion of all our team members should be recognized and rewarded. That’s why we offer competitive compensation, benefits and development programs that support our team members personally and professionally.”

Kaiser says pickets, actions at hospitals July 24-29 aren’t strikes, facilities remain open

By Allen D. Payton

The 85,000-member Coalition of Kaiser Permanent Unions is holding nationwide pickets and actions at Kaiser hospitals and facilities, this week, July 24-29 to protest staffing shortage and wages, less than three months from their contract expiration on September 30. The two sides are in the midst of bargaining and the next session is scheduled for Tuesday, August 1. The one-day protest at the Kaiser Medical Center in Antioch was held yesterday.

The Coalition unites 85,000 members of four international unions at Kaiser hospitals, clinics, and facilities throughout the United States.

In a July 13, 2023 post on their website labeled “Bargaining Update 4”, the coalition claims, “At bargaining this week, the ‘non-profit’ that pays its CEO $16 million a year gave a clear message to the EVS (environmental services) worker raising a family on $48K a year in LA: ‘You make too much money.’

It’s unbelievable. Kaiser pays 49 executives more than a million dollars a year, but they think a PCT (patient care technician) earning $52K a year in Portland is making Kaiser unaffordable. The corporation that has over $113 billion in investments – including questionable ventures around the world – believes they are paying healthcare workers $450 million a year too much in wages that are ‘over market.’

We will be submitting a full economic proposal – including wages – at our next bargaining session on August 1, but the fault lines in negotiations are becoming more and more clear: our Coalition spoke about how we are falling behind, struggling to afford living where we work, and losing ground to rising costs. Kaiser spoke about outsourcing more of our work to low wage, for-profit companies – undermining middle class jobs.”

The unions have offered a list of concerns and demands:

• We want Kaiser to grow as a union company with leading wages, benefits, and quality care. Instead, Kaiser is spending $5 billion of our patients’ premiums to launch a non-union, non-partnership company that will lower labor standards.
• We want a guaranteed PSP payout we can count on when we reach our goals. Kaiser is still defending their shameful decision to deny frontline caregivers our PSP while paying big bonuses to managers.
• We want Kaiser to make meaningful investments in solving the staffing shortage: increase training funds, eliminate barriers to promotion, justify unposted vacancies, create paid externships, provide referral/ retention and recruitment bonuses, and dial back wasteful registry spending.

The coalition further claims, “It’s clear that the only way that we will get Kaiser to listen to us is to make some noise.”

Kaiser Responds: Not Strikes, Hospitals & Facilities Remain Open

Kaiser Permanent responded with a statement that the events are not strikes and their facilities remain open.

Following is the complete Statement from Kaiser Permanente on Coalition picketing July 24 to 29:

“It’s important for our members and patients to know that these events are not strikes. Our medical facilities will remain open and operate normally.

Kaiser Permanente is the largest union-represented health care employer in the U.S. — with nearly 75% of our employees represented by unions. We are currently bargaining with the Coalition of Kaiser Permanente Unions, which represents about 88,000 employees in a variety of roles and is part of our historic Labor Management Partnership.

Our priority is to reach an agreement that ensures we can continue to provide market-competitive pay and outstanding benefits. We are confident we’ll be able to reach an agreement that strengthens our position as a best place to work and ensures that the high-quality care our members expect from us remains affordable and easy to access.

Given where we are in the bargaining process, it’s clear the picketing by the Coalition isn’t about drawing attention to new issues, but rather an attempt to create bargaining leverage.

We have been and will continue to address the real issues that are affecting health care and our employees. On the heels of the global pandemic and given today’s economy, these challenges include inflation and rising costs to deliver health care, increasing competition from nontraditional businesses, labor shortages, supply chain disruptions, and increases in the demand for access to health care. We look to the Coalition to be a constructive partner in helping address these and other challenges affecting us all.

Staffing

The staffing challenges mentioned by the Coalition have been happening all across health care but are actually less true at Kaiser Permanente now than elsewhere.

It’s worth remembering that during the pandemic, we took extraordinary steps to support and protect our workforce. This included providing $800 million in employee assistance to ensure that front-line employees had access to alternate housing options, special child care grants, and additional paid leave for COVID-19 illness and exposure.

The average employee turnover rate across health care is 21.4% (Source: PwC Saratoga 2022 Survey). While it crept up a bit during the height of the pandemic, we are thankful that our current rate of 8.5% as of June 2023 is significantly lower than the rest of health care.

At the beginning of bargaining in April, Kaiser Permanente and the Coalition agreed to a joint goal of hiring 10,000 new people for Coalition-represented jobs in 2023. We are making great progress toward achieving that goal.

Talented people want to work at Kaiser Permanente, which is why 96% of candidates accept our employment offers, which is 5.3% above the U.S. health care industry average (Source: PwC Saratoga 2022 Survey).

Our staffing approach reflects our shared commitment to ensure every Kaiser Permanente patient receives extraordinary care, every time and in every place.

Wages and Benefits

We are one of the leaders in employee wages and benefits in every market we’re in. We offer employees market-competitive pay and outstanding benefits, opportunities to learn new skills and grow their careers, and we’re committed to providing a safe and equitable work environment. We also want to ensure that we help our employees build long-term economic security with low-cost health insurance, industry-leading retirement plans, and other benefit programs to support their health and well-being.

We have discussed with the Coalition that in some regions Kaiser Permanente is paying Coalition-represented employees up to 28% above the market average wage rates — impacting our overall costs and ability to attract new members. In other regions, we are paying at or slightly above the market average, which hurts our ability to attract new employees and retain the excellent employees we already have.

We look forward to continuing to work collaboratively with our union partners in bargaining. We will reach a great agreement. To get there, we all need to be responsible stewards of our members’ and customers’ needs and resources and be mindful of the rising costs of health care and our collective role in addressing it.”

By Renée Saldaña, SEIU-United Healthcare Workers West (SEIU-UHW)

Starting the week of April 10, healthcare workers at medical facilities across California, including Walnut Creek and Antioch, will hold events to speak out against the dangers of short staffing and the effects on patients and caregivers.

On Tuesday, a protest will be held at Kaiser Permanente in Walnut Creek from 11 am to 1 pm and on Wednesday, another protest will be held at Kaiser Permanent on Sand Creek Road in Antioch, also from 11 am to 1 pm.

“After years of understaffing and dealing with the pandemic, we are stretched thin and burnt out. Healthcare workers are leaving the field, and those of us who have stayed are doing the work of two or three people. We can’t give our patients the care they deserve without enough staff,” said Datosha Williams, a service representative at Kaiser Permanente. “We are calling on Kaiser to do what it takes to hire more caregivers so that we can deliver the best care possible for our patients.”

After three years of the COVID pandemic and chronic understaffing, healthcare workers are calling on management to provide safe staffing levels and additional support. Caregivers say that short-staffed hospitals can lead to long wait times, mistaken diagnoses, and neglect, making it harder to give patients quality care.

Even before the pandemic, California faced a massive shortage of allied healthcare workers to care for its aging population — as many as 65,000 workers annually, according to conservative estimates. The stress and the toil of fighting the pandemic has led many to leave the industry, creating a full-blown healthcare staffing and patient care crisis.

A survey of over 30,000 SEIU-UHW members, Crisis in Care, highlighted the short-staffing crisis in California, with 83% of responding healthcare workers saying their facility is understaffed. At the same time, healthcare corporations are reporting record profits.

The Physicians’ and Dentists’ Organization of Contra Costa (PDOCC), a labor union representing more than 240 doctors in Contra Costa County’s public health system, announced a contract agreement with county management. 

The agreement was supported by 90 percent of voting PDOCC members and approved by the County Board Supervisors on Tuesday, May 21. It avoids a historic strike which would have impacted operations throughout the county health system. 

The contract enhances the time doctors have to manage their panels of patients and also makes the compensation package more competitive in the Bay Area market. 

The contract addresses many issues PDOCC members raised in their negotiations. During the negotiations county doctors and dentists pointed to high patient caseloads, insufficient time for administrative tasks, long waits for primary care appointments and specialty referrals, chronic short staffing and high turnover – all of which combine to negatively impact patient care and health impacts. 

“Our new contract advances our goal of improving the ability of Contra Costa County to recruit and retain top medical and dental talent to best serve our communities,” said Dr. David MacDonald, PDOCC President. “We will continue advocating for the patient care issues we called attention to in our negotiations, but we are optimistic about our progress and path forward.” 

 

In the midst of contract negotiations

“a physician vacancy does not mean that there is a clinical vacancy, nor that care is compromised.” – Kim McCarl, CCHS

“A bigger medical and dental staff would help alleviate some of the load that our current employed members are carrying.” – Dr. David MacDonald, President, PDOCC

By Allen D. Payton

Last month the Physicians’ and Dentists Organization of Contra Costa (PDOCC) released data showing a high number of doctor vacancies in Contra Costa County Health Services.

According to a Feb. 16, 2023, PDOCC press release, based on county data, there are currently 83 out of 285 employed positions listed as vacant in Contra Costa Health Services, a 29 percent vacancy rate in the system. That includes 27 vacant positions in family medicine and primary care adult medicine, 5 vacant dentist positions and 5 vacant OB/GYN positions. With 19 vacant psychiatrist positions, only 27 percent of employed psychiatry positions are currently filled. 11 vacant employed positions in the emergency department – half of the department’s employed positions – means the county is unable to safely staff the emergency room.

Since November, 5 emergency department doctors have left county employment. The county interviewed and offered positions to 21 new emergency department applicants, but the offer was declined by every applicant.

The problem is expected to get a lot worse in 2024 when Contra Costa County will need an additional 40 primary care providers to care for 30,000 new Medi-Cal patients being added to the county’s health services due to an agreement between the county and California’s Department of Health Services.

The problem continues to worsen. Contra Costa County Health Services added 12,200 patients in the last two months, while only adding 1 new primary care physician. The result is that the average primary care physician employed by the county now has almost 200 more patients on their panel than at the end of 2022. There are no new primary care physicians anticipated to join county employment before July 2023.

On average, the county has only been able to fill three primary care doctor vacancies annually over the last three years.

In response, CCHS Communications Officer Kim McCarl, said doctor shortages are a nationwide challenge, are not compromising care, and confirmed that negotiations between the union and county “are underway”.

She wrote, “We value the medical staff who work across our department.

Health systems across the country are struggling to recruit and retain medical staff at all levels. Contra Costa Health is no different.

It’s important to note that a physician vacancy does not mean that there is a clinical vacancy, nor that care is compromised. We are confident that the right provider is caring for the right patient in the right way at Contra Costa Regional Medical Center and Health Centers every day.

We provide flexibility in work schedule, an emphasis on proactive care, and mission-oriented work that helps us recruit and retain physicians who want to practice in an integrated environment. It’s not uncommon for our physicians to be expert in many areas of clinical medicine which our system values.

We value physicians who embrace our mission and choose to work for Contra Costa Health on a full-time, permanent basis but we also welcome doctors who take a less traditional approach to their careers by working part time or in partnership with other health care entities. These approaches help to alleviate the burnout that has been so costly to hospitals and healthcare systems since the height of the pandemic.

We are proud to be home to one of the most highly rated family medicine training programs in the country. We recruit well-trained physicians who are familiar with our system from each graduating class.

Recruitment and retention of physicians is a top priority at Contra Costa Health. We will continue to explore ways to fill every vacancy across our healthcare system.”

Doctors, Dentists Disagree

That opinion, however, is not shared by the county’s doctors and dentists or by best practice standards for patient care.

The severe shortages most certainly impact patient care, including the time a physician can devote to each patient along with the availability of appointments, according to county doctors.

Contra Costa County’s own policies recommend no more than 1,500 patients to a primary care physician’s panel (the number of patients assigned to a physician). Currently the average panel size for Contra Costa’s employed primary care physicians is 1,879.

“County leaders may be willing to turn a blind eye to severe staffing shortages, but doctors care too much about our patients to let the problem go unaddressed any longer,” said Dr. David MacDonald, PDOCC President. “We hear from patients all the time about how difficult it is for them to schedule appointments in our system. When they finally get an appointment, it is rarely for the amount of time they need because doctors are overstretched and taking on more patients because of all the vacancies. The patients who rely on Contra Costa County Health Services for care should not have to settle for less time and attention than patients in other systems or ones with private healthcare.”

In addition to the primary care vacancies, there are 5 vacant dentist positions and 5 vacant OB/GYN positions. With 19 vacant psychiatrist positions, only 27 percent of employed psychiatry positions are currently filled. 11 vacant employed positions in the emergency department – half of the department’s employed positions – means the county is unable to safely staff the emergency room.

The problem is expected to get exponentially worse in 2024 when Contra Costa County will need an additional 40 primary care providers to care for 30,000 new Medi-Cal patients being added to the county’s health services due to an agreement between the county and California’s Department of Health Services.

PDOCC is calling on county leaders to be proactive by filling the position vacancies which will improve patient care and support county revenues. “It’s hard to believe that Contra Costa County is not working more closely with our union to help it become more attractive and competitive in retaining and recruiting medical and dental talent. I believe the county is moving in the wrong direction and I’m concerned that patients are being put at risk,” MacDonald said.

PDOCC members are currently in negotiations with county management towards a new contract. Issues raised in negotiations by PDOCC members include high patient caseloads, insufficient time for administrative tasks, long waits for primary care appointments and specialty referrals, chronic short staffing and high turnover – all of which combine to negatively impact patient care and health impacts. PDOCC members also state that burnout is at an all-time high.

County Health, PDOCC Respond to Questions

Questions were sent to both McCarl and the union’s spokesman asking if the PDOCC is in the midst of contract negotiations with the county and if so, is this an effort to obtain an increase in compensation for its members.

While McCarl responded, “Yes, negotiations are underway” she did not respond to the additional question about their criticism.

The questions were also sent Tuesday afternoon to PDOCC president, Dr. MacDonald with the .

He responded, “PDOCC is engaged with Contra Costa County in negotiations at the level of state mediation. We have one more session to go.

We are focused on improving patient care and making the workplace in Contra Costa Health Services (CCHS) more sustainable.

We have to be able to hire new medical and dental talent, so compensation has to be more market competitive. This would also help with retention. A bigger medical and dental staff would help alleviate some of the load that our current employed members are carrying. The situation at this time is untenable. And, per an agreement between CCHS and the state’s Department of Health Services, CCHS will become the single system to provide care for MediCal patients in the county (aside from small fraction of MediCal patients covered by Kaiser). This will mean for an additional 30,000 new patients into our system as of January 1, 2024. We’re not ready for that. We will need an additional 40 new primary care providers to handle the influx of new patients. The County is nowhere close to hiring that many (I believe the County has 3 new providers scheduled to start after July of this year).

In addition, half of our emergency department employed positions are vacant. This means that the County partially fills the gap with very expensive temp doctors. We think it would be smarter for the County to take the funds doled out to temps and invest that money in committed, dedicated and County career minded docs who will be here for the long term.

Another issue is that our primary care providers need more protected time to manage their patient panels. The in-basket work – lab follow up, med refills, answering patient calls & emails, etc., has been escalating. Our physicians take this work home with them and it takes away time from their families and individual restorative activities.

All of this after the three-year pandemic onslaught has left our physicians and dentists suffering more from burnout than ever before. The County must step up, be proactive, and work with our union on how to achieve meaningful improvements that will enhance patient care and move our system in the right direction.”