California’s Health Care Crisis
Photo by Kyle Oster/Shutterstock.com
Patients and visitors to Sutter Health’s shiny new hospital in Santa Rosa, California, are greeted with large banners, “Heroes Work Here.” This no doubt is true. At Kaiser Permanente’s hospitals we learn much the same, the giant HMO has awarded itself five stars for service. And this of course is all about COVID-19.
California’s new spike in COVID cases is centered in Los Angeles, but it has moved throughout the state, including into the sprawl that follows U.S. 101 through Sonoma County’s wine country. As I write, California, leading the country, has recorded half a million cases, with 10,000 deaths so far. Sonoma County, largely spared until now, reports 400 new cases in just the last 2 weeks.
Inside Sutter’s new facilities, the doctor’s offices are quiet; much of the work is now done on video. But the hospital is another story. The confusion begins at the doorway, crowded with nursing assistants, “security” and often frantic patients, waiting to be screened. It’s chaotic. And it’s not just at Sutter. Just down the freeway in Santa Rosa center, these “heroes” have been on strike at Memorial, part of the Washington state-based Providence Health chain. Memorial workers are demanding proper safety on the job and protection of their own health benefits. They have worked without a contract for more than a year.
Why? “We don’t have enough PPE to keep us safe, but management wants us to pay twice as much to insure our families,” says Shannon Signer, a radiology technician at Memorial. At the same time, doctors in the OR are reported to have N-95 masks, but nurses and others only have surgical masks. These conditions are statewide, as are furloughs, short time cuts in pay and benefits.
The strikers at Memorial report that while the chain lavishes its executives with six-figure bonuses, it demands that its “heroes” accept insufficient PPE, unsafe staffing levels, cuts to paid-time-off, including sick leave, and sharp increases in health care costs, including more than doubling the coast of annual premiums over four years for the most popular family plan from $1,817 to $4,609.
“Our health has never been at greater risk. We need our hospital to support us, not to squeeze us for every last dime during this pandemic,” says Signer. It might be added that these same workers bore the brunt of two disastrous wildfires. In the deadly Tubbs fire of 2017, in the neighborhoods in Santa Rosa set ablaze, workers were called to work, some even as their own homes burned.
Everyone has heard of plastic garbage bags in place of PPE and the alarming number of healthcare workers infected, some dying, across the county. California liked to think it was different, that it had flattened the curve early on and that it was safe to open up. But few believed this in the hospitals where most patients are not tested when admitted, not unless they are known to have COVID. Staffing shortages are commonplace and access to PPE problematic—workers are often anxious, highly stressed and scared.
California’s hospitals are barely regulated and then the regulations that do exist are unlikely to be enforced, resulting in this self-inflicted catastrophe. And this in an industry much of which remains awash with cash. Memorial netted $201 million in operating profits over the last three years. Providence operates 51 hospitals and 1,100 clinics, mostly in the western states. A New York Times feature suggested the health care giant “resembled a Silicon Valley powerhouse as much as a health care company.” It reported $12 billion in cash reserves in 2019, yet it still received half a billion in government COVID stimulus funds. It’s CEO, Rod Hochman receives a salary of more than $10 million annually, typical of profit-maximizing executives who can’t be trusted to do anything else. Nevertheless, it began furloughs in July, and notified workers to expect pay cuts. Its workers, despite all this, fight to keep themselves and their patients safe, while trying to keep from drowning in debt, victims of a failed healthcare system in a failing state.
The story is much the same in Southern California. The Fountain Valley, a hospital in the Tenet chain in Orange County neglects to test all newly admitted patients for COVID. It requires workers to care for both COVID positive and non-COVID patients on the same shift, while wearing the same protective face coverings. And it refuses to test workers who have been potentially exposed to COVID, while forcing many to continue working in the hospital, whatever the risk.
“It’s completely unsafe,” says Christina Rodriguez, a respiratory therapist at Fountain Valley. She suffers from asthma and must social distance from her husband who is a cancer patient. “They only care about their bottom line. Cases are going up. Incidents of exposure are going up. We’re at war with something we cannot see and we’re expendable.” In early July at least four Fountain Valley nursing assistants tested positive for COVID.
Not every worker wants their name in print, not in an industry that routinely imposes gag rules on its employees and when unsuccessful responds with bullying and retaliation. In Southern California, a year ago an EVS (cleaner) worker could be fired for not immediately disposing of an N95 mask on leaving the room of a TB patient. This summer, one worker, a janitor as well, had to clean rooms with no PPE at all. In a COVID patient’s room, he was infected; he then took the virus home and infected his family and children. Today, few hospitals allow for one mask per patient. Some allow for only one for an entire shift, others one for a week, still others only when they are shown to be contaminated with blood or bodily fluids.
The system, says Sal Rosselli, president of the National Union of Healthcare Workers (NUHW), is “in crisis.” There is “chaos everywhere.” Rosselli attributes this in large part to the industrial practice of “lean and mean”—now decades in evolution, with “just in time” inventories, minimal preparation for emergencies and short staffing.
NUHW, to its credit, saw this crisis coming. It settled most of its contracts with one year agreements (except at Memorial and Kaiser), put bargaining on the back burner, and has focused on COVID and health and safety, both for patients and for its members. It shifted early on to distance work for its staff and stewards, to Zoom with members whenever possible. Importantly, it produced a “Bill of Rights” for its members and the public; and this “Bill” is not just an abstract statement, rather is a program to fight for.
Jessica Early, a nurse practitioner, heads up patient advocacy for NUHW. She found that on key issues the Center for Disease Control (CDC) was failing and that OSHA (Occupational Health and Safety Administration) regulations were minimal at best. “We couldn’t rely on these. We went to our executive board, to the stewards and the members to learn what they were seeing. They reported chronic understaffing, supply shortages everywhere and the ethos ‘do more with less.’” They found a system that couldn’t pivot, couldn’t respond and government agencies that were just listening from the hospitals. Early helped produce the Bill of Rights:
1. Personal Protective Equipment,
2. Testing for COVID,
3. Safe Work environment,
4. Safe Staffing,
5. Proper Training,
6. Mental Health Care,
7. Temporary Housing,
8, Work from Home,
9. Input and Accountability.
10. Time to Care for Our Families.
(More information can be found here: https://nuhw.org/members-promote-nuhws-covid-19-healthcare-workers-bill-of-rights/
NUHW’s contract with Memorial remains open. It has settled with Kaiser, though with less than most members wanted and only after a long fight, including two strikes and staving off Kaiser’s last minute demand for a gag clause. Kaiser wanted the union to take down its mental health websites and agree not to publicize executive salaries. Short staffing remains for Kaiser’s therapists and counselors—patients wait for a month, sometimes even longer, to see a therapist. And this when suicide is the second leading cause of death for adolescents and young adults, when an average of 20 veterans die from suicide every day, when an estimated 17.3 million adults have at least one major depressive episode each year and anxiety disorders are the most common mental illness in the U.S. affecting 40 million adults every year. Only a third of these receive treatment. And now COVID brings increasing desperation.
Kristin Quinn Siegel (LMFT), a therapist for Kaiser in Richmond, California, and a member of NUHW’s executive board, reports cases “skyrocketing” with a flood of new (COVID time) patients: uncertainties, more depression, fear of death, of losing homes, of leaving loved ones behind. And stress that becomes physical pain, headaches, hypertension, back pain, and domestic abuse.
NUHW members have long been on California’s front lines in the fight for decent health care and above all in the mental health care movement. This includes the streets. When COVID cases started to rise in Orange County, NUHW members called on county supervisors to reinstate orders requiring people to wear masks in public spaces. The order had been rescinded when anti-mask protestors threatened the safety of the county’s public health officer, leading her to resign. Many of the same protestors interrupted a rally of labor and community groups demanding that the board of supervisors restore the mask policy. Connie Montesano, a lab technician and NUHW member at Fountain Valley, was among the speakers who were attacked as “communists” by hecklers who called COVID “a hoax.” The whole thing was “insane,” says Sophia Mendoza, NUHW’s secretary treasurer, “thirty people yelling, interrupting, pushing their signs in people’s faces.” (On another front, the union has joined in support of the Black Lives Matter movement: https://nuhw.org/).
The elevation of front line healthcare workers into “heroes,” however hypocritically, is gratifying and certainly well-deserved. And this includes not just the doctors and nurses but the whole array of service workers who keep the country’s home care system of hospitals, clinics, and nursing homes running. Surely a moment’s thought tells anyone paying attention that these workers, even in the best of times, work hard, are poorly compensated and carry out the mostly thankless tasks behind the scenes.
It is also inspiring to see healthcare workers standing up for themselves and their patients in scores of worker-led actions—walkouts, wildcat strikes and vigils (including the brave reply of Lansing nurses to the car caravan of (fascist) Trump supporters).
It is a shame their employers don’t see it this way. Health care corporations spend millions promoting themselves, most often by parading the quality of the care they provide and dedication of their workers, yet almost universally they fight union drives and resist the demands of union members when they exist. Alas, they also happily promote divide and conquer schemes whenever they can, for example at Kaiser where more than a dozen unions, divided into two factions, compete, making a mockery of the union mantra, solidarity forever. NUHW is now widely seen as in the vanguard of the fight in California for safe working conditions in this age of COVID, for parity for mental health care at Kaiser and for justice for health care workers of color. This is the United States, however, so it is not surprising to find others in the workers’ movement nipping at their heels—in this case United Healthcare Workers (UHW-SEIU), typically, in San Francisco, and United Nurses Association of California (UNAC-AFSCME) in Southern California. Neither, with little better to do it seems, has succeeded in attempts to decertify NUHW, each in collusion with respective managements.
The fight then is a tough one and we have a long way to go. Never, however, has it been more clear that our health system is broken—and never, says Rosselli, has it been more important to demand a fundamental transformation—Medicare for All. NUHW is a union in the trenches where unions belong and where words have meaning—in the “war” against COVID, for mental health parity, for Black Lives Matter, for Bernie. More power to them. They are heroes. Z
Cal Winslow is author of Labor’s Civil War in California (PM). His latest book is Radical Seattle, the General Strike of 1919 (Monthly Review).