[ In California for example, the California Nurses Association
(CNA) spent 13 years fighting and winning the first—and thus far
only—legislated safe nurse-to-patient staffing ratios in the
country.] [[link removed]]

HOW HAVE HEALTH WORKERS WON IMPROVEMENTS TO PATIENT CARE? STRIKES.  
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Suzanne Gordon
September 30, 2019
In These Times
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_ In California for example, the California Nurses Association (CNA)
spent 13 years fighting and winning the first—and thus far
only—legislated safe nurse-to-patient staffing ratios in the
country. _

More than 2,200 nurses went on strike against University of Chicago
Medical Center on September 20. , (Photo: National Nurses United)

 

On September 20, 2,200 nurses represented by the National Nurses
United (NNU) went on a one-day strike at the University of Chicago
Medical Center. The Chicago nurses were protesting unsafe working
conditions and forced overtime—and had been in contract negotiations
with the hospital for months. The Medical Center has just spent $269
[[link removed]] million
on a hospital expansion that it, insists, represents an “
investment to improve our community's health.”

In response to the strike, the Medical Center’s top officials went
on a P.R. offensive
[[link removed]],
accusing  striking nurses of engaging in “shameless behavior,”
and insisting they are recklessly endangering their patients. 

Nothing could be further from the truth, says Astria Johnson, an
Emergency Room nurse who has worked for the hospital for 10 years.
“This strike is about providing safe patient care. I can’t do that
when I am assigned four patients, two of whom are intensive care (ICU)
patients and two of whom are very sick. Someone may be on a ventilator
to breathe for them.  Someone may be septic and require intravenous
antibiotics and require constant monitoring.  Some people are getting
their first diagnosis in the ER and I can’t educate them about their
disease or medication.”

In response to the strike, management locked nurses out of the
hospital for four days. The nurses went back to work Wednesday
morning, and bargaining is expected to continue now that they’re
back on the job.

Healthcare professionals like Johnson do not view striking as their
first option.  Most spend years going through “the proper
channels,” speaking with management, and engaging in endless
internal negotiating sessions to resolve patient care problems.  When
they do finally go public with their concerns, their actions often
result in improvements to patient care.

In California for example, the California Nurses Association (CNA
[[link removed]]), the organization
that was the founding member of NNU, spent 13 years fighting and
winning the first—and thus far only—legislated safe
nurse-to-patient staffing ratios in the country: In 1998, California
Government Pete Wilson
[[link removed]] vetoed
a safe staffing bill that was passed by the legislature.  In 1999,
after more intense lobbying and activity by the CNA, legislation
was passed and signed into law by Governor Gray Davis.
[[link removed]] Ratios
were finally implemented in 2004. According to one study
[[link removed]],
in California, mandated ratios had a positive impact on patient deaths
as well as nurse burnout.

Other healthcare workers have gone on strike to address vexing patient
care issues. Since 2010, the National Union of Healthcare Workers
(NUHW), which represents 4,000 psychologists, social workers, and
other mental health clinicians at Kaiser Permanente in California, has
mounted a campaign to publicize and remedy a critical shortage of
mental health workers at the state’s largest HMO.  In 2011, the
NUHW filed complaints to the California Department of Managed Health
Care (DMHC) charging Kaiser was violating a regulation that requires
that HMOs must see mental health patients within 10 business or 14
calendar days of their request for an appointment. The complaint was
accompanied by a 34 page report
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“Care Delayed, Care Denied.”

In 2012, the NUHW went on strike to expose Kaiser’s failure to hire
sufficient mental staff and give patients access to timely care.
 These mental health workers pushed the DMHC to take action to
fulfill its mandates to protect patients.  In March of 2013, the DMHC
released the results
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its investigation. It found
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up to 40 percent of patients at various Kaiser facilities experienced
appointment delays that violated California law. In June of 2013,
the state of California
[[link removed]] fined
the system $4 million
[[link removed]],
issued a cease-and-desist order against Kaiser, and ordered the HMO to
correct the problems. In 2015
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a follow up survey by the DMHC, based on a sampling of hundreds of
individual patient charts, revealed that, in Northern California
alone, 22 percent of patients suffered excessive appointment delays.
The DMHC called the violations “serious.”

In 2015, one of these serious violations resulted
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the death of, 83-year-old Barbara Ragan
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according to her husband Denny Ragan. Barbara had worked for Kaiser
herself for more than two decades. She’d been seeking
[[link removed]] mental
health care from Kaiser and, according to her husband, faced lengthy
delays for treatment and ultimately died by suicide.  Kaiser has said
it is not responsible for Ragan’s death and insisted that she had
received adequate care.

In 2017, the state ordered
[[link removed]] follow-up
inspections to make sure Kaiser was in compliance with state laws and
regulations. As a result, Kaiser has also hired hundreds more
therapists. 

Even though the union’s actions have played a role in forcing Kaiser
to improve patients’ access to an initial visit or assessment,
workers say problems continue when it comes to providing follow-up
care. “Kaiser has not hired enough staff so that, after an initial
telephone appointment, patients get needed follow-up care.  Today
patients have to wait up to two months for a follow up in person
visit,” says Kirstin Quinn Siegel a Licensed Marriage and Family
Therapist at Kaiser Richmond. “People who have been suffering in
silence, perhaps for years, and finally call to get help should be
seen immediately not in two months.” 

After experiencing delayed care, another Kaiser patient,
19-year-old Elizabeth Brown
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died by suicide in 2018. Kaiser has declined
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comment to the press about Brown’s care.

Peter Ly, a psychologist on the Child Team at San Jose Kaiser, says
that “A teenager struggling with depression, or who is self -harming
or has suicidal thoughts needs to be seen right away and then
consistently every week or two.  We can’t do it.  We are asked to
put people into groups when what they need is individual one-on-one
therapy.”

That’s why he and roughly 4,000 other workers went on a five-day
strike in December 2018.  Former Congressman Patrick Kennedy (D, RI)
the sponsor of the mental health parity and addiction Equity Act flew
to California to join striking therapists on the picket line.

 “We do not go into this work to make money,” says Susan Whitney,
a marriage and family therapist at Kaiser in Bakersfield. “There is
no cap on our caseload.  In order to help patients we keep accepting
more and more of them. We can’t take lunch or even bathroom
breaks.  We don’t act until we and our patients are at the breaking
point.  And our number one concern is “how will this affect patient
care?”

In a response to union allegations, Kaiser has issued
[[link removed]] a
public statement insisting that, “Kaiser Permanente is committed to
finding solutions and creating a model for mental health care that
meets the growing demand for mental health care and responds to the
shortage of qualified professionals.”

But according to Whitney, “We’ve been going through official
Kaiser channels for years and the only way we’ve seen any
enforcement or improvement is when we go public and enlist the support
of patients, community leaders and political representatives.”

In July of 2019, Kaiser  announced
[[link removed]] that
it had added 300 more mental health staff statewide and was continuing
to recruit staff. NUHW members have proposed that they participate in
decisions about where new staff are assigned both geographically and
to which clinical teams.

In 2004, two researchers investigated management claims that
healthcare workers represented by unions jeopardize patient care. 
Michael Ash and Jean Ann Seago found instead that patients on cardiac
units in hospitals where RNs were represented by labor unions had a
reduced cardiac mortality rate.  They concluded that, “The
protections offered by unionization may encourage nurses to speak up
in ways that improve patient outcomes but might be considered
insubordinate and, hence, career-jeopardizing without union
protections.”

What was true 15 years ago is even more so today as
healthcare corporations consolidate
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hospital mergers and acquisitions,
[[link removed]] gain
more power, and act to protect the bottom-line rather than patient
care.

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