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California Nurses Strike Kaiser Again and Again

On April 16, 1997, 7500 nurses employed by Kaiser Permanente (the world's largest HMO) held a one-day strike to protest escalating patient care abuses and massive concessions demanded by Kaiser. The nurses, all represented by the California Nurses Association (CNA) were joined by more than 10,000 people who marched in front of Kaiser facilities and participated in rallies and vigils. Over 95% of Kaiser RNs and Nurse Practicioners took part in the strike and more than 85% of the five supporting unions took part in the walkout.

Nancy Cassazza, RN, chair of the nurse bargaining team expressed a common sentiment saying, "Kaiser wants to devalue the profession of nursing and roll back the economic status of a primarily female profession. Nurses have a sacred trust with our patients. We are the last line of defense between our patients and corporate greed. Without nurses, Kaiser will have free reign to deny care and withhold treatment options. Who will be there to speak out? When there are no nurses present, patients lose their rights and can even lose their lives - it's that simple."

Kaiser Permanente's administration expenses have risen by nearly 260% in Northern California the past four years, even as the HMO continued to reduce patient services, according to data supplied by Kaiser to California's Department of Corporations.

While recording record membership growth in Northern California (up 250,000 the past two years), medical and hospital expenditures by Kaiser Permanente Foundation Health Plan in Northern California have remained essentially flat the past four years, rising just 1% from $4.127 billion in 1993 to $4.149 billion in 1996. But total administrative expenses have mushroomed from $52.6 million to $136.3 million, a whopping 259% increase over the past four years.

"Kaiser has become very accomplished at cutting costs for patient care, but opens the bank when it comes to administrative expenditures," said Kit Costello, RN, president of the California Nurses Association. "What these numbers demonstrate is a shift in resources from patients and caregivers to corporate overhead and management consultants. RNs, other caregivers, and many patients see the effects of these tragically misguided priorities every day."

Kaiser Permanente facilities in Walnut Creek and Martinez, Ca. are riddled with problems that have had a direct effect on patient safety, according to a 110-page report released recently by the federal Health Care Financing Administration (HCFA).

At the heart of the investigation, that was prompted by a series of patient complaints, is repeated problems with inadequate staffing and long waits for emergency care for Kaiser patients. The investigators also blast Kaiser officials for numerous problems with quality assurance, medication errors, and inadequate patient record keeping that affects follow-up care.

One case cited was a patient who bled to death on May 24 after a detachable IV line became detached. Monitor alarms had been turned off or were broken. Another case involved a man with a history of Sickle Cell disease who suffered through a 23-hour wait in the Kaiser Martinez emergency room while he and his wife were told there were no hospital beds available due to lack of nurse staffing. Waits are so excessive that on one night checked by the inspectors, 19% of the patients "left without being seen."

While resisting CNA's patient care proposal, Kaiser continues to demand:

  • Lower wages for RNs who work in all clinics and in hospitals in Sacramento, Santa Rosa, and Fresno.

  • Deep cuts in wages for new hires -- from 19% to 35% of current pay scales, an incentive for Kaiser to displace its most experienced RNs for cheaper labor.

  • Reduced Kaiser health care benefits for RNs who work less than 32 hours.

  • Required co-payments of up to $1,300 per year that RNs would have to pay Kaiser for Kaiser health benefits for their children and spouse.

  • Retirement health benefit co-payments up to 50% for RNs who worked less than 25 years at Kaiser .

  • Limits on time off that would force RNs to use vacation and holiday time for illnesses of less than 8 days, pressuring RNs to work when sick at risk to patients and themselves.

  • An overall decrease in the amount of paid time off.

  • No seniority rights in layoffs, further depriving patients of access to long-term Rns.

  • Severely restricted seniority rights in job bidding and promotion.

  • No pay for Nurse Practitioners forced to work beyond 8 hours.

  • Elimination of guaranteed every other weekend off, a benefit won by strike in 1974 because of Kaiser's abuse of weekend scheduling .

  • Elimination of penalty pay for scheduling RNs to work every other weekend.

  • "Merit" bonuses conditioned on arbitrary patient satisfaction surveys, which pressure RNs to manipulate patient perception about their quality of care in order to get raises, while denying RNs right to have meaningful authority over patient care decisions.
  • CNA also criticized large pay hikes Kaiser has handed out to top executives while demanding belt tightening for direct care providers and fewer services for patients. In the past five years, Kaiser CEO David Lawrence has received a 78% increase to a current salary of $1,250,000. In the past four years, Kaiser President Richard Barnaby has collected a 293% hike to $827,715, according to IRS filings. Additionally, 42 other top administrators were paid over $200,000 in 1995.

    Kaiser has also racked up $3.3 billion in profits, and boosted its advertising budget by 700% the past five years. The increased expenditures have gone into a statewide ad campaign, partly funded by Kaiser medical groups, and a new publication to be mailed to Kaiser's 5.1 million California enrollees,funded by members' dues, that are intended to deflect alarm over deteriorating care in Kaiser.

    The issues remain unsettled and the and the nurses continue to struggle for adequate standards of patient care. A two-day event took place on July 17-18 in response to Kaiser's tactics of intimidation since the original walkout. Five other Kaiser employee unions supported the walk out; an estimated 25,000 employees participated. Check the CNA web site for details. Kaiser RNs protested the continuing downsizing of nursing staff and cuts in patient services that have led to repeated problems throughout the Kaiser system. In response to growing alarm at conditions in Kaiser, and Kaiser's failure to address RN concerns in contract talks, nurse negotiatiors recently announced plans to hold a regionwide strike at all Kaiser facilities, including Santa Rosa, later in October. Most recently, the CNA had a two-day strike on Wednesday and Thursday, January 28 & 29, 1998. This is the fourth strike action since the old contract expired a year ago. The Service Employees International Union, Local 250, an AFL-CIO union which represents most Kaiser employees, has advised its members to cross the nurse's picket lines.

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    Revised & updated September 30

    Last revised January 31, 1998