Affiliated with AFSCME and AFL-CIO

The State of Our Union in 2009:  Standing Tall and Carrying the Message                        

By Stuart Bussey, M.D., J.D., UAPD President 

Good morning, UAPD Colleagues, Brothers and Sisters! During a Town Hall meeting this summer an internist stood up and asked his Congressman this question,” Who speaks for the doctors who pull this country’s Health Care wagon?” This short and interesting query triggered a flood of emotions for me, a solo Family Physician of 25 years. I have watched in dismay as the Government, Insurance Companies, and Managed Care have eroded doctors’ prestige and authority. If I were that Congressman here’s what my answer would be: “Sir, find yourself an organization that can represent both public and private doctors, specialists and primaries, dentists and podiatrists, that can ally with professional and labor groups, that will stand tall and carry the message of the working doctor.” I smiled to myself as I realized that I already am fortunate to be part of such a group--The Union of American Physicians and Dentists.

Our history of carrying the doctors’ message has spanned over 37 years, but I sincerely believe the most exciting years are ahead of us. Indeed, the delivery of Medical Care in this country may be at a crossroads. Since the last Triennial our Union has navigated through some fast and tricky currents. We have had significant successes and some setbacks. First, let’s look at our growth. Our Union’s census has swelled about 30%, from nearly 3000 to nearly 4000 doctors. Despite this remarkable growth we have maintained a high level of personal service and support to our members. This success is due to our talented and dedicated Union staff and stewards. I have enjoyed working with and learning from our Labor Representatives and our Consultants Gary Robinson, Joe Bader, and Dr. Bob Weinmann. And especially, UAPD’s Executive Director, Al Groh, who has steered our ship to success. But I can’t say enough about the commitment and loyalty of our dentists and doctor members, especially our stewards who have taken on that extra role for the good of our organization. Given the salary increases our Union has negotiated for most of our members during this period, our financial and political strength has also grown. But we must not fool ourselves. There are numerous road blocks in our way. We have suffered with a Governor who has openly exhibited his disdain for unions and public employees. Who does not honor contracts already agreed upon. Who has imposed illegal furloughs? We have many hostile County administrators as well as a weak kneed State Legislature. We have an economy that is the worst in 80 years. And, as mentioned in our Health Care Reform seminar yesterday we are looking at a shift in the way that Medical care is delivered. How can we stand up together against these obstacles using political will, legal expertise and professional solidarity? Over the next half hour I want to analyze and discuss with you how we as a Union have succeeded or come up short and what strategies we need to develop.

The French writer Balzac once said of Bureaucracy: “It is a giant mechanism operated by pygmies.” Having worked as a State of California Medical Consultant, a County doctor and a Federal flight surgeon, I thought I knew something about Bureaucracy. But our current State Contract negotiations proved me wrong. Today is the 460th day since our last contract with the state expired, and we’ll probably wait at least 460 more days, after Governor Schwarzenegger leaves office to get a new one. We knew going in that bargaining would be difficult, but none of our team, including Executive Director Al Groh, Dentist Bryan Kennedy, Drs. Nghiem, Farooqui, Thomatos, and ably led by Senior Representative Zegory Williams, was prepared for the State’s neurotic and unprofessional behavior. Hard-won agreements on various articles were rescinded by the State without adequate explanation. Information requests were ignored. Statistics were fudged. Were we dealing with the largest State Employer in the country--- or Tony Soprano? UAPD filed an unfair labor practice charge against the State for refusing to offer us the same number of furlough days as they offered SEIU 1000. But SEIU’s gloating over their supposedly special contract deal was short lived, as the Governor and the California Legislature refused to pass their MOU into law. Somewhere in all the confusion all the state unions lost Lincoln and Columbus Day without apparent due process. We filed a grievance on this issue and contemplate a suit. This summer UAPD arranged and convened a meeting of all state bargaining units for the first time in years in order to discuss various strategies. Many of the unions in this new coalition have filed lawsuits challenging the legality of the furloughs. Two of these cases have already been successful. The coalition has called for an accounting of the hundreds of millions of dollars of that the state has wasted on contracting out.  And we have made our displeasure known to the Legislators through AFSCME, especially to the Democrats who supported the furloughs.

Now let’s look at what has transpired in the past three years for our State members.  First, our CDCR prison and parole physicians and dentists. Many of our great stewards, including Dennis Bealick, John Dupre, Cyril Mathai, and Paul Malarik, are here today. Thanks to you all. After Federal District Court Judge Thelton Henderson appointed former County Administrator Bob Sillen in 2006 as his Federal Receiver things changed rapidly for our CDCR members in both good and bad ways. Sillen raised our physicians’ salaries nearly 50% under the Plata Court order. Our prison psychiatrists and dentists soon had their salaries similarly raised under the Coleman and Perez orders. But he also vowed in the press to clean out all the “bad doctors” from the prisons. He used the Professional Practices Executive Committee (PPEC) as his tool. At first UAPD challenged the authority of the state to perform centralized peer review, but there was both legal precedent in other states and a Federal emergency order that appeared to support it.  Union reps Jim Moore, Zegory Williams, David Trujillo, Steve Cook, as well as  members’ personal attorneys, have defended dozens of our doctors accused of clinical competence issues. Many of these cases were dropped, some were settled, some doctors retired, and some were fired. Then suddenly some poetic justice occurred. The Receiver, Mr. Sillen, was himself fired by Judge Henderson in January, 2008. The official explanation in the press: “management style” issues. Our new Receiver, Judge Clark Kelso has evidenced a more balanced and reasonable approach to discipline. And UAPD completed negotiations last year with CDCR for a new form of disciplinary hearing. Instead of the usual panel of State Personnel Bureaucrats adjudicating a doctor’s appeal, a new Judicial Review Committee (JRC) of three experienced, but neutral doctors would decide issues of clinical competence. Even more importantly, the standard of care they would apply is that of the prison medical environment, not of the surrounding medical community. I am happy to report that the first such appeal case has come in for our UAPD member with a stunningly positive verdict. Our member was reinstated by the JRC to his former job with full back pay. The JRC apparently saw through CDCR’s petty and heavy handed disciplinary style. SPB quickly affirmed this decision. Now that CDCR has been set back on its heels we intend to go further. Receiver Kelso has sent us a letter asking that we jointly explore local peer review strategies.  We must take advantage of local peer review forums as an opportunity to strengthen our medical staff autonomy. UAPD will use all means legal and political to help our doctors once again regain more control of their work.  And here is some more good news. The UAPD Board has just sanctioned a new Legal Consultation fund for all of our members. This fund will provide legal fees of up to $500/year for each member whose disciplinary case meets certain criteria.               

There have been some other recent developments in CDCR worth mentioning. UAPD successfully engineered the grandfathering in of higher salaries for several of our prison doctors who have been working for years as staff psychiatrists. This required extreme patience, skillful negotiation and even a court order. Zegory Williams also has engineered the recalculation of scores of salaries- both the under and over payment by the State-of many of our doctors and dentists.  With this type of incompetent accounting Is it any wonder why our State is billions of dollars in debt? Speaking of the nearly 300 Dentists in CDCR, I want to congratulate and recognize all of you here today, including Drs. Perez, Repasky and Smith who provide very skillful and often difficult dental care in a dangerous environment. Your perennial activism and suggestions have made our Union stronger. With the probable downsizing and restructuring of the prison inmate population and more emphasis on Parole and Rehab, UAPD is hopeful that workload issues will abate for our prison doctors and dentists.

There seems a bit less optimism in our Mental Health (DMH) doctors in some of our five facilities—Napa, Patton, Atascadero, Coalinga and Metro— Why is this? Our members have had a “double whammy” placed on them. Both the State and Department of Justice oversight have been unresponsive to workload and autonomy issues. To make matters worse, over the years our Union Psychiatrists have had psychologists challenging their prescribing and attending authority. You know the difference between a psychiatrist and a psychologist? If you tell a Psychiatrist “I hate my mother”, he will ask “Why do you say that?” but a psychologist will say “Thanks for sharing.”UAPD, along with other unions, have always successfully thwarted pro Psychologists’ bills in the Legislature. Now the main complaints of our DMH doctors seem to involve their Administrators and Micromanaging supervisors who do not listen to our doctors’ ideas on patient care. Examples abound. In Napa, a patient is admitted by our doctor to a locked ward with close observation orders because the patient drinks water excessively. This behavior could lead to serious electrolyte disturbances. The order for a controlled ward is countermanded by a supervisor without explanation. Sure enough, the patient goes on to over-drink and have a seizure. At Patton, behavioral mall hours and their attendant paperwork are increased at the behest of the DOJ Court Monitors.  This is happening despite complaints from Chief of Medical Staff Dr. Farooqui and others that it is not in the best interests of patient care. Or is it in the best interests of the behavioral psychologists who work there? These “suggestions” for medical care of psychiatric patients are coming from two Federal Court monitors who move from state to state every few years, One is a psychologist and the other a psychiatrist who does not even hold a California Medical license. Both men are collecting nearly a million dollars a year salary from our bankrupt state. Both claim they are not really practicing medicine, just making suggestions. Huh? I have written a formal letter of complaint to the California Medical Board asking sanction against Dr. El Sabawi for violating the Medical Practices Act. The UAPD will continue to pursue the truth about the Court Monitor’s practices and carry our members’ messages to our Attorney General, if necessary. Some good news is that these Court Monitors may soon be leaving the State on a midnight train to Georgia, their next “project”. Another of the more bizarre DOJ Special Orders is the Mortality Review Process. It goes like this. Whenever a patient at a DMH facility dies a hospital police officer arrives to secure the area and “question” the attending doctor. Sort of like CSI. Then a Mortality Review Committee convenes to do a type of an M & M evaluation.  Most of the committee members are not even physicians. There are serious confidentiality issues. Why is all this necessary? Is the doctor being accused of something? Does he/she have the right to refuse to answer questions? We asked DMH officials these questions in a facility wide videoconference earlier this year. They reassured us this review was only for “educational” purposes and that none of our doctors should be upset by this process. UAPD does not agree and will closely monitor this process for any breaches in doctor’s or patient’s rights. Because there are countless instances of the abrogation of state employee privacy and disciplinary rights across all branches of our state, UAPD is preparing to sponsor a State Employee Bill of Rights in the next California Legislative session. We already have a author and the support of several other unions. This is an exciting concept which could deter employer transgressions that are not covered by our contract or the Dills Act. I am asking each of you now to discuss and develop this idea of a State Employee bill of Rights with your colleagues and let our staff know what you might like included in it.

In other DMH news the long running Atascadero lawsuit, involving DMH’s excessive payments to its many contractor physicians, continues with evidentiary hearings. They say that an incompetent attorney can delay a trial for months, a competent one for years. If that’s true the State has many great attorneys. These hearings should eventually prove that these high contractor salaries are the main reasons why doctors who come to work at ASH choose not to join civil service. The last important DMH issue involves the negative interplay of the Administration and the Medical Staffs.  Ask Dr. Firdouse Huq , Napa’s Chief of Medical Staff. She recently challenged the description of her assigned duties, citing the Medical Staff bylaws. She stood up for the Napa Medical Staff and so will the UAPD. In conjunction with the CMA we are exploring avenues to prevent management disrespect of our Medical staffs. We will utilize grievances, legislative or even whistleblower statutes if necessary. UAPD will also extend its political power with alliances with CMA and other groups in appropriate circumstances.

Actually, another such opportunity does exist now for our VA Doctors at Yountville Veteran’s Home. With minimal public notice the Yountville Home Administration precipitously closed the acute care ward 1 South after decades of use and gave 8 of our doctors layoff notices. Of over 1700 State Bargaining Unit members only a few other doctors received layoff notices. Why did the California Veterans’ Department and the DPA single out our Yountville doctors? We think it is because the nursing staff and Administration have always wanted to turn Yountville into a giant nursing home. But nursing is not the only care that the WWII Veteran Residents were promised when they decided to move into the home. Holderman Hospital has been essential to their care. Now, instead of treatment on campus by doctors they know and convenient in-house labs, x-rays and urgent care, these elderly residents are being shuttled by expensive ambulances at all hours of the day to distant Queen of the Valley and St. Helena Hospitals. To doctors they don’t know. Who may not want to treat them. For unnecessary admissions. For conditions that could be treated at the Home in a more cost effective way. Closing or downsizing California State hospitals is nothing new. Agnews Hospital near San Jose was recently closed, but the DDS did it with years of careful planning and a transition program. The CVDA is playing this one fast and loose. To the CVDA and the community UAPD has responded with three simple words “Save Holderman Hospital!” We held a joint resident/staff meeting this summer and collected petitions with hundreds of staff and veterans’ names. UAPD members Orlando Chavez and Denise Rettenmeier were instrumental in these endeavors. Assemblywoman and Veterans Committee Chair Mary Salas is holding a formal investigatory hearing this month. UAPD is moving ahead with its lawsuit filed shortly after notice of the closure plans. The Union is in this for the long haul. Our arguments are simple and demonstrable—the Holderman closure is bad medicine for the Veterans and too expensive for a state that is already bankrupt. I would like to recognize the entire Yountville Medical staff for its efforts in fighting for this hospital’s reopening. UAPD will support the self governance of this staff along with any other Medical Staff that is not heard by their Governing Body.

The world of the California State Medical Consultants (MCs) is a world that I am personally familiar with after almost 19 years of employment. Our union has over 260 MCs employed by the Departments of Social Services, Health Care Services and Public Health. I would like to recognize some MCs here today for their contributions to UAPD—stewards Rick Dann, Dan Lucila, Sandy Clancey, Marcia Ehinger and John Peters. All the MCs provide invaluable services for the state and its residents—short term disability evaluations, long term social security disability evaluations, Medi-Cal fraud investigations as well as authorizations for doctors and various Public Health Services. These members of our Bargaining Unit are besieged by a burgeoning workload, fueled by the Great Recession and three furlough days a month less to do this work. This is mentally grueling assembly line type work. And it has been especially galling for our MCs when their own analysts are paid overtime for extra work that our MCs are expected to finish during their shortened work hours. UAPD has advised our doctors to work to spec, to ignore any work quotas that management imposes, which are illegal under our state contract. Any quota demands by management to our members, in any state facility, should be reported to us immediately. If MCs or other UAPD members are already documenting more than a 40 hr work week they may ask for an additional fractional appointment at straight pay, as per a clause in our state contract. Our union also filed one of the first lawsuits against the Governor which demanded that MCs be exempt from State furloughs. We even asked the state for a 5% equity raise for these underpaid doctors. Almost all of our MCs are paid wholly or partially out of special or Federal funds, not the state General fund. Other issues are of concern for the MCs. They are often asked by management to evaluate out of state disability cases or order potentially dangerous procedures without examining the claimants. UAPD has formally asked the Medical Board and Attorney General for his opinion on how far the MC’s duty to the claimant extends. And whether they have any doctor-patient relationship.

Regarding our Developmental Disability Services (DDS) doctors, there are four major facilities that UAPD covers—Lanterman, Fairview State, Porterville and Sonoma. Our 100 doctors who work at these facilities are some of the longest tenured UAPD members, and we want to recognize them. DDS doctors, such as De Bui, Pitr Conroy and Cuong Nghiem deal with some of the state’s most difficult patients – all of these patients have significant physical and mental problems. The state is getting a good deal with our talented doctors-because most of them function as both physicians and psychiatrists without any extra remuneration. But UAPD did manage to negotiate a significant pay raise for these members in late 2007, just before the State Budget fiasco hit. We are also proud of the show of solidarity which one of the DDS medical staffs exhibited last year. One of the doctors was on call and at 3am delayed ordering an extra large dose of narcotic to a patient he had never seen before. He called back a short time later and heard the patient was sleeping ok. When he arrived at the hospital the next morning he was shocked to be accused of elder abuse by a social worker and was summarily stripped of his privileges. UAPD responded strongly and quickly to the Administration and the entire medical staff signed a letter of support for him. He was soon reinstated. This is the solidarity we like to talk about. It seems a small act to individually support your fellow colleague—but it creates tremendous power and morale.

For our California State University (CSU) members who diligently take care of students on dozens of campuses across the state we thank Dr.Floyd Anscombe for his efforts to ensure that there isn’t one less campus clinic.  Our newest UAPD Board member Carole Smith from Fresno State should be an invaluable  resource to both our union and to the CSU in their perennial battle to secure funds from the Chancellors for health care and their campus clinics.

And now let’s turn to our County Doctors. And to the infamous LA Bargaining Unit 324, UAPD’s prodigal son that came back to our union family after the Megaflex fiasco of 2001. You may recall that shortly after we organized over 700 Los Angeles County doctors, the County refused to negotiate Megaflex benefits with our new members. We filed a lawsuit alleging discriminatory bargaining and got a law passed that enforced a County’s duty to bargain fairly. It took six long years, but in one of UAPD’s finest hours we won our Court case and Appeal. I was privileged to be on the team of UAPD Consultant Joe Bader and Attorney Larry Rosenzweig as we spent all day negotiating a $10 million dollar plus settlement for our doctors who were cheated out of Megaflex. We showed a true commitment to these doctors of Los Angeles County. We never forgot them and apparently they did not forget us. They voted us back in last year as their exclusive Bargaining Unit Representative and this past summer they voted for Agency shop. One of the reasons for this was UAPD’s role in negotiating an historic 20 step pay scale that has returned annual 3% step increases. That is impressive in these bad economic times. Our Southern California Labor Representatives and Staff Members--Lux Irvin, Jake (Skywalker) Baxter, Steve Cook, David Trujillo--all deserve big kudos. And please give it up for John Murillo, our Southern California Administrator and Chief Negotiator. Along with Drs. Rex Cheng, Janice Nelson, Lee Nelson, Michael Medici, Gary Posner, and others, John just completed a new two year contract with LA County with almost the same terms. Earlier in the year LA BU 325, the Psychiatrists finished their successful negotiations.

The doctors from San Francisco, San Mateo, Santa Clara, and Santa Cruz Counties have also completed successful contract negotiations over the past year. Our San Francisco County team, led by Senior Rep Patricia Hernandez, Deb Brown, John Smith and Roger Wu successfully prevented four layoffs and received a 3.75% salary increase. They did it with a combination of political skill, compromise and a helpful push from our parent organization AFSCME. Being the first San Francisco union to concede to furloughs didn’t hurt either. A little compromise is the mother’s milk of good employer relations. I want to recognize a super doctor and steward Derek Kerr who has rightly and courageously blown the whistle on the City and County for a the Ja Report, a suspicious RFP involving Laguna Honda Hospital. Later this morning you will hear San Francisco Mayor Gavin Newsom talk about the important role our Union doctors have had in establishing his Healthy San Francisco program, one of the first and most successful examples of Universal health care in the United States. In Alameda County our members also kept their 3% raise. And Dr. Jackie Bolds, a UAPD member for over 20 years, wisely recommended that his unit reject a 1% raise which would require each doctor to see a certain quota of patients in the ambulatory clinic. Good job. In San Mateo County, Drs. Carol Boyd and Asha Swaroop will enjoy a 3% raise. In Santa Cruz county, Drs. Jeff Young and Pat Teverbaugh helped get a similar 3%. Santa Clara County members have rolled over their contact for 2 years. And in San Joaquin County the doctors and dentists finally won their rights to retirement benefits after years of expensive legal battles with the county. Pat Hernandez and our UAPD attorney Andy Kahn deserve a lot of the credit for their tenacity and skill. David Trujillo negotiated a good contract in Santa Barbara County, but Sacramento and Solano County doctors are facing layoffs.

Last year in Manhattan Beach the UAPD convened the First UAPD County Leadership Meeting—to share best practices and ideas, to meet with friends and to discuss the establishment of a county rep or steward system. Our stewards are the lifeblood of our organization and the UAPD will make sure our counties develop similar systems. The meeting was an enjoyable and illuminating experience. We plan to make it a regular event as we organize more of California’s 58 counties.

We are honored to have at our Triennial Dr. Donald Sharps, one of the leaders of the Orange County Psychiatrists and Physicians. They want to join our Union, but their parent group, the Orange County Employee Association (OCEA) won’t let them. OCEA is a mixture of nonmedical professionals that does not serve the needs of Don and his colleagues. This is essentially the same cause that UAPD championed in the early 1980’s on behalf of doctors stuck in CSEPA. We helped them to form their own exclusive unit, now known as SEPA. Mention must also be made of the steadfast commitment of the Ventura County doctors. We had already won the lawsuit declaring that they are unionizable employees of Ventura County clinics and the county dragged its feet on an appeal for two yrs. Yesterday we got the good news that we won the appeal!

The organizing possibilities for our Private Practice Sector are increasing with Health Care Reform apparently on the way. As I mentioned earlier private physicians need to push the system, not pull it. During the 2008 AFSCME International Convention in San Francisco the 5000 union leaders present unanimously passed UAPD’s resolution to level the playing field for doctors and insurance companies. Specifically AFSCME is committed to sponsor and support state and/or Federal legislation to create collective bargaining for independent, non-employed physicians. Also to sponsor legislation and work to modify the 1947 McCarran Ferguson Act, which gives advantageous anti-trust exemptions to insurers. These companies don’t deserve any more bargaining advantages than they already have. The entire profession of Medicine needs to carry this message to the Government and Insurance companies—let experienced and working doctors help make decisions regarding medical necessity, coverage and reimbursement. We should be driving the system. Private doctors are also reaching out to promote collective bargaining. I presented such a proposal to the Senate Finance Committee and will present a similar resolution to the House of Delegates of the American Academy of Family Physicians in a couple of weeks. I ask all of you in other specialties to consider the same strategy. We need broad based political activism. The kind UAPD has shown in LA County, in Yountville, fighting State furloughs or leading a 1000 member AFSCME March last year in San Francisco to protest the Governor’s minimum wage proposal. That’s what we are all about-- standing tall and energizing our profession.  Despite these ideals our private membership has not grown in the past several years. We are concerned about this and want to improve this. Drs. Keulen and Statti have volunteered their time to spread the word at Specialty conventions. UAPD’s staff and reps provide terrific services to our private members. We regularly help our docs collect delinquent reimbursements from payors and review HMO/PPO contracts with our members. We have an excellent Audit Defense service. We are creating a new group Long Term Disability Plan. We have a successful IPA, led by superdoc Dr. Bob Weinmann, with many contracts covering millions of lives in California. Some of our doctors are making six figure incomes from these contracts. We sponsor and support legislation in California designed to improve the professional lives of private doctors. I would like to thank our UAPD lobbyist Doug Chiappetta and AFSCME lobbyist Willie Pelote for all their hard work. This year UAPD sponsored AB 933 which would require workers’ compensation utilization reviews to be done by California licensed doctors. The Legislature passed our AB 245 which requires that the Medical Board remove expunged felonies and misdemeanors from its public website. We supported SB 920 which provides sweeping peer review reform in private hospitals. Sham review and the concept of the “disruptive” physician should be of concern to all of us in the increasing political atmosphere of the private hospital. And the UAPD Legal Consultation service that we are starting should be of help to all of our private members.

The perception of an organization is related to its ability to communicate. In this respect we are very fortunate to have a great team of public relations, website and media people. Many thanks to Sue Wilson and Ken Tyler for their long hours of work to perfect our UAPD website. There are new improvements and ideas to pursue such as CME webinars and web groups. With the capability of rapid computer surveys we are learning what our members think, feel and want from us. Please feel free to make suggestions.. For those still not in love with computers UAPD’s glossy monthly newsletter goes out to all members. Lastly, I want to recognize the efforts of the staff in all three offices that make our union run. In Los Angeles, Nancy Baldovinos, In Sacramento, Carolyn Snipes and in Oakland, our own living legend and songbird Gloria Duarte, Claudia Modrall, Christine Cordova, and Cheryl Clark. Lastly, Fran Williamson, who has greatly helped our private sector and IPA for over 20 years, will be retiring soon.  Thanks for everything, Fran.

I’d like to close with a quote about courage and fear, by David Ben-Gurion, former Israeli Prime Minister: “Courage is a special type of knowledge. The knowledge of how to fear what ought to be feared and how not to fear what ought not to be feared.”  Stand tall, UAPD, and carry the message!