By Stuart Bussey, M.D., J.D., UAPD President
April 8, 2008
“…Coming together is a beginning, staying together is progress, and working together is success…” Henry Ford
I want to take this opportunity to thank all of our doctors and Union staff for making my first eighteen (18) months as UAPD President one of the most interesting, challenging and fun periods of my career. I have learned a great deal about what makes our Union successful and what needs to be tuned up. Working closely with the UAPD and SEPA Boards, the Staff and Executive Director Al Groh has convinced me that our union’s direction is definitely up.
I offer you a brief midterm evaluation and review. In my address at the 2006 UAPD Triennial Convention I mentioned that for UAPD to stay on the road to success we must look inward, outward and forward. First, we should look inward and re-identify and assess who our membership is. Then we should look outward and be proactive in the political landscape. Finally, we must continue forward to work on our communication, courage and camaraderie. I firmly believe we have made great strides in all of these areas.
To better define our membership we created and sent out a survey last year to all of our members. The results were both validating and surprising. Of those 20% of the members responding, most voiced their opinions that contract negotiation, lobbying and union representation were the most important functions of our union. This was expected. What was surprising was that most of the responders had never utilized UAPD for any significant problem of their own. The public sector doctors responded in a higher percentage than private sector doctors that they were satisfied with their jobs. From my own experience in both sectors I understand how increasingly difficult it is to make a living as a private doctor. Though all of our groups--state, county and private--viewed Staff, Stewards and Executive Boards in a positive light, a large number did not specifically know who these people were. This will hopefully change with more UAPD meetings, visits and our improved, interactive website. Similarly the majority of our members across sectors were unfamiliar with the benefits of our 10 year AFSCME affiliation. As for our members’ political affiliation, we have definitely moved to the Left since the prior survey of the early ‘90s. The responders were 45% Democrats, 25% Republicans and 20% Independents, with a smattering of Libertarian and Green. Our County Physicians were the most Democratic group while private Dentists were the most Republican. Top Presidential favorites before the campaigns and primaries began were Obama, Giuliani, and Clinton. The surprise here was Giuliani’s poor performance and McCain’s resurgence. As for Health Care Reform Plans, almost half the responders prefer Single Payer. A minority of us favored the Schwarzenegger, Perata and Nunez plans, all of which went down in defeat. Our members may be wary of the role of Insurance companies in Health Care Reform. We will survey our members more frequently in the future on a variety of issues via the website.
As an increasingly connected and interdependent organization UAPD continues to successfully move outward onto the political landscape to achieve gains for our members and their patients. The State doctors in our largest local, SEPA, can attest to this. Over the past 18 months the UAPD has craftily maneuvered into a favorable bargaining position between the Federal Receiver and the California Department of Corrections. When the controversial Receiver Bob Sillen was appointed in 2006 to implement the Plata reforms, UAPD’s prison physicians, were grossly underpaid. In addition to negotiating fairer disciplinary procedures with the Receiver’s office, UAPD helped to win Plata physicians, such as Georgia Thomatos and Robert Clinton, two huge salary increases in 2007, totaling over a 40% increase. Our Coleman prison Psychiatrists, such as John Dupres and Jesus Juarez, also received 35-40% pay increases last year. Even bigger winners were the Perez prison Dentists, such as Sheldon Brooks and Floyd Hansen. Some of the dentists actually doubled their salaries.
These high CDCR salaries set up a chain reaction which UAPD used to gain parity raises for other departments of SEPA. Coleman “equivalent” DMH psychiatrists sent a petition signed by 127 of our members to Judge Karlton which warned of a potential “brain drain” of psychiatrists to higher paying CDCR jobs. As a result of our Union speaking out, the Department of Personnel Administration (DPA) raised the salaries of DMH, DDS and DVA psychiatrists to just 5% short of the salary of CDCR Psychiatrists. Dentists in these three Departments used a similar argument and received a similar increase. And this past December, just before California’s $16 billion budget shortfall was announced, Jim Moore, Al Groh and Drs. Huq, Poh, Nghiem ,Chavez and myself, met with DPA. We convinced them to give Plata equivalent physicians and podiatrists at DMH, DDS, and DVA a two step raise of over 16% beginning in January 2008. All of these spectacular raises occurred as a result of a combination of UAPD staff, steward, and rank and file input as well as our legislative and lobbying efforts.
Make no mistake there are still problems to be surmounted with these raises and salaries. Some of the Plata equivalent raises along with those of 5 other unions must still be approved by the Legislature later this month. Several of our DMH members have received irregular and inadequate salary checks. We immediately called DPA and the Department of Finance to correct this situation. Also, several of our CDCR Psychiatrists have been denied the Coleman raises because they did not meet the Court’s minimum credentialing qualifications. Some of our members have had foreign internships and some non-ACGME approved residencies. Some non Psychiatric specialties (Internists) were conscripted by CDCR in 2001 to take courses which allowed them to function as successful and dedicated prison Psychiatrists. All of these doctors should be paid “like pay for like work.” Senior Rep Zegory Williams and myself made the argument to SPB last month and hope to grandfather in raises for these doctors as well.
One of the unfortunate byproducts of these higher State salaries is increased scrutiny, both by the Public and by State of California Management. You may have seen the Sacramento Bee website where individual State Employee salaries may be obtained. The Bee and the California Supreme Court say that the Public has a right to know where its money is going. UAPD, led by VP Ronald Bortman, as well as other unions have vigorously protested this website as an invasion of privacy. In an atmosphere of recession and budget deficit however, there is envy rather than sympathy for us. Strict adherence to work schedules and workloads, increased documentation and paperwork are more evident in all of our workplaces. This management vigilance could lead to a lower threshold for discipline. UAPD does not intend to stand idly by if our members get into trouble.
We recently met with the new Receiver, J. Clark Kelso, to discuss the future of PPEC and the SPB hearing process. Mr. Kelso, a law professor, has publicly expressed his endorsement of an appeals panel of 3 independent, non CDCR physicians to review all disciplinary actions meted out by PPEC. This panel’s decisions will be given great weight. Kelso has signaled his intention to the SPB that they may overturn this panel’s decisions only in rare situations. The UAPD basically concurs with this proposal. And we appreciate the input and feedback from all the CDCR members with whom we have spoken. Meanwhile, fair, confidential and expeditious termination settlements between our members and CDCR continue to be brokered by our UAPD reps. We will continue to push the Receiver and CDCR for local peer review, the reformation of PPEC and for greater authority of CDCR medical staffs. Also, we discussed the formation of explicit scope of practice guidelines and protocols for our members. He agreed that our rank and file should have a greater voice in shaping medical policies in the prison system.
In the Department of Mental health, we have faced slightly different challenges. At several DMH institutions the positions opened by our doctors leaving for CDCR have been filled by contractors. In fact, the majority of Psychiatric positions at Atascadero are now contracted out. Many of us, including Dr. Lisiak, have met with DMH administration on a number of occasions to protest the wasting of taxpayer money on expensive and less dedicated contractors. We have an appeal next month at the SPB regarding the violation of state law by DMH in continuing to use these contractors on an “emergency basis.” We are also contemplating filing a lawsuit regarding the issue. Many of the contractors would like to become civil servants and Union members if we can either convince the state to increase our members’ recruitment and retention bonuses or give the contractors a signing bonus. Meanwhile, Dr. Boutros and only eight other “physical” doctor members are admirably taking care of over 1000 ASH patients in a dangerous and understaffed situation. Another DMH challenge is the increase of group therapy “mall” hours unilaterally imposed on our members by the DOJ. Dr. Farooqui of Patton State Hospital has led the way in opposing this change of job description. The other challenge looming is the annual attempt by psychologists to obtain attending privileges in DMH. Time and again various organizations such as CPA, CMA and UAPD have joined ranks to defeat these ridiculous bills. Though the psychologists are increasingly well funded, we expect to prevail again this year.
In the Department of Developmental Services UAPD has created an innovative program. Agnews Developmental Center is closing. We needed to prevent our doctor members from layoffs, as well as to maintain continuity of patient care for the developmentally disabled. We convinced the State to “assign” our doctors to care for discharged patients in private community centers and programs. This unusual hybrid arrangement of public employment in a private setting will be reviewed on an annual basis. Kudos for this innovative solution should go out to Representative Jim Moore and Doctors Ramos, Sumanqui, Okawa, Khalilnejad,and Heideh.
UAPD has lobbied for the fair distribution of moneys by the California State University system to its Health Services. With attrition over the years there are fewer CSU physician members than ever. Led by Board member Floyd Anscombe and Carol Smith UAPD continues to ask for financial transparency from the California State University Chancellor’s office.
The doctors from the Department of Social Services and the Department of Health Services have similar staffing problems. At DSS where I have worked since 1990, we face a huge backlog of national and California social security disability cases. As our doctors retire or quit they are not being replaced. The E-Mac computer network has allowed management to distribute local cases electronically across state branches. This allows them to utilize the doctors in higher staffed branches across the state to do the cases of understaffed branches. This may be good for production statistics, but it is not good for quality of decisions. Simply put, local doctors have better knowledge of local resources .Every incorrect disability decision costs taxpayers tens of thousands of dollars. In 2006 UAPD members Rick Dann, George Bugg, Dan Lucila and myself negotiated a lucrative and effective temporary bonus plan. This quickly erased the case backlog, but the plan was scuttled by management a few months later. Our short staffed psychiatrists are now being offered a less lucrative bonus opportunity to do extra cases while the physical doctors rarely get a similar chance. DHS doctors who are fragmented throughout the State have also been attritioned . Doctors including John Haight, Marcia Ehinger, and Bryan Quattlebaum are overloaded with cases. Diligently they do treatment authorizations, medical fraud cases and serve as expert witnesses for the State. Both of these groups of doctors need help, with new hires and competitive salaries.
The DSS and DHS medical consultants were not included by DPA in the recent salary hikes because they don’t see patients. But they are no less important to the State for the work they do and must be paid accordingly. In our upcoming State contract negotiations, beginning in late April, these administrative physicians and dentists will get top billing. Since Federal moneys pay for most or all of their salaries, the State Budget deficit should be less of a problem.
Our Dentists and Podiatrists are now enjoying significantly higher salaries and improved environments, thanks to the Perez case and our other negotiating successes. We will remain attentive to their needs and appreciate their suggestions and leadership. I particularly appreciate the high proportion of Union stewards who come from these groups.
Beginning in late April of this year we face the challenge of negotiating a new State Contract. Because UAPD has already won significant salary increases for most of our members, and because the budget deficit looms large this year, UAPD will now focus on improving working conditions, addressing on call and space issues, and increasing benefits like CME, disability insurance, and vacation. As I mentioned, we will fight to improve DSS and DHS salaries despite the challenge that the state budge presents.
The exciting news for our County sector centers around Los Angeles. After the team of Joe Bader, Attorney Larry Rosenzweig and myself negotiated a $ 10.1 million settlement with the County in 2006 over the Megaflex issue, we began the campaign to reorganize the LA County doctors. Our entire SoCal staff, especially Jake Baxter and Lux Irvin, pitched in to educate and obtain authorization cards from the nearly 700 doctor employees of the County. UAPD Board Members Deb Brown, Ron Bortman, Allen Doran, Hoe Poh, Dave Keulen and Executive Staff made the rounds of Harbor/UCLA, Martin Luther King, and Oliveview on a regular basis. We telephoned and tracked down physicians in clinics and hospitals to distribute their settlement checks. Finally in August we finished collecting the cards needed to become LA County Physician Employee’s official bargaining representative. The action didn’t stop there as we began regular negotiation sessions with County officials in November. We hammered out a 20 step pay scale which gives all County doctors at least a 12-15% pay increase over the 21 months of the contract, beginning January 1, 2008. And many doctors will get considerably more! Moreover, the Megaflex benefits package was preserved for current employees, and CME and job security was improved for everyone. Our cohesive team was led by Executive Director Al Groh, Southern California Director John Murillo, Representative Lux Irvin, Drs. Rex Cheng, Janice Nelson, L. Nelson, Michael Medici, Pedro Ortiz-Colon, Alice Singleton, Orlando Pile, Dr. Khan, Gary Posner, Edgar Velayos, and myself. We signed off on all articles of the contract in February, got a 96% member ratification vote, and now eagerly await the LA Board of Supervisors’ approval. This contract is a historic first for LA County doctors and strengthens our Union immeasurably. The politics and health care delivery in LA is particularly complicated—from the accreditation problems of Martin Luther King Hospital to the University’s attitudes on stipends and privatization. Keeping this bargaining unit humming is going to be an exciting challenge.
Earlier this month our San Francisco City and County members approved an important new proposal which should improve the long-term economic health of the CCSF retirement system. While our current members will retain full retiree health coverage after only five years of service, employees hired after January 2009 will receive 50% coverage after 10 years service and full coverage after 20 years service, just like State employees do. The County agreed to annually compound future COLAS and to increase the pension benefit schedule to 2.3% at 62. For its part UAPD agreed to a one year extension of the current SF contract. The April 2009 step increase will be implemented, but there will be no new salary increases through 2010. All of these retirement changes will be presented first to the SF Board of Supervisors in the form of a Charter Amendment and then to the SF voters in June, 2008. As always our team of Rep Patricia Hernandez, Dr. Roger Wu, and Dr. Derek Kerr did terrific work.
Our members in San Joaquin County are facing a unique situation with courage and solidarity. Their bargaining unit is the only one in that county not included in the retirement system. Our members, led by Doctors Edelsohn, Nelson, Russell, Brock and Antoine, refused to sign an MOU in 2007 which did not include retirement benefits. Thus they have been working ever since without a contract. The majority of our members, using their own funds, have sued the County in Superior Court. After our initial legal victory the County has agreed to provide retirement benefits in 2010. The bargaining team is trying to convince the County to accelerate this date by changing their salaries to a combination of fixed and incentive pay. Various Department members met recently in Stockton to close ranks and sign a statement of solidarity. We hope to have some good news regarding a creative settlement in the near future.
Meanwhile in Ventura County, a PERB hearing officer recently made a tentative ruling that the members in our bargaining unit are County, not Clinic employees and thus could engage in collective bargaining with the County. The County has appealed this decision. UAPD has ample evidence that the County controls the clinic operations and thus, our members. We expect to prevail in this matter in the very near term. We wish to express thanks for the confidence our Ventura members have shown during this difficult time.
There is smoother sailing for UAPD members in the Counties of Alameda, San Mateo, Santa Barbara, Santa Clara, Sacramento and Solano. All are enjoying well crafted contracts negotiated by Zegory Williams, Patricia Hernandez and Jim Moore. Sue Wilson, our new Communications Specialist/Representative will soon begin negotiating the contract in Santa Cruz, exhibiting her many talents.
Our Private Practice doctors, though under a thousand in number, are doing well. Our own UAPD IPA continues to offer excellent health plans with many patients to our members, some of whom are seeing excellent returns from these plans. In addition, they are coming up with ideas and legislation which positively affect medical practice everywhere. For instance, Our tireless IPA President Bob Weinmann has introduced legislation this year (AB 2969, D-Lieber) which will help Workers Comp doctors better treat their patients. At present, the system may use out of state physicians without California medical licenses to do utilization reviews on California cases. This is patently unfair. UAPD is leading the way in putting an end to this practice. When Governor Schwarzenegger first came out with his mandated health plan and 2% “doctor tax” early last year, I immediately sent out a letter, on behalf of our union, condemning this practice. Surprisingly, it took months for the CMA to respond to this issue. The “doctor tax”, along with the Governor’s plan, soon became extinct.
Dr. Gil Mileikowsky seems to be a lightning rod for Medical Board and Due Process issues. A Southern California Gynecologist by training, Dr. M. was labeled “disruptive” by his hospital after he made negative comments about a workplace problem. His hospital hearing was summarily terminated by a hearing officer who was an attorney, not a fellow physician. He won his subsequent lawsuit against the hospital (see UAPD website/Medical Board/Legal), but the case has now been sent back to the California Supreme Court for review. UAPD’s longstanding outside counsel, Andy Kahn, has written an excellent Amicus Brief which may be viewed on our website. Several organizations, such as APS, ACLM and CMA, are rallying around this case. Sham Peer review can affect everyone in both private and public practice. UAPD has had a long history of fighting sham peer review, from the Seymour case in the 1980’s to the Sinaiko case, championed by former UAPD Due Process Chair Deane Hillsman. I recommend that you read both stories on our website. It seems that whistleblower retaliation by hospitals and government agencies is on the increase. Our CDCR doctors have been aware of this since the Receiver came onto the scene and our private doctors are vulnerable as well. An amended California law (Health and Safety Code 1278.5) which UAPD helped to craft, went into effect 1/1/08, and will give some relief. Under this new law there is a rebuttable presumption that a health facility is retaliating against the physician if it takes discriminatory action against him/her within 120 days of the physician’s grievance/whistleblower complaint. Remedies include lawsuits to recover lost income and reinstatement from the offending facility, even while peer review is occurring. This should give pause to hospitals who want to “control disruptive physicians” by peer review.
There is more that UAPD is doing for California citizens through its legislative advocacy. AB 515 (D-Lieber) is formulated to protect people from carcinogens in the workplace. AB 1944 (D-Swanson), if passed will enable rural hospitals to directly employ physicians and thus allow them to collectively bargain. This bill will thus enable Californians to have better access to medical care in physician shortage areas. Lobbyist Doug Chiappetta should be congratulated for his efforts to bring this opportunity to the Legislature. Other significant UAPD legislation this term involves Safety Retirement for LA County (AB 1917 D-Dymally) If passed our LA County jail and mental facility doctors would represent the first doctors of the 57 counties in California to obtain Safety Retirement .
Our organization is moving forward with more courage, camaraderie and better communication. As I visit the State and County facilities to meet our members and listen to their concerns I can sense that we are “rowing together” more. Whether covering for each other in overnight call, doing yeoman duty in understaffed County or State facilities; whether pooling resources, ideas and wills to fight Bureaucratic whimsy and oppression, our members see the Big Picture: Medicine, besides Science and Art, is a Political activity. We need your courage and camaraderie to stand by your fellow staff member and your patients. On our part UAPD will continue to represent you for any grievance or complaint that has even a germ of merit. We will explore ways to protect your job and privileges. In addition to our annual State Stewards meeting in October, we are planning to hold the first annual County Stewards Meeting in September of this year. With nearly 700 LA County doctors about to enter UAPD the County sector will nearly match our State Sector in sheer numbers. Our new website, expertly constructed by Sue Wilson, will provide new opportunities—for questions and comments, surveys, town hall meetings, organizing possibilities and current news.
With our membership about to increase from 3000 to 4000, we are the largest post graduate physician union in the U.S. We are going upward—in numbers, income, influence and responsibility. We are getting calls from private physician groups in New York, Pennsylvania, Puerto Rico and North Dakota, from County and State Physicians in Oregon and New Mexico. Doctors are recognizing their vulnerabilities as employees in huge systems. They seek to maximize their power- as advocates for their patients as well as themselves. But in addition to increasing our influence by virtue of increased numbers, UAPD must also deliver good service to its members. We must help stabilize your jobs, and improve your salaries, benefits and working conditions so that you can reach your potential to be great and happy doctors. We will try to hold the line on your dues--who knows, we might even be able to reduce them.
With the extra income from more members and the higher salaries we are hiring more reps, especially for Southern California. In the upcoming summer we will begin to organize the 180 doctors in the UC Student Health Care clinics around the State. In addition there are dozens of County Health systems in California that still need a doctor union. We will continue to pursue private clinics and hospital groups that have doctor employees with mailers and personal visits. If you know of a private doctor, hospitalist or ER group that could use our IPA or contract review services let please let me or the Staff know. Our longstanding UAPD treasurer, Peter Statti has come up with several good ideas about increasing membership in our Private sector. At our UAPD Board meeting we passed his proposal to endorse contracts only with collective bargaining clauses.
Our relationship with our parent Union, the American Federation of State, County and Municipal Employees (AFSCME )continues to be strong after ten years of affiliation. In Sacramento and Washington, DC UAPD is increasingly recognized as a “player” in the health care field. We strongly encourage our members to contribute to the PEOPLE fund. By strengthening AFSCME’s political arm, we strengthen our own cause. AFSCME will be holding its Biennial International Convention this summer in San Francisco. It will be an opportunity to showcase our Union, especially with the Health Care Debate and various Healthcare reform plans in the public eye. Please write and submit any resolutions that you wish UAPD to present at the convention to us before June. Better yet try to become one of UAPD’s delegates. It is a fascinating experience .With the possibility of a labor friendly Democrat in the White House next year, UAPD may be able to promulgate collective bargaining in the private sector as part of a bill or reform package. As a growing force we must also recognize our moral obligation to sponsor and support environmental, consumer and patient friendly legislation.
The State of Our Union looks bright. Its direction is up. I believe we are a Union of talented and good people. Please let me know your ideas and suggestions via email or phone so that our Boards and Staff may keep us going strong and make a difference. I look forward to meeting you in person. Thanks again for your continuing trust in my leadership
In Solidarity
Stuart Bussey, MD,JD, UAPD President