Affiliated with AFSCME and AFL-CIO

Midterm State of the Union Report Coming Soon!

The State of Our Union
Looking Inward, Outward and Forward Presented by Stuart A. Bussey, M.D., J.D., UAPD President

Good morning, Brothers and Sisters! As I stand here before you as your new UAPD President, I am here to report that the State of Our Union is strong, and with our collective will, can only become stronger After a third of a century the words of our Charter ring truer than ever:

 

               “We Physicians and Dentists, in order to provide optimum medical

                care for people...to enable doctors to give of themselves, unhindered

                by extraneous forces...to ensure reasonable compensation for doctors...

                and the responsibility they bear for the life and health of their fellow

                beings, do establish this Union.”

 

This pledge was promulgated by our founder and first President, the late Dr. Sanford Marcus. It has been ably upheld over the last 17 years by our second President, Dr. Bob Weinmann, now a working Consultant.  But what really makes our Union the best in the country are all of its moving parts--the Staff, rank and file members, stewards, the Board, and all of their families and loved ones.

 
As we transition to new leadership in a new landscape, we, as a Union, need to look inward, outward and forward in order to survive and prosper. First, who are we now?  We are Public physicians, dentists and podiatrists serving the state, counties and cities. . . and we are Private doctors, serving our patients in a variety of practice settings. We are 3000 strong and as diverse a group as you could find. Yet, we must be ever mindful of the term Union, and support each others’ causes for the collective stability of the group.

 
Our State sector membership has struggled with the frustrations of bureaucratic, legal and political roadblocks and unremitting turf wars from ancillary professions  Our Prison doctors are facing a hostile Administration and Federal Receiver bent on replacing our loyal, experienced and dedicated Civil Servants with inexperienced and uncommitted contractors. They have slandered our members and impugned their abilities with sensational and exaggerated stories and statistics. They are forcing a self serving, irrelevant and ineffectual academic exam down the collective throats of our members. But UAPD continues to fight back against QICM, both as a Union and through individual physician lawsuits. Courageous doctors such as Jack Friedman, John Colocousis, and Chuck Hooper are rightly challenging the validity of this exam. And salary relief is at hand!  That UAPD Prison doctors have been undervalued and underpaid is borne out by the recent contract raises engineered by staff Gary Robinson, Jim Moore, Zeg Willams and the State negotiating team. Salary increases under the Plata and Coleman decisions are closing the gap even further and the Receiver Bob Sillen has promised even more salary increases over the near term.

 
What about our doctors in the Mental Health facilities and hospitals? According to Federal, state and common sense standards they work in an understaffed and dangerous environment. Their expertise and authority to manage patients are being constantly challenged by professionals with less education and experience.  The Psychologists who have tried to substitute the Behavioral Model of care for the Medical Model are only promoting more chaos in an already difficult setting  Were it not for the persistent legal efforts of Dr. Michael Lisiak of Atascadero, the Underground regulations promoted by the California Psychologists Association would have become law. These regulations would have significantly usurped the authority of our Psychiatrists to manage patients. This competing group has been defeated for now. . . but make no mistake, they will be back. In the meantime our Bargaining Unit doctors in Mental Health will enjoy substantial raises over the next 18 months. And we are fighting to make sure that our understaffed Psychiatrists will get an additional 10% salary increse.

 
Our Developmental Doctors perhaps have the most complex and difficult patient population to manage--both physically and mentally handicapped.  Ask Dr. Cuong Nghiem, who has worked at Lanterman Hospital for decades. A patient sits in a corner banging his head against the wall. He or she is a member of the public. By protecting these patients from self destructive behaviors our doctors are in a real sense protecting the public. They should be therefore entitled to the same Safety retirement benefits as our Mental Health or Corrections doctors. This is the argument we have and will continue to make to the State at negotiation time. We greatly appreciate our DDS doctors for their service.

 
Our Social Services Doctors face a new type of bureaucratic nightmare. The Social Security Agency in Washington, DC, with minimal physician input, has imposed a fragmented, confusing and untested computer system to evaluate millions of disability claims. Claims processing time has predictably increased across the country, especially so in California. Our physical and psychiatric medical Consultants have struggled to fairly integrate and adjudicate the mountain of medical evidence in this difficult system. Management predictably has not come up with any creative solutions. But leave it our own UAPD members Rick Dann, George Bugg, Dan Lucila and yours truly to come up with the solution. The Bonus Plan is coming on line as I speak to relieve the case backload and supply our more energetic doctors with a financial incentive.

 
Our110 Health Services doctors across the State who create and interpret Medi-Cal policy, fight against fraud, and serve as Expert Witnesses are unsung but are greatly appreciated. Amongst our most credentialed and educated they need Union representation to prevent management from flooding their desks with cases they expect done yesterday. Each of their cases has serious legal ramifications for State physicians and the Public. Our DHS doctors such as Marcia Ehinger and Bryan Quattlebaum must continue to articulate the need for adequate time and resources to do their job effectively.

 
Our California State University doctors continue to quietly excel in delivering care to students at universities across the State. Their negotiations have been consistently amongst the most cordial and successful of any of our groups, thanks to the efforts of Staff Joe Bader, David Trujillo and John Murillo, and of physicians such as Floyd Anscombe and Carol Smith. Our Union must share these successful negotiation strategies and best practices whenever possible amongst all our union members.

 
Not enough good can be said about our Dentists and Podiatrists, who toil with low salaries, poor working conditions and inadequate equipment. They still manage to deliver quality dental and podiatric care in the prisons, hospitals and other facilities. In the past several months we have heard their messages loud and clear. The Union must do its part to support the Dentists in the upcoming Perez case. The fallout from this lawsuit will be much like Plata in improving salaries and working conditions. We are fortunate to have a dentist, Dr Bryan Quattlebaum, on our UAPD Board. And I would encourage more of the dentists to take on leadership roles.

 
And now let us look inward at our County sector doctors, who have to contend with a different type, but no less petty bureaucracy. Take the case of our besieged Los Angeles County doctors. Their ranks were decimated as a result of the discriminatory rescission of health benefits by LA County and the subsequent misleading campaign of a few union busting physicians. But the Truth usually prevails. The Superior and Appellate Courts have ruled that taking away the Megaflex benefits from our Union doctors violated the Meyers-Milias-Brown Act and another state law enacted through Senator Gil Cedillo. With the teamwork of our Southern California staff and Sacramento lobbyist par excellence Doug Chiappetta we proved our case. UAPD now expects to realize millions of dollars of back pay for the hundreds of doctors who left our union. When we are able to distribute this money in a few months to these doctors we hope the Team in Southern California union doctors such as Alice Singleton and Orlando Pile can get most of these physicians back into our union family. For the rest of the LA County bargaining unit we are confident of substantial raises in the near term. As for the LA County Psychiatrists they face the same challenges from Psychologists that our State Mental Health docs have. Because of understaffing of Union physicians, psychologists have demanded prescribing privileges.  This is unacceptable and dangerous. The UAPD will closely follow and be involved with the Baca v. Walker case which deals with this issue.

 
In our San Francisco County Bargaining Unit our doctors work hard for the City and County.  At San Francisco General Hospital Urgent Care, five Union doctors were faced with losing their full time positions. But with the tenacity and political savvy of Dr. Deb Brown and others these positions have been preserved. At the giant 1100 bed Laguna Honda Hospital there are less than 2 full time Psychiatrists caring for these 1100 beds. Through the efforts of Rep Al Groh and Drs. Derek Kerr, Roger Wu and myself we recently have obtained immediate and substantial raises for these 2 beleaguered psychiatrists and signing bonuses to recruit new doctors. The SF County negotiating team led by Al Groh did very well for the other doctors in the unit.

 
In Alameda County at the John George Psychiatric Pavilion our UAPD doctors provide steady services. But the Board of Supervisors and the Administration tried to replace our docs with contractors without even meeting and conferring with our reps. This, of course, is an unfair labor act. Our legal eagle, Rep Patricia Hernandez, along with Al Groh and Dr.Milt Lorig were successful in preventing the contracting out of these jobs. Similar scenarios go on from time to time in other county and state units. As our brothers’ keepers we must be vigilant of any of these shenanigans and report immediately any contract or policy violations to our union stewards and reps.

 
As for our Private Union members, though they have dwindled in numbers over the past few years, they are fighting battles and forces just as powerful as our Public sector doctors.

Take the case of Dr. David Keulen, a hardworking internist from Southern California who does right by his patients. He belongs to an IPA that has instituted Pay for Performance criteria. The performance and documentation of certain clinical procedures should be rewarded as good medical practice. Dr. Keulen did his part. But the insurance companies and his IPA refused to pay him for his good medical practices and blamed each other for the shortfall. Because of Dr. Keulen’s tenacity, good documentation and the personal presence of UAPD staff, he is being rightfully reimbursed and hopefully changing policy. Speaking of IPAs.  Our own UAPD IPA has been up and running for over a decade. Led by Drs. Weinmann, Peter Statti and Wally Wenner we continue to select and administer insurance plans which provide good service to patients and fair and timely reimbursement to our members. And of course there is the legislative program for private practice. We sometimes concur and sometimes disagree with the California Medical Association’s position on bills. But we always adhere first to the best interests of patients and our doctors. The lobbying and behind the scenes work of Doug Chiappetta, Gary Robinson, and Dr.Weinmann have become the stuff of legends. More about that in a bit.

 
As a reponsible health care organization the UAPD must look outward at the political landscape and be proactive. We must strive to be good citizens of the healthcare community.  In the private sector we need to speak out against unfair and unnecessary Medicare cuts to physicians. Congress has proposed a 5% cut in Medicare physician payments against a backdrop of rising federal spending and beneficiary premiums which have almost doubled since 2002.  As a result fewer physicians will accept Medicare patients into their practices. Last week we instructed our AFSCME lobbyist in Washington to begin contacting Congressmen about our displeasure with these cuts. It certainly does help to have friends in high places.

 
California’s Workers Comp system, recently tilted towards insurers and away from doctors and patients by the Schwarzenegger Administration, must be readjusted. Doctors must be allowed to practice medicine as they see fit and have some latitude from the current ACOEM guidelines. Utilization Review should be done by California licensed doctors only.  Finally, physicians must be allowed to continue dispensing medications from their offices at a fair rate. All of these issues have been addressed by the UAPD/AFSCME team starring Bob Weinmann and the dynamic Willie Pelote. A group of us recently met with the Head of Workers Comp who seemed genuinely receptive to our views.

 
Another issue of concern for the private doctors is that of balance billing, the ability to ask the patient to pay for charges that the insurer will not pick up. We must actively lobby against the proposed position taken by the Department of Managed Care to prevent balance billing. Without this ability E.R.s, Clinics and practices may go under.

 
As for looking outward at the County sector, the number one priority in the short term is to get our LA County unit back  In San Joaquin County we will stand by our County doctors as they mount a legal challenge to obtain retirement benefits. Currently they are the only bargaining unit in the County not to have a defined benefit package.  As a cooperative venture these doctors are sharing the legal costs of this suit. We are hopeful for a positive outcome. This pooling of resources, similar to the Corrections doctors’ lawsuit against QICM shows the value of unity amongst our members.

 Organizing campaigns, such as in Ventura County, where 55 doctors want to join us, must be pursued.  Jorge Rodriguez has been our main organizer for many years. He is to be commended for his work in Ventura and we look forward to the renewed efforts of our LA office to vigorously pursue bargaining units in San Bernardino and other nearby counties. Our organizers can point to the successful contracts we have recently negotiated in Santa Clara, Santa Cruz and San Mateo. The greatest ambassadors to recruit new members are, of course, our current UAPD members.

 
The respect and esteem with which UAPD is held in State politics is crucial to all of our membership, but it is especially important to our State members. Were it not for the manueverings of our own Doug Chiappetta and Willie Pelote of AFSCME the recent spate of ill conceived Corrections bills would have passed the legislatures. Do not underestimate the powers of alliance with other unions to defeat such noxious laws or referendums. As you will recall, last years anti union Propositions sponsored by Schwarzenegger were defeated through the efforts of AFSCME , SEIU, the teachers, nurses and fireman’s unions. Privatization and contracting bills have been stopped with the help of the powerful CCPOA prison guards union. Now more than ever we need the political and legal muscle of AFSCME to positively shape the prison reforms being promulgated by the Administration and the Federal Receiver Bob Sillen. We also urge you to vote for pro union candidates in the upcoming November election. Support them with your vote. We will support them with our PAC funds.

 
Because of the difficulties in recruiting physicians and dentists for prisons and mental health facilities salaries must be increased. We must continue to make the public aware of our program to improve the quality of medical care in the mental health facilities. Besides achieving adequate staffing ratios safety issues in these hospitals must be constantly addressed. The recent admixture of violent prisoners into mental health facilities with inadequate security portends dangerous reactions for both staff and patients.  Health care reforms may be achieved in prisons and mental health facilities through development of stronger medical staffs.  These staffs should exist and be strengthened in every large prison and hospital. UAPD intends to amend state law to ensure that CTCs are included.

 
For our doctors in social and health services we must remain ever vigilant to new and creative solutions to the information crunch we are subject to. In Social Services this has meant taking a “we’re all in this together” attitude with management. In Health services as well, creation of a coverage systems and regular team meetings will increase productivity and morale.  Of course more regular meetings with union reps and stewards will increase knowledge through communication.

 
That word communication seques into the last part of my address. Moving the Union forward requires, in my opinion, “The Three Cs”. The first C, Communication comprises union members communicating amongst ourselves, our stewards, reps, and with nonunion doctors. We can share best practices and ideas with each other via an improved UAPD website and local interactive networks. Our current website is woefully dated and behind our own current events. We must hire staff sophisticated in web development and networks. Great care must be given that private and confidential information not be disseminated to injure or embarrass any other member. Recent group conference calls between staff and union groups have been quite successful. We can hold a town hall meeting via a computer network. We need to involve members from outlying facilities, share ideas, both good and bad. We, as a union of three sectors would do well to get to know one another’s issues. The recent Stewards workshop in Oakland began to include county stewards as well as state. There is no real reason that private doctors could not learn labor relations skills at these workshops.

 
It has been suggested that we appoint a Chief Steward to organize and lead our stewards. This is a good idea. There are facilities in the State that do not have enough members to warrant a steward. The Chief Steward could appoint regional stewards for these facilities or take care of the problem by him or herself.  Given the number and complexity of grievances at various stages, a Chief Steward could be helpful to our overworked reps, who must travel great distances frequently to the various facilities. With our recent contract eliminating a grievance step at the local level we can put pressure on the State to resolve our grievances faster and without arbitration.

 
The second C is Courage.  I refer to the type of courage which is tempered with thought more than emotion. The managerial powers of the State are great, as evidenced by the recent PERB decision allowing QICM testing. Before grieving or entering into legal battles we must dispassionately assess our contractual or legal position. The UAPD has an experienced Executive Director and labor reps, several groups of specialized labor, administrative and constitutional attorneys. Even a President who passed the Bar exam. Before reacting unwisely or spouting off to a supervisor consider the situation and the consequences. Take a deep breath, cool down and get some advice. Then show your union courage by standing up for an injustice that you see, whether it is obvious or subtle. If you get in trouble with the Medical Board remember the UAPD Medical Defense fund will cover your representation up to the Accusation level. Then you must make your own legal arrangements.

 
The third C is Comaraderie. This refers to a positive attitude towards our colleagues and staff. There is much scientific evidence that such an attitude improves your own health and appearance as well as your success in work and your personal life. Have some fun on the job if you can. Make the best of each situation and your patients, colleagues and even your supervisors will treat you better.

 
I would be remiss without discussing our Union’s financial health and growth potential. Because of the various major legal battles of the past 2 years we are running at a deficit. We are taking measures to improve our bottom line. We are downsizing the physical size of our Oakland headquarters, limiting our outside legal expenses whenever possible, and planning to ask our County members for a small dues increase. It has been only a year since we raised State member dues and many years since we raised the County dues. We would still have dues less than one percent of our salaries.

 
We value our AFSCME affiliation. AFSCME has been invaluable as advisors , researchers, lobbyists. The Twenty First Century initiative was discussed at the recent Chicago Convention and calls for some expansion of services. This requires a higher per capita over the next three years. To continue our lobbying and legislative programs we need the power of AFSCME.

 
One of the dividends we have from AFSCME is the power to enter into an agreement with an employer and employees connected to AFSCME . This will enable the UAPD to launch its own Taft Hartley health care trust. We can administer various health plans to these employees through our own union private practice doctors and attract other doctors for these patients who will be required to join UAPD. In this way we can provide quality health care for union workers by union doctors and increase our membership in the process. Besides this recruiting idea there are demands for unionization on a national level. We have had recent calls from doctors in Pennsylvania and Washington State to form bargaining units there. Other less successful doctor unions in other states may go under. By tightening our own financial belt and carefully venturing out to organize in local California hospitals and clinics and then adjacent states we could one day soon realize our title of the Union of American Physicians and Dentists. Thank you for your time. Solidarity Forever!