Contract Negotiations
The UAPD is tallying the results of the contract negotiation surveys returned by union members. It is likely that there will be a major fight with the state this year over the issues of wages and benefits. The Governor is asking for a $70 million reduction in compensation for state employees. The UAPD will be asking for increases in compensation for its members.
Corrections Proposes Major Changes
UAPD Negotiating On Plata Lawsuit Program
The California Department of Corrections is proposing a sweeping upgrade in the provision of medical services in the department. As a result of a lawsuit settlement in a case known as Plata, CDC developed a thousand page program to provide the framework for the improvement; however, the department is not providing any additional resources to meet its new standards. As a result, the Plata program is a hollow paper shell without the major increases in medical, nursing, and ancillary staff and other resources needed to carry out its mandates.
Copies of the nearly 1000 page Plata program were sent to Health Care Managers at each institution in early 2002. Every doctor in Bargaining Unit 16 has the right to review the program. The UAPD recommends that every doctor talk with the local Health Care Manager about how they can review the crucial information in the program.
UAPD Negotiating with the Department
The UAPD is conducting negotiations with the Department of Corrections over the Plata medical services program. The UAPD negotiating team is composed of Executive Director Gary Robinson, Representative Zegory Williams, Scott Anderson, M.D., (CMF Vacaville), and Joseph Perez, D.D.S., (Valley State Prison for Women).
The UAPD team proposed that there be major changes in the program. One important issue is the role of medical staffs in quality assurance. The UAPD team is adamant that local institution medical staff must be responsible for quality assurance of medical issues. Initial discussions with the department indicate that this issue may be resolved in a favorable manner.
QMAT Team to Review Quality
A second key issue is the role of a new departmental program called QMAT (Quality Management Assessment Team). It is contained in Volume 4 of the program. QMAT has already been implemented at Pelican Bay State Prison with extremely bad results. Pelican Bay is covered by a separate lawsuit settlement known as Madrid. Pelican Bay is being used as a testing grounds for QMAT and other CDC new programs.
At Pelican Bay, QMAT is a cookbook formula of services that physicians must provide whenever they treat an inmate. There are inadequate resources to provide the required services, so the physician is to blame whenever anything on the list of mandated services is not provided. The department rates Pelican Bay doctors on a percentage scale. When the performance of a doctor falls below 85% on the department''s scale, the physician is called in for counseling. The percentage ratings are then used to evaluate, discipline, and even fire doctors. Despite a requirement that all working conditions and disciplinary changes be negotiated between the department and the UAPD before they are implemented, CDC failed in its responsibility to notify the UAPD of the program at Pelican Bay. The UAPD will file charges against CDC on this matter.
The CDC team initially said that the Plata QMAT plan was a quality assurance program and was not intended to discipline doctors. The UAPD team proposed that the Plata program specifically state that QMAT cannot be used to evaluate or discipline doctors. The CDC team then changed its tune and said that it would not agree in writing because the department wanted to use QMAT to discipline physicians. This issue remains outstanding and will be a key part of the ongoing negotiations.
Chronic Care Guidelines are Cookbook Medicine
One outrageous part of the Plata program is contained in Volume 7, the Chronic Care Program. Volume 7
spells out defined guidelines that physicians must follow in providing general medicine, cardiovascular, diabetes, gynecology, HIV, pulmonary, seizure disorder, and tuberculosis care.
As an example of these cookbook guidelines, the general medicine guidelines include:
For "patients whose disease process is not well controlled" or who are "noncompliant with the therapeutic regimen", patients will be seen by their doctors "monthly or more frequently."
In spite of this likely increase in workload, medical visits will become much more complicated and lengthy due to a list of 24 responsibilities which physicians must comply with when seeing these patients (Section 7-4-5). These will include, among other obligations, performing a "thorough history and physical examination" on "all patients with a GM disorder," assessing the "degree of control of each chronic disease," "ordering monitoring," "providing appropriate educational information ... at each visit," and "ordering all medications," presumably even psychiatric medications. Moreover, if patients decline any therapy they must sign a "refusal of treatment" form and the treating doctor will be "responsible for providing a system whereby noncompliant patients ... will be counseled." Doctors are responsible for "documenting in the health record all relevant information at each visit" and for "scheduling the next appointment". The list goes on and on.
Lawsuits Will Proliferate
While each of the guidelines may be a worthwhile goal, the vagueness of language, i.e., "ordering all medication" or "documenting all relevant information" is an open invitation to lawyers for the inmates to sue the department and the doctors. The length of the list, the lack of doctors, nurses, and ancillary personnel, and the lack of other resources, make the program a classic Catch 22. The doctors must provide specified services, and the department won't provide the time and resources to provide the services.
The UAPD Response
The UAPD team's initial proposal was that the guidelines be scrapped and that a joint team of management and rank and file physicians develop guidelines which are workable within the context of the resources available in the CDC. This proposal was rejected by the department.
It became clear to the union team that it will be difficult to make major changes in the guidelines. The courts and attorneys have already approved them. While this indicates bad faith bargaining on behalf of the department, it is an important consideration.
The UAPD bargaining team then decided that the best approach would be for the UAPD members in CDC to do a detailed analysis of the time and resources necessary to comply with the chronic care and QMAT guidelines. Doctors in each CDC institution need to review the chronic care guidelines in Volume 7 of the program and QMAT guidelines to determine how much time it would take them to abide by the guidelines. They also need to determine what other resources are necessary to comply.
The UAPD will gather this data from our members and negotiate with the department about increased staffing and other resources. If CDC is unwilling to provide the resources necessary to comply with its own guidelines, the union will be compelled to go to the Plata court and ask it to order the department to hire the additional doctors and nurses and provide additional resources needed for compliance.