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State of Our Union in 2018 — DBA (“Doing Business As”) UAPD

By Stuart A. Bussey, MD, JD, UAPD President

Fellow UAPD members, staff, and honored guests, 

I will start this State of the Union address with a well-known quote from Ruth Stafford Peale… “Find a Need …and Fill It.” These words describe the essence of a successful business model. Whether a service or product, the customer’s needs must be satisfied in order for an organization to survive, to thrive. In the case of our nonprofit corporate entity, the Union of American Physicians and Dentists, the customers are you, the members. You pay dues, you support our staff and each other, and you give good care to your patients. Our job is to take care of you. Among the services that our union has provided to our members for nearly half a century have been to bargain contracts, to enforce their provisions by grievance and arbitration, to represent them in disciplinary actions, and to fight for a safe workplace.

Since 1977 public unions, including ours, were assured of a 100% “customer base” by virtue of the US Supreme Court decision Abood v. The City of Detroit. That court decided that members of bargaining units who didn’t want to be part of a union for whatever reason still had to pay their ”fair share” for the contracts and services their union provided them. But times have changed. Our country has changed. With the rise of an oligarchy, increasing corporate influence, technology, and global outsourcing, unions have lost their influence. In the 1950s 36% of workers belonged to unions. Now only 11% do.

Those who never fully embraced the philosophy of union membership seized upon this summer’s Janus Supreme Court decision to drop out of their unions, to become non-members. Across the country, public unions now face a reckoning. While some unions lost only a few members, others lost almost half of their membership. Despite our best efforts to convince them to remain or become full members, UAPD lost a fifth of its membership. Almost all of that loss was from the fair share sector. Only a handful of our loyal full members have dropped out. That is good news. But make no mistake. The fair share member loss has significantly decreased financial resources with which to serve our members.

Now UAPD must respond -just as any diligent business would-to a temporary adversity. We must continue to provide you, our loyal customers with good services, win back our old customers, and maintain financial stability. Here are some business strategies we will be employing. Think of them as keeping our economic bucket full.  Adding more resources and members into the bucket, while plugging up holes and excessive expenses at the bottom of the bucket. First, let’s look at those holes.

In the past year, we have tightened our belts by reducing or eliminating several staff positions and payroll without compromising our representation. We could do this because we were relatively overstaffed in some areas. With skillful staff reassignment and deployment by our Executive Director Zegory Williams in Sacramento and Charles Lester in LA, we have literally saved hundreds of thousands of dollars. Zegory, for those who don’t know, will be retiring at year’s end. I would like to formally congratulate and thank him for his 17 years of outstanding work at UAPD. He has made our union stronger, fairer, and a great place to work. The extra workload has been picked up by our remaining staff. Please stand up and be recognized. In addition to staff payroll, we are addressing other expenses that need reduction. Take our legal expenses. For the past couple of years, we have been spending money on lawsuits against Alameda Health System and Multicare Health Corporation in Washington. I am pleased to report we have had successes in both areas. Thanks to the solidarity of our AHS doctors, especially Dr. Milton Lorig,  Senior Representative Patricia Hernandez, and Leg. Staffers Doug Chiappetta and Adrian Mohammed, contracting out of our positions at AHS is now effectively prohibited. Our new legal team of attorneys David Rosenfeld and Ann Yen was instrumental in this victory. We are now on a financially streamlined monthly retainer with this firm. In Washington state, the Rosenfeld group will play an even bigger role in fighting Multicare and other health care employers. With these savings we will continue to provide our legal consultation fund to those members in need. Since 2010 this fund has aided dozens of members.

Office consolidation is another area where we are saving money. As many of you know, we consolidated the Oakland and Sacramento offices in September into one office in Sacramento, thereby saving $168,000/year. The transition has worked out well. There has been little problem absorbing extra staff into our Sacramento location. In Los Angeles, we are looking to purchase a small office building and sublet our oversized rental space in El Segundo. We signed a broker contract last week. And anticipate a major saving. Lastly, meetings and transportation costs need to be reined in. We plan on using hotels that are comfortable, economical, and accessible. Staff meetings and small member-rep meetings will be done with Skype or Webex whenever possible. We will conduct more board and larger member meetings in our own UAPD offices.

To fill up our bucket with dues-paying members we will employ numerous strategies. First, we are polling nonmembers about why they are not in our union. We must also utilize organizing methods that other right to work unions have employed for years. That is, we must still honor the right of representation and earn the trust and loyalty of non-members. At the AFSCME international Convention held this past July this strategy was hotly debated. The rationale is that if nonmembers are treated with less vigor than members then a two-tier union will be created and the employer will use that to undermine us. We have already seen some successes converting non-members back into the union. To win back our non-members we will need the continued effort of our great corps of ambassadors, our UAPD stewards. Please stand up and give yourselves a hand. Without a doubt, you are the backbone of our union. Without you, we could not function. The other group I want to recognize today is our bargaining team members. They battle through difficult negotiations which affect all of our lives. Please stand up. One of the realizations of this past year during my site visits is that many of our members do not feel heard or appreciated. In the past, we have been a union closely tied to the Democratic politics of California. However, a significant portion of our members is not Democrats. These members must be heard. The direction and culture of UAPD should not be based on whether members are a Democrat, Republican, Libertarian, white, black, brown, male, female, straight, or gay…it should be based on our common identity as health care providers. We are an increasingly diverse melting pot of physicians, dentists, NPs, PAs, Pharmacists, Podiatrists and most recently, veterinarians. I would like to recognize LA Vet Dr. Amy Raines. Our Vice President, Dr. Ron Lewis, and others will be working this year to provide a sounding board, a non-partisan caucus, to hear all points of view.  Listening to different opinions is what makes an organization strong. Speaking of communicating, we continue to increase and improve upon our website and teleconference meetings-both for business purposes, as well as camaraderie. We just initiated a monthly happy hour teleconference in September to trade travel, union news, and hobby tips. This type of exchange is the glue of an organization. I welcome any suggestions from you to learn about and from each other.

For a business to thrive it must diversify its service lines while shoring up its traditional base. Here I am referring to the eroding State of California work sector. Once an 1800 employee state sector we are down to around 1000 members. With a reduced pension ceiling thanks to the PEPRA law, an aging membership, and an anemic hiring effort by the state, the outlook for state union jobs is not robust. But with a more union-friendly Governor likely next year we will attempt to fill our 400 plus vacancies with a more transparent state hiring process. The major diversification UAPD is attempting in the post-Janus world is the creation of private provider bargaining units under the NLRB. Thus far we have been successful in organizing four groups in the Seattle/Tacoma area- Auburn Medical Center, Legacy Urgent care, Indigo Urgent care, and Swedish Urgent care. With persistent bargaining and collective member action, we are on the verge of completing contracts for the first two groups. I would like to formally recognize the efforts of our Tacoma staff—Laura Anderson who retires next week, John Diel, and organizers Joe Crane and Gabrielle Hanley. These people are pioneers and innovators. There are other NLRB type units in California that our staff will be organizing. Other health care groups are interested in affiliating with UAPD. Medical students, who emerge from professional school with a quarter million dollar debts or more are looking for guidance to find their place in the brave new medical industry. Bradley Heinz, a UCSF medical student, was at our Board meeting last night and represents a potential giant alliance.

Finally, we need to cement old relationships with our union partners and forge new ones with like-minded professional groups. We have been affiliated with AFSCME international now for 21 years. They have provided valuable support, research, and organizers for UAPD during our campaigns-most recently in Washington. We need them and they need us. I would like to introduce our AFSCME  International Western Organizing Director, Walter Blair and California Political Director, Brian Allison. In order to garner political leverage, AFSCME depends on its 1.4 million members to enroll in the PEOPLE program, which costs members only a $100 per year. I would like to recommend that every one of our members here today enroll or remain in the program.  One last comment before I review UAPD’s issues of the last three years. I had the privilege of attending the third world medical union meeting in Lisbon, Portugal last month. Doctor unions from dozens of countries were represented. The doctors were an affable and fascinating group. Even though they are paid far less than American doctors, their top issues were their own personal safety and that their employers, usually their government, exploit them by excessive workload and hours.  Personal time is becoming the most important currency. I am proud to report that UAPD will be hosting the fifth international medical union meeting here in San Francisco in the Fall of 2020.

Let’s review what UAPD has accomplished since the past triennial and the specific challenges that lie ahead for the next term. First, some history of our State Sector. BUs 16 and 1 were organized by our founding President Sanford Marcus and then ED Gary Robinson and were established in State law by Governor Jerry Brown in the early 1980s.The increase in the inmate population in state prisons and mental hospitals meant a need for more physicians to treat and care for them. When the Plata, Coleman and Perez class action suits were decided in 2006, the Prison Receivership was born. More money and resources flowed into the prison system. More physicians and psychiatrists (like Drs.Agarwal and Aramandia of Stockton, Dr. Kamen of Avenal, and Dr.Mehari of DVI) were recruited to satisfy the primary goal of Federal Judge Henderson-to provide prison health care equal to that of outside society. The Receivership thus far has accomplished much to improve and organize the prison health care. Sixteen of 35 facilities have passed court audits. But sadly, like all bureaucracies, it has taken on a life of its own. It has become its own weather system with layers upon layers of supervisors. Meanwhile, Governor Brown has reduced the inmate population from 163,00 to its current level of  115,000. Scores of our rank and file positions in hard to fill geographic areas have been filled by our telepsychiatrists. Based upon a rosy CDCR report regarding telepsychiatry the State and inmate attorneys were on the verge of eliminating 20% of our psychiatry positions. But this plan came to a grinding halt last week when Chief CDCR psychiatrist and whistleblower Michael Golding, MD forwarded a 160-page report to Coleman Court Judge Muller. This sealed report details alleged misrepresentations and exaggerated data that CDCR has published about the virtues of CDCR telepsychiatry. UAPD is a stakeholder in this drama and will not sit idly by. California’s inmates, doctors, and taxpayers deserve to know the truth and formulate a better mental health delivery and hiring system at CDCR. Over the next year, UAPD intends to intervene, hold public hearings, and publish its own treatise on how to effectively staff and service the CDCR.  As far as our CDCR Plata physicians their vacancy problem is less than the 44% vacancy rate of their psychiatrist colleagues, but still significant. Several of our members have to take call several times a week. (Dr. Greenberg, Dr. Neubarth)They skip lunch and breaks to finish endless paperwork. Last year UAPD was able to limit the mandatory use of laptops by physicians for calling in orders while on call. But the CDCR continues to stretch the scope of our physicians. They are pushing for a Medication Assisted Treatment (MAT) Program to detoxify addicted inmates. Our physicians have expressed serious professional judgment concerns and UAPD will vigorously defend their position.  Regarding the new governance policies and professional practices executive committee (PPEC) UAPD has met several times this year with the Receiver’s representatives to increase our rank and file presence on this committee. Many thanks to previous PPEC members Ron Lewis and Gabe Borges for their years of service. I would be remiss for not mentioning our CDCR dentists who deliver care to inmates in a difficult environment (thanks to those  here today –Drs. Landers, Fransdal, Frier and Edwards)

Now to the Department of State Hospitals (DHS). Besides the chronic DSH vacancy problems, especially at Atascadero and Patton State Hospitals, the issues of the past three years involved management’s preoccupation with timekeeping our members and the ill-advised and overreaching Office of Law Enforcement Security (OLES). First, I am happy to report that a long overdue management housecleaning has occurred in the last couple of months at both Patton and in Sacramento. This has resulted in much-improved morale and a more realistic attitude and practice regarding our overworked members. Many thanks go out to those who saw the timekeeping issue for what it really was—a flawed attempt to retaliate against several of our more outspoken members. The latest bureaucratic attempt to keep state police fully employed is OLES. UAPD has already acted to curtail this group’s incursions into the clinical practices of our members. We have proposed at minimum a subject matter expert panel (SMEP) of DSH directors to screen patient complaints before they go to the OLES police. Some of these complaints have already resulted in anxiety-producing criminal accusations. We will continue to seek further remedies that ensure fairness for both patients and doctors. (My thanks to Drs. Wartena, Dang, and Yang)

At the Department of Social Services (DSS) there have been the usual attempts to increase workload and case quotas beyond what our contract has always stated. The expectation and workload memo mandate that our Medical Consultants complete their work within two business days. That has always been unrealistic, especially with the ever-increasing caseloads. Ask Drs. Bitonte and Resnik. Other issues relate to an onerous vacation leave policy. UAPD will be polling the DSS MCs about this shortly. Some good news is that the department has recently clarified that our members are eligible for alternate workweek flextime. The Department of Health Care Services (DHCS) UAPD has objected to the Department’s asking that our MCs enter into individual “Results, Accountability, Flexibility and Teamwork” (RAFT) agreements. We see no imperative for this after many years of successful MC productivity. I would like to recognize our long-time stewards from LA—Drs. Ken Seiff and John Haight, who retired this summer for their years of loyal service to UAPD. Kudos to Brian Kennedy and Ralph DiLibero in Sacramento. Regarding the Department of Developmental Services, we received notice this past winter about the future closure of the centers. Nevertheless, BU 16 members continue to accrue quarterly retention stipends to encourage them to remain on the job during phase I of the closures. In addition, MOD calculations are now being done correctly. I would like to recognize our SEPA Board President Peter Conroy for his loyal service and innovative ideas in service of DDS. At the Department of Veterans Affairs in Redding, new security cameras are being installed. In light of the mass shooting at Yountville VA two years ago, we think this is a good idea. The Department of Public Health and the UAPD are involved in ongoing talks about the department’s reorganization.

The University Student Health Centers are represented by about 80 of our doctors at the CSU campuses (BU-1), including Drs. Gamo, Thomas, and Tringale and well over a hundred doctors at ten UC student health centers (Drs. Alper and Nelson). Recruitment and membership at CSU is on the rise with increased enrollment and a great contract negotiated this year by Rep Jake Baxter. We are now initiating a Labor-management committee regarding legal representation and geographic differentials. At the University of California health centers, there are many separate policies and, thus, many separate issues. We have active grievance systems and stewards at each site. UC contract negotiations start shortly with Tim Jenkins as lead negotiator.

There has been much positive growth in our county sector over the last few years. Leading the way is Los Angeles. Our membership there has increased under the organizing efforts of Charles Lester and his staff. In the past, we had membership in the 40% range but we currently stand at 67%. The UAPD is working with DMH, DHS, and DPH about physician recruitment and how we can use loan repayment to recruit doctors. We already have obtained several commitments from psychiatrists to work in LAC. They will receive $50,000 per yr for up to 5 years. In addition, UAPD is making changes to recruitment brochures and reaching out to the Committee of Interns and Residents (CIR). UAPD has a seat on the Integration and Advisory Board which oversees the integration of the three departments into one health agency. (thanks to our LAC leaders here today -Drs. Glinicki and Pedneault). We also have rank and file health agency transformation advocates, positions used for union and management projects. This partnership is aiming to make the workplace a better working environment. UAPD has already used the Just Culture algorithm to solve grievances both informally and formally. Also, we just had our first interdepartmental CME on Burnout at Harbor hospital, sponsored by UAPD. Finally, we are in the midst of bargaining with the County on all three unit contracts—301,324,325. We could have them all wrapped up by year’s end. The LA County Ambulatory Joint Labor Management Committee will meet regularly to improve operations at the clinics At the Twin Towers correctional facility our doctors are now under the authority of DHS. Understaffing there has led to the creation of retention bonuses and loan repayment opportunities. Regarding the Pharmacists, in BU 01 they are one of our best-represented groups, at 90% membership. Pharmacist Sandhya Radhakrishna is now one of our UAPD Board members. (Drs. Ogun-Buraimoh, Nwanze, To and Wong). Thank you. The new Director of Pharmacy, Jean Peralles, is considering the need for Advanced Practice Pharmacists.

Other county units are also thriving. To Help Everyone Health and Wellness Clinic (T.H.E) has grown in the past three years from 8 to 13 members. They are in bargaining now. San Francisco County has been ably represented by Rep Tim Jenkins. With a good contract and membership at nearly 95%, our SF members deserve lots of praise. (Drs. Behrman and Wu have been instrumental)Proposition F appointments have allowed our members to remain retired annuitants. A wildcat strike at the Potrero Hill Clinic was recently avoided when a disruptive clerical employee agreed to leave. County of Sacramento personnel officers are having a hard time activating our contract incentives. UAPD (Dr Padilla)is working with them to resolve this issue. In Santa Clara County bargaining (Drs Wong and Yazgan) will begin in the spring. One thorny issue is the payment of tuition reimbursement. Doctors can get $4500 in a year and rollover this benefit once to the next year, but the process is too slow and onerous. A Santa Cruz County doctor successfully rebutted a poor performance appraisal. In San Mateo County our union, led by Dr. Herbert, is challenging the contracting out of physicians at the new jail. The solution may lie in what UAPD did for the Alameda Health System (AHS) last year. We passed a bill into law which precludes AHS from contracting out unit positions without clear and convincing evidence of cost savings. UAPD is considering similar legislation on a county by county basis. Nearby in Alameda County Senior Rep Patricia Hernandez recently completed an excellent contract for her members with large market adjustments for psychiatrists. Again, political intervention helped to persuade the employer to settle up. Other good contracts have gone into effect at San Joaquin County (Drs. Nelson, Soofi), Gardner Family Health Center, Northeast Valley Health Corporation (NEHVC) and Santa Barbara County. The latter two were engineered by UAPD Rep Glynnis Golden Ortiz. Thanks to all here today.

As I mentioned previously our goal in the post-Janus era is to diversify our membership into the Private Sector. As most of our independent private doctors have retired or gone salaried the UAPD Board earlier this year decided to dissolve our dwindling and unprofitable IPA. That was a difficult, but necessary business decision. At this time I would recognize the giants of our private sector- Drs Weinmann, Sinaiko, Sutton, Statti) In its place we continue to explore the world of corporate medicine, where providers and younger doctors are taking high paying jobs to resolve their debts. The best place to develop this service line is in Washington State. There are relatively friendly labor laws in the northwest and plenty of overworked doctors and providers interested in unionizing. For the past two years, we have been organizing hospitals and urgent care centers. We just recently organized Indigo and Swedish urgent care clinics. We are on the verge of completing two contracts—one with Auburn Medical Center and one with Legacy Urgent Care. Both are units of 50 providers and doctors in Tacoma. The final sticking points are compensation for AMC and closing policy for the Legacy providers. The latter issue lies at the heart of provider burnout and may soon require collective actions by our members and public pressure to convince the employer Multicare. Corporate employers are a different breed than what we are used to. Although they claim non-profit status they are singularly focused on the bottom line and demand that providers earn every penny of their salaries. That means long working hours and constant access to patients. I want to recognize our Washington staff and Indigo members who are here today—Sara Pedersen and Daryl Browne. The long-distance relationship with our Washington providers has required a long-range outlook. To succeed in a new territory requires skill, patience, and financial commitment. I want to thank our Board, our members and our Washington staff for staying the course. We will succeed and make history in the northwest. Our organizers have been receiving calls from doctors around the country who are rooting for us to stand up for those on the assembly line of industrial medicine. We are looking to chronicle this adventure. Yesterday Robyn Symon presented the burnout problem with her incisive documentary Do No Harm.  We hope that her next movie about UAPD will be called “The Empire Strikes Back”

Besides competent staffing, marketing and communication, and legal support, unions such as ours need political and legislative cover. Whether in LA, Sacramento, or Seattle, our legislative staff of Doug Chiappetta, Chris Ige and Adrian Mohammed are up to the job. They have proven time and again that contracts, benefits, recruitment, and employee advancement depend on both negotiations and political pressure. Contracting out and hiring transparency bills will be written next year in California. Covenant not to compete and Certificate of Need bills in Washington. Our UAPD members who are currently in the legislature, and those seriously considering entering politics, like Dr. Kevin Jetton, are necessary for our union to thrive. They are the vanguard in the battle to restore control of our once proud profession back to where it belongs—to doctors and providers. We need a tough business attitude more than ever to represent and protect our members in the new industrial world of medicine. We intend to apply those principles to make our union bigger and ever stronger. Long live the UAPD!