Tuesday, June 29, 2004

Petition Update

Thank you readers for signing up to sign the petition. We got a wonderful response. The current secret budget process and consulting spending spree is not yet spending Measure money. Measure “A” funds will start being collected in July and should hit the Medical Center sometime after October. Unfortunately with budget being developed now and the Authority Board signing over millions of dollars in the consultant contracts it will be spent long before it arrives. The public got a reprieve this week, two Authority Board members have resigned and the rest of the Board declined to pass the proposed budget. Rumor is a flurry of grand jury subpoenas have made the Authority Board much more “thoughtful” about their decisions. The proposed huge staffing cuts have created fear and concern about patient safety. Many of these cuts are in critical patient care areas, like the emergency department, the critical care units, and the cancer and AIDS clinics. We will be moving forward with the Attorney General, Bill Lockyer petition and will need you and your mother’s help. Thanks for your support and stay-tuned.

Correction: the two trustees did not resign they just resigned from their offices, but it is a step in the right direction, toward the door.

Recommended Reading

Grand jury reports come out yearly in July, the Dirt suggests that you put it on your summer reading list. The civil grand jury acts as a “watch-dog” by investigating the efficiencies of the county and local governments. The Dirt loves watch-dogs and did you know that anyone can make a grand jury complaint?

You got to love our justice system, here’s the link: www.co.alameda.ca.us/grandjury/civil.htm

There’s Good Money in Bad Medicine

The thing about medicine is, it’s hands on, actually good medicine is many hands on. It’s about giving care, touching, and listening. It’s not a vending machine kind of product. The same is true of hospitals. Good hospital management looks at patients first, operations second and financials last. You come into a hospital to be nursed; you might need IVs, dialysis, breathing treatments. If you’re really sick you could need many doctors, a dedicated nurse, a respiratory therapist to run your ventilator, a dietitian to make sure the tube food they give you does not provoke non-stop diarrhea, and when you’re well enough, a physical therapist to teach you to walk with your accident changed body. Hospital operations are no joke, making things run well takes talent, commitment, and real hands on experience. So explaining how a 10% staffing reduction (300 people, 600 hundred hands), will have a negligible effect on patients and operations, while simultaneously fixing the “financial picture” is no simple feat.

In defense of the consultants currently running the Alameda County Medical Center, they have been dealt a tough hand. They have been directed to make massive staffing cuts without disclosing that they are crippling or closing services. Honest outright closing of services would necessitate embarrassing public meetings, which the Alameda County Board of Supervisors are determined to avoid. This has forced the consultants to come up with very imaginative, if unrealistic proposals. The lay-off list presented to the unions included staff that had retired or left the Medical Center years before. Doorknobs were scavenged from bathrooms in old clinic areas, unfortunately they forgot to tell the staff who still work in those areas and employees have gotten locked in the bathrooms. Instead of ordering more linen for the new Clinic and Critical Care Building, they just took half the linen from the hospital floors. Supply shortages create work and inconvenience, staffing shortages can lead to accidents and deaths. Fear of the bad patient outcomes has become a real concern for Medical Center employees. Some employees have pledged to bring toilet paper from home, if it would help soften the proposed caregiver cuts.

If the county of Alameda has funds to pay for two Sheriff’s deputies on jet skis’, and every County Supervisor has a staff of 6, why can’t we afford to pay nurses to give the 300 to 400 hundred doses of chemotherapy that cancer patient need each month? If the consultant’s calculations are right and you don’t actually need these nurses to give chemotherapy, perhaps Supervisor Gaile Steele and her hoards of hired help will come down, and hang IV bags for patients.

Numerous patient care and safety concerns have been raised to the Cambio consulting crew and they have finally begun to respond. They have begun an extreme public-relations makeover. They no longer call themselves consultants; they have renamed themselves and the Board of Trustees as, “our leaders.” It’s a curious choice since they have done nothing but follow the Board of Supervisors directives and they couldn’t get staff to follow them to happy hour. Hopefully, they will continue the makeover, soften the look, ditch the power suits, the cologne and the tight shoes. At the point that Temporary Chief Executive Officer, (TCEO), Mike Burroughs, puts on some scrubs and works three twelve hour shifts in a four bed room with three confused patients and one combative patient, no nursing assistant, no sheets and no toilet paper, well then he’s earned the right to be called a co-worker. When TCEO Burroughs gets real and tells the Board of Supervisors, he can’t safely run the Medical Center and give them 10 million dollars a year, the staff will gladly call him a leader. Until then the consultants proposed cuts have created fear and apprehension about the “human costs” these savings will exact.

Tuesday, June 22, 2004

Answer This!

The Dirt is thinking about petitioning California
Attorney General, Bill Lockyer, to investigate the
"irregularities" associated with the way
Measure A money is being spent (i.e. on slash &
burn consultants and not on patient care).

This action is deemed necessary because the Alameda
County Board of Supervisors appear to be either
unwilling or unable to do the job.

If The Dirt were to create and circulate such a
petition, would you sign it? Could you get your
mother, your neighbors, and your co-workers to
sign? The Dirt needs you!

My mother said she'd sign. Please email me your
thoughts, opinions or pledges of support.


Tuesday, June 15, 2004

Inside and Outside the Rightsize

So what’s it like getting right-sized? Is it like loosing 30 pounds in one week without dieting for only $19.99? Not exactly, the Cambio Health Solutions consultants are in the process of fixing the Medical Center’s “financial picture.” They want to produce some attractive little charts and graphs to show how much money they are saving, some dramatic power pointable figures. Consultants produce piles of pie charts and fancy reports. In fact their contract says they will produce a MAP “Management Action Plan.” The Medical Center paid extra for the clever language. None of the little people who provide the care have seen the MAP and budget meetings are top-secret: open only to consultants, bureaucrats and politicians. The Medical Center’s staff sincerely hopes that somebody has a plan, or a map, or at least a clue.

On the ground level, the consultants have been cutting and chopping. By most reasonable estimates staffing the new Critical Care and Clinic Building would require 140 additional employees. The consultants ran their secret formulas and determined the new building could run just fine with no extra employees. It will look great in the report, more for less, better, cheaper, faster.

So, back on the farm, what actually happens? Well, waits in the new building’s sparkling new pharmacy are up to four hours long just to drop off your prescription, that’s before you start waiting to have it filled. The housekeeping staff is stretched so thin that they don’t have time to mop and clean in the old building, and in the new facility the dust bunnies are winning the war. The radiology department also finds itself barely limping along.

Cost containment isn’t good enough for the Board of Supervisors; they brought in the consultants to cut costs! And that’s exactly what they plan to do. Through more expert analysis they determined that, all three of these departments have an excess of staff. They have proposed cutting 5 positions from pharmacy, 12 from radiology, and 14 from housekeeping. These consultants really know how to pinch a penny.

Understaffing and lay-off offs are the sunny side of the right-sizing and fiscal responsibility program. The really mean-spirited stuff is aimed at the patients. The Medical Center has a new “Charity Care Plan.” Around the hospital it’s called the “You Better Get Blood From a Turnip or Else Plan”. Patients must now pay a $100 deposit per Highland clinic visit. This plan ought to keep people from coming to the hospital. They haven’t figured out how we will control or monitor diseases like TB or SARS with the new financial barriers to care, but the saving should be stupendous. It’s the no money no honey medical services model.

But enough about the insides of the rightsize, what about the outside. What about the nice numbers, the pie charts, the return on investments and the politicians who will cash in on these cuts. Well, if things keep on their current path, the Board of Supervisors should be whistling all the way to the bank.

Transitional Care Patients at Highland Hospital are in Danger!

By C. Gathright, Registered Nurse TCU

The consultant team, Cambio has proposed that the nurse/patient ratio be changed from 1:3 to 1:4 in the Transitional Care Unit (TCU). There was no tour of the unit or assessment of the patients done by the consultants. No input was solicited from the staff who work in this unit. There were no statistics presented to justify this staff reduction. Cambio bases its service cuts on “proprietary statistics” which they refuse to share, even with the Board of Trustees.

Many people are upset with Cambio for these proposed cuts, but the real responsibility lies with the Alameda County Board of Trustees. It is their ethical and moral responsibility to ensure the safety of the Medical Center’s patients. Have they forgotten that they are making life and death decisions when they cut medical services? Many of the patients in TCU are very sick and should actually be in Intensive Care Unit. The 1:3 ratio ensures that these patients are properly and safely cared for.

The Board of Trustees has already shown the employees of the Medical Center how little they value their work by approving huge staff cuts and by neglecting the day-to-day management of the Medical Center. We wish that ensuring the safety of patients in TCU were as worthy an expense to the Board of Trustees as the consultants they continue to spend millions of dollars on.

Tuesday, June 08, 2004

Where’s The Beef?

Your Tax Dollars At Work and Play

So what do you get for $200,000+ dollars a month from consultants and outsourced executives? The Dirt asked hospital employees what they think of our new management. The most common answer was, “What management?” Most Highland employees have never seen the “turnaround team.” One housekeeper said he thought he saw one but it turned out to be a patient’s lawyer. It is rumored that our leaders are busy consulting among themselves, power pointing, writing expense reports, and spending, $56 thousand dollars in April alone.

The consultants have engaged in a very effective cost cutting strategy, they aren’t paying the bills. If they continue this strategy another year the deficit may disappear, the hospital spends thousands maybe millions on things like blood, medications and surgical supplies. Although no one can stop the Board of Trustees from spending millions and millions on consultants, the hospital staff must now get multiple signatures for any spending of greater then $2,500 dollars. These signatures come from our out-of-state executives. Since executive signatures can be hard to get, staff that have to buy expensive items like AIDs drugs and chemotherapy spend their time writing lots of little purchase orders.

Before the Board of Trustees tilted the hospital budget with their consultant-spending spree, the Medical Center’s finances had begun to improve, according the pre-consultant CFO, Robert Strawn. So with the new state of the art Critical Care and Clinic Building, the budget improving and Measure A money about to come in, why did the Board of Supervisors search out a “slash and burn” consulting firm? With the future looking so bright why didn’t they bring in permanent administrators with the skills to improve operations and a desire to advocate for the Medical Center?

Could it be just old-fashioned greed and self-interest? If the Medical Center gets cut to the bone or goes bankrupt, where does the Measure A money go? The top county bureaucrat, Dave Kears, insisted on getting his piece of Measure A up front, 25% of the yearly revenue (25%of $90 million.) Here’s where the “bait and switch” comes in. Voters never would have supported $90 million dollars a year to be spent at the discretion of politicians and bureaucrats. They know better, they supported the Medical Center and the services it provides. That’s why the politicians need consultants. No real hospital administrator would let the county take money away from the Medical Center; the consultants on the other hand might.

Rumor is that Alameda County’s Health Care Czar, Dave Kears, already has his hand out and wants an additional $10 million dollars a year from the Medical Center to go back to the county. They can’t take the Measure A money directly, that would be too obvious, the money has to be laundered. Where can the Medical Center get $10 million dollars a year? Well, those consultants got right on it, they determined that by laying off 350 hospital service providers you could save $14 million dollars a year. After giving $10 million to the county there would still be a $4 million dollar cushion for any additional consultant spending or expenses. After cutbacks, kickbacks and consultants, the Medical Center’s patients will be lucky to get new band-aids out of this deal.