Monday, November 22, 2004

Big Hug

The chest pounding and brow beating goes on. The medical center employees accepted a contract and important people are still talking about lay-offs. Physicians are pushing forward to try to fix clinic scheduling and develop programs to manage chronic illnesses, but no one is reaching out to staff to move on and move forward. Come on guys, if you don’t want to “charm and disarm”, just shut up.

The one truly multidisciplinary program in the hospital got offed, the part-time program specialist for the department of diversity affairs got canned (Cambio probably needed the cash for executive salaries). Diversity is dead, but we still have the “pink book” to train us on cultural sensitivity (it has a long section on the Amish, but doesn’t cover African Americans.) Many employees find it amusing, but no one has ever described it as useful.

As another morale raiser, the Sheriffs escorted a patient through the hospital at peak visiting hours with a loaded shotgun. They forgot to tell nursing they’d be heavily armed and when a social worker asked what was going on, he was told it was, “none of his business.” Discharging a shotgun on a crowded nursing floor could easily result in a buttock full of buckshot for social workers, nurses, other patients, and their guests. Many employees feel the our new VP of marketing will have a hard time marketing “Bright Birthing Beginnings” at Highland, if we have Sheriffs wandering around with loaded shotguns, but hey, what do they know, they’re just the hired help.

What, what, what is to be done? My thoughts exactly as I headed to Two Star Liquor for a six pack of Bud (to wash down my McNuggets.) As I headed back to my car, I passed Full Moon Seafood House. At night diners look like fish in an aquarium and someone caught my eye. At a table for six sat: Nate Miley (county sup), Floyd Huen (authority board trustee), Jean Quan (Floyd’s wife and Oakland city council woman) and a couple of other political hacks that I couldn’t readily identify. Undoubtedly they were discussing the same dilemma as I: what, what, what is to be done? They looked far more miserable than I felt, I briefly considered crashing their party, but my McNuggett’s were getting cold and my Bud was getting warm. Besides, I have two lovely kids at home, and an evening with dyspeptic politicians isn’t my idea of fun. So I went home to discuss the situation with my family. My advice is not original; in the words of Tinkie-Winkie, Dipsie, La La and Poe (the Teletubbies) it’s a good time for a “Big Hug.”

Medical Center Employees Accept a Contract

Service Employees International Union Local 616 has created a high quality blog! If you want to see the terms of the contract accepted by union represented employees of the medical center or just want to check it out.


SEIU local 616 represents some medical center employees, county employees, homecare workers and daycare providers. They have become an articulate voice and advocacy organization for care-providers. The Director Fran Jefferson has also recruited some exceptionally talented staff: Brad Cleveland, Wayne Templeton, Carol Ingoe and Angela McWhinnie to name a few. They’re the little union that could. Hey, the Dirt’s day’s maybe numbered, I’m getting out-blogged

Tuesday, November 16, 2004

Charge Back

The medical center must learn to compensate for its underprivileged status in the county bureaucracy. Dave Kears, much like George Bush, has pushed a privatization model on county health services. Non-profits, the medical center, and for profit healthcare providers all compete for limited county healthcare dollars; instead of cooperating to provide coordinated care. So if a mental health agency can drop off an alcoholic for a week or two at Highland and then let the medical center find them a place to live, it makes their bottom line look good.

Here’s a hypothetical you’re a private hospital administrator with a problem patient: she needs a nursing facility, she’s too young for Medicare, she has multiple sclerosis, she can’t walk, she’s incontinent, she has bedsores and psychiatric problems (which she refuses to treat.) She’s sitting in your thousand dollars a day hospital bed screaming and scaring your paying clients with non-stop profanities. In an effort to manage her screams and complaints her doctor has her on enough morphine to knock out a bull elephant and of late she’s taken to throwing food at the nursing staff and talking about suicide. Then she does you a big favor, she jumps out her first story window and sustains some scratches landing in the bushes below. In a stroke of administrative genius, it occurs to you, this is your opportunity. You dial 911 and when the ambulances arrive you tell them she is a trauma victim and have them take her to Highland. Patient dumping or appropriate triage, you be the judge?

Enough speculation, it suffices to say many clients with complex needs and problems miraculously end up in the medical center. This occurs in spite of private and public mental health services, adult protective services, the county conservator, Telecare, Regional Center and more. We have an enormous number of poorly coordinated county services and contractors. Somehow problem clients from all sorts of county funded services end up at the medical center in bad shape, at this point it falls on the medical center to fix not just their medical problems, but also their social and economic problems. The hospital has to get them well and get them a place to live. These patients sit in the hospital for weeks to months, until medical center’s social workers can find them a place to live with an appropriate level of care. These clients get put on administrative days (Medi-Cal won’t pay for their stays) so the medical center eats the costs.

So county agencies, private hospitals, non-profits and for profit providers all dump their “problems” at Highland. Once these clients end up in Highland the medical center must find them a place to live. At the end of the year county contractors receive “fiscal rewards” for providing cost effective services and the medical center gets to booby prize for spending too much on the sick. So what is to be done, well Cambio Healthcare Consulting could use a tool frequently employed by our corporate cousins, the “charge back.” This is a sound business move and since county healthcare services are based on competition instead of cooperation, it’s a smart defensive tactic. If the CEO of the moment kept records of all the costs incurred by medical center clients who are supposed to be managed by other agencies they could “charge back” these costs to the county at the year’s end and demand their “fiscal reward. “

Monday, November 08, 2004


“Mommy, you forgot to make the world a better place today”
James Gregor Nomura Fisher, 4 years old

Well, I guess its time to stop crying in my beer and get on with it. November second hit hard and hurt. At least Measure Z Oakland’s give potheads a break initiative passed. They had a big light it up party. Deep slow inhale… “Yeah... take this Ashcroft.” I don’t smoke pot, not because of moral objections; I just don’t care for it. In time times of hardship, loss, and crisis I hide in poetry, movies and books. Here's one of my favorites:

Children of Our Era

We are children of our era;
Our era is political.

All affairs, day and night,
Yours, ours, theirs,
are political affairs.

Like it or not,
your genes have a political past,
your skin has a political cast,
your eyes a political aspect.

What you say has a resonance;
What you are silent about is telling.
Either way, it’s political.

Even when you head for the hills
You’re taking political steps
on political ground.

Excerpted from “Children of Our Era”
miracle fair
Selected Poems
of Wislawa Szymbrorska

So the poet is right. The world is what we make it. How can the Democratic Party capture the hearts and minds of the county, if we the faithful barely believe in them? Our party has controlled California for a long while and liberal democrats own the Bay Area. So, why do we have crumpling schools and hospitals and why are we spending our limited monies building new prisons and hiring more police? County Supervisors whine and complain, “it’s prop 13, it’s term limits or it’s the State.” We need to stop waiting for vision and leadership; it is time for the good people of Oakland to put down the pot and to make our local officials build the city and county we deserve.

Without Compromise

Geeeez, well negotiations have broken down between the unions and management at the medical center. It’s heavy posturing, Cambio sent forth flunkies with a “last best and final offer.” The real decision makers never actually enter the room with the union team (it’s beneath them to meet directly with the hired help.) So executive temps and sub sub consultants with no real decision-making power run back and forth. Come on guys, hurt feelings are half the problem; a little courtesy goes a long way. The employee's negotiating team said, “ nope," to “last, best and final.” So, Cambio has effectively forced another strike vote. Then there are the ever-helpful trustees, rumored to be saying they will put the lay-offs back on the table. Come on guys, people are quitting in droves, lay-offs are entirely unnecessary.

The Tribune

The medical center made the front page. The inner workings and dirty details of inspections. The grapevine says those pesky inspectors tore apart a private hospital this week, let's hope the Tribune will show the same zeal in exposing their dirty laundry. I think not, Sutter unlike Highland has big suction with the press.

To read the Tribunes latest click here:,1413,82%257E1865%257E2520137,00.html?search=filter

Monday, November 01, 2004

Trick or Treat

Well, we’re close to a year and four CEOs into the Cambio Healthcare Consulting experience, at the medical center. Expect inspectors this week, these are the State guys, they give new meaning to the term nitpicking, they have been known to check between people’s toes. These guys are less fun than an elevator full of consultants.

Hopefully, this week we’ll get some good news. The Board of Trustees is having an emergency meeting to decide whether to give workers a tiny or small raise. Once a contract is signed a labor-management committee will be formed to review restructuring plans. This should allow employees to help fix processes and organizational problems. The CEO of the hour, Claude Watts, has also expressed a willingness to meet with workers directly, without management to get a more complete picture of how things work at the medical center. Is all of this good news a part of the new “stop-loss” program that Cambio is rolling out?

Barbara Selfridge’s Crib Sheet for November 2, 2004

State Propositions
1A Keep Local Tax Revenue Local. YES. In this summer’s budget compromise, Schwartznegger kept his No New Taxes pledge by stealing tax revenues from future generations (who will have to repay our bonds instead of funding their own needs) and local governments (property and sales taxes, etc). Prop 65 would stop the $1.3 billion dollar annual shift unless 50% of voters approve it; Prop 1A (put on the ballot to stop Prop 65) allows Sacramento to take the money for only two years and after that only if 2/3s of the state legislature okays it. The Greens like 65 better, but they say vote yes for both.
59 Limits on Government Secrecy. YES.
60 Open Elections. YES. Don’t let rich GOPers wipe everyone else off the ballot.
60A Earmarking Revenue. NO. This isn’t much money $30 million/yr but are we so anti-government that we won’t let Sacramento debate how to spend it?
61 Bond for Children’s Hospitals. NO. The Greens say we need big fixes, like single-payer health coverage not costly band-aids like this one.
62 Close Elections NO NO NO As in Louisiana, only the two highest vote-getters (read best-funded most-Republican) would make it onto our ballots.
63 Tax the Rich for Mental Health Services YES Good tax strategy.
64 Put Corporate Law Breakers Above the Law NO Don’t lose your right to sue.
65 Reverse the Theft of Local Tax Revenues YES Better than Prop 1A.
66 Three VIOLENT Strikes YES YES YES Amend an unjust costly law.
67 Phone Tax for Hospitals NO The Greens say only 1% goes to 911 services 90% to hospitals and MDs, and they don’t like Sacramento grabbing county funds.
68 Let the Mafia Run Casinos NO A set-up to take down their Indian biz rivals.
69 Forced DNA Sampling NO, NO, NO Even innocents would lose their rights.
70 Expand Indian Casinos YES? There are lots of reasons to vote no: gambling, non-union labor, non-environmental protections. But yes is pro-Indian.
71 Bonds to Fund the BioTechs NO Stem cell research is good, but the Greens say this would be a $3 billion giveaway to private industry (plus the $3B interest).
72 Healthcare Coverage Even Without a Union YES YES YES Wal-Mart, Target and other large employers would prefer their workers use ERs and Medi-Cal.

About the Propositions

My Sacto insider explains them thus: it’s the legislatures job to debate what needs California will fund and how we will raise those funds. But the Republican minority stops new taxes and the outsourced/ tanking/petroleum-dependent economy stops new surpluses, so it’s gridlock city in the state capitol. And so special interest groups good and bad go for propositions, most of which say protect my needs (or my tax bases) from the budget negotiations, please! So if representational democracy is not the way to get our societal needs met, we fall back on propositions? And they become law, even if hardly any voters can read them? What if they’re worded badly? What if they don’t go far enough? That’s how you end up with the good people who want stem cell research being opposed by the good people from Our Bodies Ourselves.