All Offense

That’s right it's county budget time again. The battle of the bureaucrats: the Sheriff and Dave Kears have started staking out positions, the lobbying and bullying has begun. Local politicians have already started poor mouthing and blaming the medical center, the governor, the religious right, the mediocre middle and the apathetic left for the current state of financial affairs.

The sups plan to cut cut cut healthcare, but ask them about the prison budget, they’ll tell you, “You know the Sheriff is very popular.” Poppycock they’re scared of the dude.

This is not just another year, this year the public plans to weigh in on the budget. That’s right we’re fed up with county budgets that don’t reflect our values and priorities. This budget will not be balanced on the backs of the elderly and sick. This time we all get a say, stay tuned, it's pressure and accountability time, this is gonna be fun!


Postscript: In spite of ongoing problems and leadership deficits the medical center has a nearly balanced budget.

Just Unplug Me

In writing on the record, “I do not want to outlive my brain. I do not want to persist in a vegetative state.”

Brain injury or cognitive problems don’t get discussed. We talk in terms of lists of deficits, level of consciousness, attention problems, and memory and language deficits, movement disorders. We have a whole lexicon of terms to describe “cognitive deficits” we try to take it apart and track and describe the differences. We like to fix and improve things, better diet, better joints better boobs, medicine fixes and improves.

With brain injuries we watch and see, we teach compensations and we coach the family to accept the changes caused whatever happened inside their loved one’s head. When you work with the families of brain-injured clients they often say to you, “they are not the same person.” That’s when you know they have started not just to understand but also to accept what has happened. Sometimes families never accept the changes in their brain injured relatives and loved ones and they keep waiting for the person they remember to come back.

That’s why we don’t like to talk about brain damage, it begs big questions, where is our soul? Which parts can you take away, replace or enhance and still have the same person? Americans can spend hours discussing makeovers and surgical improvement, they can tell you which movie stars have had work done, but could they tell you the man talking too loud in the restaurant with the scar above his eye had a brain injury? No, they would tell you he’s just a jerk.

There is something terrifying about the thought of loosing part of one’s self and still having one’s body inhabiting your life. Can the soul be changed and rearranged and at what point are we gone but still here. We would rather not think about it.

So instead of a national dialog about brain injury we have the Schiavo case: court room drama, political posturing, fear, ignorance, denial, and righteousness. Never has so much been said and so little learned.

Cambio Healthcare Solution’s Twelve-Steps to Quality Care

When policy makers use the term “quality healthcare” what they are really talking about is the absence of bad outcomes, deaths, dismemberments, lawsuits or citation provoking mistakes. So has Cambio’s management caused a crisis of quality at the medical center? Yes. So how did they make the medical center dangerous? Well, actually they used a twelve-step approach.

The first step was to cut staff, and to replace highly skilled clinicians with temps in critical care areas. You want the nurse in the intensive care area to know where the “crash cart” is. If half of the ICU staff flew in from the red states the night before, not only do they not know where things are, they don’t have anyone to ask. The medical center doesn’t have enough oncology nurses, chemotherapy treatments are being delayed, this is a big no no, and will definitely get the hospital cited.

The second step: ignore maintenance in important areas, while spending extravagantly in others. Like why spend money on things like computers for doctors orders, telephones for nursing stations and patient’s rooms and elevators when you could blow millions on time clocks and PR. So under Cambio’s tenure, elevators have actually crashed down the shafts, when telephones break they don’t get replaced and computers, which generate physician’s orders for whole departments, are broken for weeks at a time. What is the point of clocking employees in if they don’t have any work because the computer broke?

The third step, keep executives away from all patient care areas, don’t articulate any long term vision for the hospital and blame employees and indigent patients for the hospital's financial problems. “Cambio doesn’t want these people in the hospital.”

So, while Cambio Healthcare Solutions failed to articulate a vision for the medical center, they have hurt patient care through cuts, bad staffing strategies, failure to maintain essential equipment and a negative attitude toward our clients. Once a consulting company causes this kind of damage what do they do? They claim victory having reined in cost and moved the facility toward “fiscal responsibility.” At the end of a consultant contract not much gets done. The Tennessee temps are busy keeping their chairs warm and trying to hire their buddy’s into high paid management spots before they fly home.

In the interest of getting a decent night’s sleep, I will skip the last nine steps of Cambio’s twelve-steps to getting blood from a stone or a public hospital. Still these consultants will be leaving on a high note; doctors, unions, managers, politicians and board members all express giddy optimism about the consultant’s departure. Everyone wants a real CEO. Awareness about healthcare has changed as well; people expect a functional public hospital. Medical center employees enjoy a new level of support and respect in the community and employees, patients and Alameda county residents expect the board of supervisors to make good on the promises of Measure A.

Belt Tightening and IOU’s

Cambio Healthcare Solutions wants to look good to the politicians, lower costs at any price. They have given up on revenue enhancement and fixing the broken billing department. They are focusing instead on more cost cutting: squeezing budgets, running off more staff, and not paying bills. Who knew you could run a hospital on IOU’s?

Cambio’s brain trust is going department-by-department chopping fat and waste. Physical therapy lost its wheel chair budget, respiratory therapy its equipment budget (those ventilators are a real excess). We fully expect that they’ll just fire all the discharge planners and replace them with new technology: the hospital ejecto-bed (which will propel patients off the roof and back into the streets of Oakland).

Actually, the consultant’s high-risk management schemes have begun melting down. Cambio Healthcare Solutions thinks unions are icky, so they have replaced many permanent staff with travelers and temps. They outsourced about half the nurses in the emergency department and the critical care areas.

Whenever a highly qualified specialist nurse tries to get hired on at the medical center, their resume gets lost. “You can teach the traveler from Virginia how to give chemotherapy. She has ten years of experience in labor and delivery it can’t be that different.”

So aside from frightening patient care scenarios this passion for outsourcing has now created a financial crisis. You see temp agencies are ruthless negotiators and when they supply a huge percentage of your staff, they can pretty much name their price. That’s just what the agency that supplies one third of the medical center’s respiratory therapists did. The raised the hourly rate from $ 38 to $54 dollars an hour. Oops, there goes your cost savings.

Cambio showed them, they cancelled the contract. Starting Saturday they’re gone, no more travelers. So now they will be paying the regular staff tons of overtime. Actually the department maybe able to run with less respiratory therapists if the ventilators get repossessed, that will really cut the work down.

Any day now, the nursing outsourcers (who provide half of the critical care nurses) will decide to gouge the medical center and raise their rates; this will catapult the medical center back into big debt. Cambio’s betting they can ride on temps, IOUs and service cuts until their contract is up. They run a lean mean healthcare machine and they’re running the medical center right into the ground.

Measure A Giveaway

The Oakland Tribune is keeping an eye on the cash. The Sups are going to give millions to Saint Rose Hospital to cover the cost of treating the uninsured. Oh, poor private hospital.

Look, I'm all for supporting hospitals who reach out to the poor and the uninsured, but Saint Rose is not known for its soft touch with needy. Hospitals who get these funds should have to demonstrate that they don't discriminate or dump patients.

If an accident victim gets discharged from Saint Rose with an unfixed broken hip, and they still need an orthopedic surgery at Highland, why should our tax dollars go to the hospital that gave the poor patient expensive advice and Vicodin.

I'm guessing there's no strings attached to this public funds giveaway and Saint Rose doesn't plan to use the funds to develop substance abuse program for all the meth addicts who live within commuting distance of their hospital.

Oh, well at least the Tribune's on the job, to read Karen Holzmeister's piece click here:

http://www.insidebayarea.com/searchresults/ci_2592564

Highland’s Good at Bad

We did it. We passed the inspection with only minimal findings. No one could find the elusive consulting team, Cambio Healthcare Solutions, the only proof we have of their continued existence is the massive revenue drain from their billing and the occasional memo. Still the inspectors actually noticed that private hospitals “dump” into the county system. Shocking, absolutely shocking. Who knew that they even cared, next time they come we’ll give them a list of dumped patients.

See dumping, or as one CEO I knew called it, “referral of underinsured patients to the appropriate public provider” is what keeps profits up and statistics pretty at private hospitals. People think you have to be poor, or a drug user, or perhaps illegal to get dumped, sure basic prejudice and discrimination counts, but the bottom line is really how costly is the disease. Cancer, now that’s an expensive disease and lupus there’s a disease that just keeps on costing. So county hospitals don’t just get the very poor, they get the very sick. When you’re real sick it’s easy to forget those extra forms and payments, and poof, insurance is gone. Bye bye, so long, you get referred to “the appropriate public healthcare provider.”

So who needs a public hospital, the really sick. The cancer business is booming at the medical center, as are all the medical clinics for people with diabetes, high blood pressure, heart disease and kidney disease. Medical center doctors can’t get rid of hard problems; they have no choice but to try to help patients to manage even the most difficult diseases. That’s why many of the best doctors in the Bay Area work at the medical center. They are really good at managing really bad health problems.

Parenting For Politicians

Our meditating, miso-drinking, dog-loving mayor wants to beef up his image. Jerry Brown wants to go back to Sacramento as Attorney General, California’s top cop. Unfortunately the “strong mayor” doesn’t look strong; he looks tired and bored, so he has to take tough stands. Political consultants and the Oakland Tribune have re-invented Jerry as the “Crime Stopper.” As part of the PR push to pump up the Mayor’s image, he rolled out the “curfew” plan for parolees.

Mayor Brown noticed that people come out of our prisons and they aren’t “rehabilitated,” in fact they are very likely to get involved in more trouble. So Jerry decided that the same unsuccessful approach that is being applied within prisons would work in Oakland, take away their freedom. The curfew keeps parolees locked in their homes from 10:00 pm to 6:00 am, it’s sort of a “time out “ “you’re grounded” approach to urban youth and crime.

Oakland has something of a crisis of critical thinking when it comes to politicians. They all want to look tough, so most went along with this bad plan. “ They just have to take some responsibility” that’s the rationale one council staffer gave me. Here’s the problem, most kids in “the system” have little or no family support, they get punished, thrown out, and beaten based on the same rationale, “you have to take some responsibility.” Any thoughtful parent will tell you “ time out” or “ curfew” is for the parents so they can calm down and figure out how to help and guide their child. Punishment in the absence of parenting does not make responsible adults.

Two adolescent boys lived in the neighborhood around my work. They lived in a run down house with their adoptive mother. Their mom died of cancer with little support and the boys struggling to care for her. The home health nurse tried to get some help for the boys but there was none. At about 14 and 15 years old they were left in the house (they didn’t own it because they weren’t officially adopted). They got lost and sad and the house became more and more run down. The kids got sick and hurt and into more and more trouble. They got evicted, the house was boarded up, and the kids had nowhere to go. They wandered the neighborhood, it was the only home they ever had. They were in and out of jail and I suppose they are in prison now. They are nice kids. We completely failed them.

Oakland youth know we’re afraid of them and that we don’t like them. They expect to be locked up, harassed, and treated like criminals, even those who aren’t. We get kids at Highland Hospital all the time who are working hard and “taking responsibility,” they get shot paralyzed, hurt or killed. The Oakland police department doesn’t investigate their cases; they barely take reports. Our kids get crippled and government moves forward as if nothing happened. It breaks their hearts and their spirits to loose so much and be treated so badly.

Stay at home, “you have to take some responsibility”. See if you don’t have adults to teach you what that means its just more punishment, it will fail for the same reasons that the prisons fail. Oakland parents talk about keeping their children alive and out of jail into adulthood. They worry about the crime, and the police. Oakland’s politicians feel safer with our youth locked up or locked in. Careful parents don’t just protect their children; they prepare them to live in the world and to make it a better place. I explain to my children that Mayor Brown and many of the City Council Representatives are racist, stupid and mean, but that most of the people who live in Oakland are not.

Preparing for Failure, Fighting for Survival

The nurse crouches over to examine the bleeding patient in the crowded emergency room. The loudspeaker cracks, and an authoritative and threatening voice comes on, “all nurses who have not completed their charting will be hunted down.” A bead of sweat forms on the nurse’s head and the patient says, “Gee that’s sounds draconian.”

For those new to the Dirt, in good financial times county supervisors leave the public hospital alone, neglect has been the prevalent approach of the county supervisors to the medical center. In tougher financial times the supervisors consistently “bad mouth” the institution, berating it for providing expensive medical services to the indigent and failing to reap a profit (this is the mission of the hospital and the legal responsibility of the county).

So when the most recent financial crunch hit, the sups supported a tax to provide financial support for the hospital (Measure A) and when the tax passed they developed a pay back plan, so the hospital, could actually give money back to the county. Now no competent hospital management team would sign off on this plan so the politicians hired, consultants, Cambio Healthcare Solutions. They have managed to run off and retired many skilled employees, they upgraded executive titles and salaries and they have gotten the hospital in deep doo doo with ”regulatory bodies.”

Anyone who works in healthcare knows the fear and dread that inspections from regulatory bodies inspire. So how does a high-end top draw consulting giant like Cambio Healthcare Solutions approach the impending invasion of inspectors? Well consultants don’t make their money in smooth running well-oiled healthcare delivery machines, chaos and crisis is what drives their business. A well-planned failure, now that would necessitate more consultants, there would be cost cuts, blame to assign, reports to write and layoffs to implement. It’s a consultant’s wet dream.

A strategic belly flop, well Cambio laid the groundwork over the last year by running off nursing staff and replacing them with temps and travelers. Many of the nurses who will be attempting to comply with Medicare and Medi-Cal regulations are visiting from Canada. They don’t even have Medicare in Cananda, in Canada nurses treat patients not the medical chart.

Managers keep introducing more and more new forms to nurses who have more and more patients. Nurses can’t fill out the tons new forms, which have been introduced in the last two weeks if they don’t have nursing assistants to help them with patient care. While nurses get crushed under unbearable patients loads, hoards of managers run around auditing charts and threatening nurses.

The terms “patients” or “quality care” have not come up in the numerous mandatory meetings, which mangers attend in preparation for the coming inspection. Why last week a hoard of mangers was seen slaving feverously over the chart of a patient who had died weeks before. It is the strong sentiment of many Highland clinicians that quality documentation is most effectively achieved through quality patient care and that sane staffing would allow them to better achieve both.

One caregiver said trying to provide quality care and appropriate documentation in the current atmosphere of hysteria and blame was like trying to fry an egg in the back of Winnebago heading down Highway One with a drunk at the wheel. While Cambio Healthcare Solutions does all they can to fail the upcoming inspection, medical center employees have risen to the challenge, they plan to beat the odds and pass.

Oaklandrising.com

Oakland lacks a newspaper interested in real investigative journalism, this crisis of critical thinking has resulted in little or no public discussion of issues. The absence of any scrutiny has resulted in a bumper crop of incompetent, unethical, inept and absent politicians. Flagrant mismanagement of public institutions and resources has become the norm; the Alameda County Medical Center is well managed compared to the Peralta College System or the Oakland Schools.

The decay of integrity and the basic competence of elected officials in Oakland has started to attract some very talented reporters to Oakland. They see career making scandals. My current favorites are: Douglas Allan Taylor, the Berkeley Daily Planet, Chris Thompson, Will Harper and Kara Platoni all of whom write for the East Bay Express.

Douglas Allan Taylor is an Oaklander, a parent and the most thoughtful and intelligent voice we have right now. His most recent piece is posted in http:www.Oaklandrising.com

Slumber Party At Mayor Brown’s Pad

Well, mayor Brown plans to pair up with Tom Orloff (the DA who couldn’t convict the crooked cops) to attack parolee’s civil liberties. The dynamic duo, the absent and the incompetent will work together to implement the ill advised (a mandatory bedtime for parolees: a 10:00 pm curfew). You see Jerry really wants to look tough on crime, he’s running for Attorney General, so he’s trying to beef up his image. He’ll be long gone when the American Civil Liberties Union starts suing the Oakland into oblivion over this curfew business.

Besides, Jerry’s a big idea man; he can’t be bothered with testy details. So what if parolees become homeless, it happens all the time, do they just have to report to a designated freeway overpass or parking lot; or are they in violation of their parole? Is homelessness now an automatic parole violation? Is this “curfew” just a tool to send hundreds of homeless parolees to prison?

What about those parolees that don’t come from stable loving homes, a cold hard truth? Say junior comes home and mom’s locked him out, do junior and mom go to jail? Let’s say little miss gets put on curfew, and someone in the stable home attacks her at 11:15 pm. Can she sue the city and county for forcing her to stay in an unsafe environment? Here’s one Jerry should know something about, say a dude with a history of disputes with his female partners, gets into an altercation one late night with his wife in their home. The attacker then uses the “curfew defense” insisting that had he not been on curfew, he would have done what they taught him in anger management and left the environment.

So do I oppose the “curfew” approach to curbing crime? No, the idea is not without merit it just needs some modification to reflect the realities of life in Oakland. You see the curfew only works if we can guarantee a safe and stable home environment for parolees. I think this is just the job for Jerry; he can bring all the parolees over to his loft for slumber parties, anger management groups and seminars on animal rights and leash laws. Jerry can start “We the Parolees” and take, real hands-on approach to fighting crime.

Vote Health Letter to Hospital Authority

The Medical Center needs a permanent, experienced public hospital management team to establish a strategic vision for ACMC and to lead its restructuring effort. Cambio's part-time management team has not and cannot fulfill this role because they have no long term commitment to the success of the institution or to county residents who depend on ACMC for its life-saving services.

We are concerned that the Board of Trustees did not begin its search for a permanent CEO last year. Now that you contracted with Russell Reynolds Associates, we ask your board to:

· Expedite its efforts to hire a permanent CEO, and
· Allow the new CEO to hire the executive team of COO, CFO and HR Director.

We also ask that the Board of Trustees conduct a performance evaluation of Cambio and its management team, and make this review public. One year into Cambio's tenure at the Medical Center, the Trustees have yet to hold Cambio accountable for delivering on its promises. Some of these failures are reflected in the most recent financial report:

1. Registry use "hit new highs" of $1.7 million in December, and runs $2 million
over budget in just six months, a 30% variance;

2. Discharged Not Final Billed has risen for the past three months;

3. Medi-Cal is under-budget by over $12.5 million, while CMSP is over-budget by
$3 million;

4. Despite an investment of $300,000 into a "marketing campaign,"
obstetrical deliveries continue to decline.

We believe the quality of care at ACMC has suffered under Cambio’s leadership. The most egregious example of Cambio’s failures involves ACMC’s growing reliance on temporary nurses. The situation is particularly dangerous at John George, and in Highland's ER, ICU and TCU. Cambio's team of consultants and managers has only exacerbated a difficult situation. According to the HR Department, there were 117 RN vacancies in November, but ACMC conducted only five interviews that month. The Medical Center hired five RNs, but eight quit. In a letter to the Trustee's HR Committee, SEIU Local 616 wrote that Cambio has failed to act on its own recommendations regarding nurse recruitment and retention, contained in its May, 2004 Nursing Assessment.

The Medical Center's staff and patients, and county residents who fund this institution deserve better. Vote Health has confidence that you will act expeditiously to hire a permanent CEO and to hold Cambio accountable for its performance.

Sincerely yours,
Kay Eisenhower
Kay Eisenhower, Chair
Vote Health http://www.votehealth.net

Harm Reduction or in Plain English Damage Control

Bare with me folks I’m running on empty. My daughter, Emma (imagine a three-year-old 40 pound Afropolurican with very good lungs) has made a serious attempt on her parent’s lives. She’s waking up three to four times a night screaming, usually with a fashion request like “I need my party shoes.”

So damage control or Harm Reduction is first and foremost in my cloudy mind. The thing about public hospitals is that they’re public. Only sound county policies can fix the medical center, fix Oakland and fix people. That’s the job, the endgame, and the bottom line. That’s where the solutions start, with sick people. Our experts look at budgets, at billing, at politicians, at contracts and studies. No one has spoken to the patients and they especially haven’t talked to the “problem patients” or “frequent flyers.”

You ask any ten homeless people in Oakland what they need, they’ll usually tell you two things: first they will tell you how sick they feel and second they will tell you they are trying to get Disability. By this they mean Social Security Income and Medi-Cal the health benefit that comes with it. You see in Alameda County we have bureaucracies on top of bureaucracies all not managing the poor and sick’s basic problems: healthcare coverage and disability benefits.

Alameda County non-profits, public services, community clinics and private healthcare providers all compete for funding. It’s every agency for itself; they don’t cooperate to get poor disabled people benefits. The very sick and poor (hence very expensive clients) just get bounced around between agencies. County agencies don’t coordinate care and advocate for patients, they compete for Dave Kears’ favor by cutting costs and position themselves for funding. In fact the prison system spends its time knocking people off benefits and then dropping them back into Oakland without a job, an income or a healthcare benefit.

It’s hard to get over that terminal cancer when you have to stand on the corner and sell the Street Sheet Newspaper to get money for yourself and your two young children. Sure you’re dying and certainly you deserve the social security income you paid into for twenty years but in Alameda County we preach the "personal responsibility approach" to getting disability benefits. Yeah, drag your sick self down to the Social Security office and fill out the forms, than fight with all the public agencies that have your medical records to try to make them give them to Social Security. In the mean time live on the street and “hey, if it doesn’t work, it’s not our fault, you have to take some responsibility.“

The good people at The Positive Resource Center, in San Francisco, keep the data on these things and it turns out 90% of claims submitted without an advocate get denied and 30% submitted with an advocate get denied. So clearly the personal responsibility policy is based more on prejudice than on data. See, many people who use county services use drugs, or did use drugs, or have been to prison or have mental illness and the county doesn’t really want to help them. Sure we have a few non-profits, who help the super-sick or special groups, but we have no coordinated plan and worse, we lack a philosophy of compassion and service, and the political leadership to address the problems of our most needy.

So in my little neighborhood in Oakland, the Dimond, we have five to ten people with all sorts of mental and physical illnesses living in parking lots and on the street. We have a clearly schizophrenic woman in urine-soaked clothes, who is sometimes too frightened to stand in line for food. We have a serial defecator who deposits little surprises in shopkeepers doorways, we have a woman with an amputation, and an assortment of men with physical, mental health and substance abuse problems. A local business owner called the county, concerned about the health and welfare of these obvious mentally or physically ill people and was told call the Oakland Police Department.

So, Harm Reduction, it’s a global philosophical approach to dealing with public health problems. It’s a pragmatic approach to substance abuse and high-risk behaviors. The idea is limit the damage. If the public health problem is AIDS, focus on stopping the spread of AIDS; not stopping sex (sex is fun and cheap and therefore very hard to stop). Try to prevent violence, instead of only investing in punishment. It’s a more pragmatic and less Puritanical approach to public health. Besides sticking drug offenders in jail has done little or nothing to slow public health problems.

So as a practical matter what does this mean. Well, in San Francisco, that great city by the Bay. It means all county agencies or agencies funded by the county must work together to get the social security benefits for eligible clients. They can’t dump them on other agencies or send clients chasing down bureaucratic black holes. That’s right, San Francisco plans to put in place performance measures and standards, they’re not just addressing the problem they’re managing the solution. This means merchants, neighbors and police don’t have to watch sick people suffering on their streets, and it means state and federal funds are used to pay for health and income benefits, this saves the county money and keeps public services like hospitals financially viable.

Postscript: Any advice on how to keep Emma "Slave-to-Fashion" Fisher off the catwalk in the wee hours of the night would be deeply appreciated.

My Favorite Non-Profit

The Positive Resource Center in San Francisco is a model of how powerful a non-profit can be. They do benefits and employment advocacy: they are thinkers, teachers, advocates and wonderful people. They fight to get benefits for the most underserved and deserving clients, and they share their expertise through classes and trainings. I learned most of what I know about benefits through their trainings.Their exceptional work makes the world a better place.

Check them out or just send them a check:

http://www.positiveresource.org/

Go San Francisco!

San Francisco Department of Public Health Philosophy
Social Security Income benefits help disabled clients achieve their therapeutic goals by improving access to healthcare and by giving them the financial means to stabilize their living situation and better meet their nutritional needs

Department of Public Health Goal
Department of Public Health clients should be screened for Social Security Income eligibility. All clients deemed eligible for Social Security Income benefits will be assisted through the application process.


Excerpted from Positive Resource Training Materials 2004

So, You Wanna to Be Highland’s CEO

The new smash hit reality TV series brought to you by the same fun loving politicos who brought you the Raiders and the Alameda county football tax.

It’s sort of a cross between ER and In Living Color. The medical center has had over 10 CEO’s in the last 12 years and while most have done little or nothing to improve or maintain healthcare services in Alameda County this crew of villains, rogues, ne’er do wells and actually a few good people are an untapped geyser of entertainment value.

So the search is on, all applicants for the newly posted position of CEO of the medical center position will be asked to participate. Ken Cohen the best CEO the medical center has had will host the show (the county supervisors got rid of Ken because of his excess of competence and real aptitude for the job.)

All contestants will begin their journey to greatness on BART or AC transit, while you can get to a football game in reasonable time using public transit from most places in Oakland, it can take hours to get to the county hospital. Contestants are advised to start early and get a transfer.

Once at Highland, contestants (dressed in clothes donated by patients) will approach the ER triage desk with complaints of nausea, pain, long-term substance abuse, and paranoid ideation. Successful candidates will be admitted to the hospital and bonus points will be given to any candidates who get transferred to the locked psychiatric facility at John George.

Once admitted to the hospital all contestants will be required to eat only the diet prescribed by their doctor and provided by nutritional services. After completing the mandatory two-day stay at Hotel Highland, successful applicants will receive coaching and legal advice from previous CEO’s.

Mike Wall will be the show’s official golf coach. Ophelia Long will speak on the Grand Jury and how an indictment does not have to end your career in Alameda County. Mike Smart will speak on the art and science of mumbling and on the importance of a close friendship with Dave Kears. Dave Kears will discuss how to write legislation to specifically exclude oneself from conflict of interest accountability. Ken Cohen, Paul Hayes, and Dr. Mittelberger, the medical center’s most competent past leaders will discuss current problems, past failures, political pitfalls and bear traps. Efton Hall will give a very short speech on how to outsource your own job. Mike Burroughs and Susan Crutchfield will discuss the joys of consulting, traveling first class and how to choose a Hilton.

Survivors will come to the Highland Auditorium for a Jeopardy style QA (on issues of medical management and local politics) Ken Cohen will host.
Sample Questions
1. The neck bone is connected to the?
2. OK, here’s a tough one, which county supervisor owned blighted property within blocks of Highland Hospital?
3. What was the name of the county supervisor who would snore audibly or read the newspaper, while matters concerning the medical center were discussed?

The winner will be selected based on his overall score, the swimsuit and talent competition and audience applause.

All proceeds from, “So, you wanna be Highland’s CEO” will be donated to the Highland Foundation earmarked for actual healthcare (durable equipment, caregiver salaries and medications); none of the proceeds will be re-invested in PR, BS or consultants.

Answers to sample question: 1. Head bone 2. Supervisor Gail Steele 3. Supervisor Mary King

The Medi-Cal Massacre

Well, the Governator is going to kick some disabled behinds; he’s going to blow the sick and infirm right off their benefits. Political insiders say Arnold’s super budget is super mean. It attacks Health and Human Services and Medi-Cal with a fevered frenzy.

Arnold, Arnold, Arnold, you’re off script, out of character, your characters were always violent, but ultimately kind hearted and humanistic. Conan didn’t run around taking blood pressure medications away from old ladies. The terminator would never rob from the sick and give to the prisons. What has happened? You’re supposed to be the good guy.

To get all the gory details from the good people who follow these things, at Health Access, click here:

http://www.health-access.org/blogger.html

Angels in Oakland

Bureaucrats love numbers and the end of the year calls for the final count. So here’s some numbers for you 86, 109, 108, 84 and 80. Murders in Oakland for the last five years friends, children, husbands, wives and grandparents lost. Oakland actually has a neighborhood called “ghost town” of course city hall doesn’t recognize the name, it's bad PR. Oakland has become a city of ghosts, of angels and people whose lives have been forever changed by violence.

Our democratic machine has approached its people and their strife from a position of fear and ignorance. Liberal democrats wring their hands, “Why don’t the youth vote?” “Why are they so angry?” “What is wrong with them?” Then they vote for more prisons and close schools. I meet Oakland youth everyday who have personal experience with violence. They have ideas opinions and a very thoughtful perspective of the world and their place in it. They don’t vote or trust politicians because politicians have done nothing to win their respect or trust. They want to be heard, to be taught and to be loved and we do little or nothing to meet their simple needs.

Poor neighborhoods can’t get a beat cop in Oakland, but affluent enclaves like Montclair get two. Mayor Brown having done little or nothing for Oakland youth now plans to exploit their suffering to promote his own political career. Having played politics with our schools and our police services, leaving both much worse than he found them, Brown, a ruthless pollster, plans to run against crime and inner city youth for state attorney general. He will appeal to fear and a tired white liberal base, who remembers him as a governor, back when he cared and came to work.

Mayor what’s his name can’t help Oakland, leadership and hope in Oakland won’t come from has been politicians; it will come from our children. RIP, Rest in Peace, our children understand death and in a funny way life better than most forty year olds. These kids know the world in a hard dark way and face it with courage and hope. They love and remember lost friends, the people our politicians are so determined to forget. They know that to our leaders they are just troubling statistics, “ urban youth problems” not people. I had one young girl tell me, “ I feel like garbage, something that someone has thrown away and forgotten.”

Local democrats need to stop sucking up to developers, stop building ballparks and ice rinks, put down their spread sheets, walk out of their focus groups and go and meet our children. Every week these young people come through Highland Hospital their lives lost or forever changed by violence, not once in twelve years have I seen a politician come to talk to these kids or their families.

You can’t solve problems you don’t understand. Oakland’s political machine doesn’t care about our youth and our youth know it. We just voted money for violence prevention, let's see those politicians walk into the neighborhoods, the prisons and the hospitals, talk to our children then bring them back to city hall. Urban youth problems cannot be solved without buy in from urban youth. If you want to change the culture you have to understand it. RIP doesn’t just mean "Rest in Peace", it means Rich in Potential and if democrats continue to ignore these children, Rise in Protest.

Dirtistics

Well, the Dirt’s a data driven blog so here are the numbers. I don’t want anyone saying I don’t know how to crunch a number or spread a sheet. Hits year to date 9,766. Average daily unique hits 24. Biggest day 129. Biggest fans consultants, they hit often and hard from Hiltons, hospitals and financial institutions all over the county. Dean Whitter, Deloitte and Touche read the Dirt; these hits definitely don’t come from my relatives, we don’t have any money to manage. Hospitals dig the Dirt: Kaiser, Children’s, UCSF, Highland, and more. Politicians read the Dirt: Alameda County, City and County of San Francisco, the City of Oakland and the California Assembly read the Dirt. Reporters read the blog and patients love the Dirt. Universities, unions and other hapless hospitals workers, under siege by consultants, all dig the Dirt.

The Dirt has more than 300 subscribers and has sent out close to 7,000 emails. An average of 47% of the emails sent are opened and an average of 32% of the readers click through to the blog. People even Google the Dirt “that dirty thang,” “the daily poop” or “low budget blog.” The Dirt gets lots of reads but no respect.

Deconsultification

Well, it’s official according to the authority board the deconsultification process has begun. Deconsulting a public institution is sort of like desalinization, it’s a great idea that would save lives and feed the hungry but no one has quite worked out how to do it. The Dirt loves to be helpful, so how about a going away party? “Come on lets party, fiesta. All night long.” Send your “Adios Cambio Celebration” ideas to the Daily Dirt.

The Consultants Who Stole Christmas

“ While decorations are intended to create a festive atmosphere….Many decorative items can pose a potential fire hazard that could result in a disaster.” -excerpted official ACMC memo

If our leaders would come down on mismanagement half as hard as they came down on Christmas, the hospital would be in the black by now. Managers were also treated to sermon on politically correct and administratively approved language to describe the holidays. They’re taking the bull by the horns on this one. Caregivers speculate that the rash of holiday memos and directives is just Cambio’s not so subtle way of saying, “there will be no free Christmas dinner, we’re just too cheap.”

So aside from the recent morale boosters, what’s up? Well Highland nurses, many of whom already have other jobs, get more discouraged by the day. Senior management continues to heap more menial administrative tasks on the already overburdened clinicians. Nurses are now responsible for getting the History and Physical Exam form from the physician and faxing it to the pharmacy. Come on guys, everyone should be responsible for their own paperwork and getting it where it has to go. So starting last week nurses the hapless middle women of this misadventure began faxing all these forms to the pharmacy. The pharmacy ran out of fax paper and started calling back nursing stations to complain about the deluge of paper. This new plan would have been really bad for morale, but since on many nursing floors less than half the staff is permanent, the temps, travelers and registry could care less. They don’t worry about paperwork. Normal management wouldn’t try to run a McDonalds with less than half regular staff, but Cambio seems to think you can run an ICU this way. Oh, well.

Cambio’s keeping the budget lines down by not spending. You need 65 signatures to spend cash and at any given time 20 of those signatures are in Tennessee, Texas or just resting up at the Hilton. Parts don’t get bought, machines don’t get fixed and even the rare nurse who wants work at the medical center doesn’t get hired. Hey, I bet that budget’s looking better though.

Measure A -the rest of the cash

To read the Tribune's report on the rest of the
Measure A funds click here:

Article Link

Holiday Hospital

Well it’s that time of year again. Yeah, the shopping, the eating, the Christmas music and family fun that never ends. The overwhelming pressure to be full of joy and good cheer is enough to unmask even the most latent psychological problems. There’s no doubt about it the holidays can be hard on your health, but they’re good for our business.

Dietary indiscretion, isn’t that a great term? It sounds like you slept with a Ho Ho. Actually, dietary indiscretion fills lots of hospital beds, it’s the salt. Tips people right over the edge into heart failure. Trust me, I spent one holiday season in the Critical Care Unit fighting with my father-in-law over a bag of pork rinds.

Booze always fills a few beds. Alcohol, cars and testosterone: it’s that magic combination that keeps trauma centers full. Drinking is a time-honored strategy for coping with the family gathering.

Then there’s always the flu, the freeways and the family feuds. Doesn’t it feel good to be needed?

The Unholy Alliance

Did you know Alameda county runs an HMO? That’s right folks, we can’t afford a hospital or clinics for the uninsured but we have adequate funds to run an insurance company to administer public healthcare dollars- it’s called the Alameda Alliance for Health.

The Alliance was established in 1996 to “administer” healthcare dollars mostly Medi-Cal. The Alliance was Dave Kears’ brainchild why run a hospital when you could build a bureaucracy- all the money none of the hassles. When the Alliance was established most of the profitable Medi-Cal clients, young women with children were immediately sucked out of the county hospital. The Alliance referred them to private hospitals. Many of the medical center’s financial problems date back to the creation of the Alameda Alliance.

How could Mr. Kears sell such a bad idea to our well-meaning but inept county supervisors? The same way George Bush is trying to sell out Social Security. Dave Kears said the Alliance offered clients, “choice.” Whenever Dave or George say, “choice” one should understand that they plan to dismantle some public service.

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.

Click here:seiu616.org/blog/index.cfm

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

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. “

Mommy

“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:
http://www.oaklandtribune.com/Stories/0,1413,82%257E1865%257E2520137,00.html?search=filter

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.

Another One Bites the Dust!

The medical center has no real communication system, sure we get the memos but people try not to read them. So when inquiring minds want to know, where do the go, the grapevine. The hospital has a pulse, it has moods and it has one of the most sophisticated systems of informal verbal communication on the planet. It’s sort of an oral history; it’s fast, funny and usually highly accurate.

So here’s what’s on the vine. The Permanent Interim CEO, Mike Burroughs, quit and that’s right, we get another Interim CEO. Let’s get real here, these aren’t “Interim CEOs” these are “Interval CEOs.” This makes four CEOs and counting since Cambio Healthcare Solutions took over in May. If it gets any worse, Cambio will be calling the executive registry and sending CEOs over to work shifts.

Rebecca's latest

Well, the medical center made the news again. The medical center has a huge budget for spin doctors, so why can't they buy us some good news? To read Rebecca Vesely's latest piece click here:


http://www.oaklandtribune.com/Stories/0,1413,82%257E1726%257E2494700,00.html

A Rally Really?

Yes, folks we have to do it again. Tuesday, October 26 at noon. Hospital employees will once again go out in front of the medical center facilities and rally. This time to remind our leaders that you have to give workers a contract and fair pay or there will be no one left to take care of patients.

See you there.

I Want A Refund

Well, the Cambio Healthcare Solutions consultants had an epiphany; they realized they have run off many of the caregivers they need to run the hospital. Half of the image technicians (people who work in x-ray, ultra sound and MRI) quit or threatened to quit in one week. Pharmacy, respiratory therapy and nursing have the same problem.

You can’t run a hospital with all of the critical service providers running out the door and what exactly have our leaders done to keep them here. Well, lets review, they told these highly trained employees they were overstaffed and threatened to lay them off. They also threatened to lay off all the support staff (nursing assistants, medical clerks, housekeepers, food services workers) all the people you need to make things run. What about wages, well these groups get paid 5% -20% less than people doing the same job in other hospitals.

Then there’s the public relations war, fought internally with piles of meaningless annoying memos and externally with “Bring it on Braley” saying the medical center just needs to cut the fat. They’ve got the medical center crawling with state inspectors and they started a war with the union represented workforce, apparently Cambio Healthcare Solutions had never heard of organized labor before they came to Alameda County.

So now that they realize they will have to pay workers or they will continue to quit, what now? Well guess what, now they say they don’t have any money. As Charlie Ridgell pointed out, “the medical center had money when they signed over millions to Cambio for consultants, they had money for PR and PG &E, they even had an extra million for more Sheriffs at John George, they had enough money for a walkout and a lockout (over a million dollars), but now that they have to pay the people who actually do the work they’re flat broke. This is entirely unacceptable.”

I’ve got a bright idea, consultant costs and expenses would pretty much cover the cost of a fair raise for hospital workers, how about if the board of supervisors just goes to Cambio and asks for a refund? I don’t know about Cambio, but most of us little people doing the work don’t think this relationship is working out, maybe its time to say, “Adios Cambio! “

Charlie’s Place

Why does the Alameda county board of supervisors dislike the medical center so much? Excellent question. Well, county supervisors have a huge budget (1,944,765,581 dollars) a bigger bureaucracy (8,658 budgeted positions) and hopelessly frustrated personal political careers. The supervisors don’t run the county the bureaucrats do: Chief Administrator Susan Muranishi, Director of Health Care Services Dave Kears and Sheriff Charlie Plummer. Every year Dave, Susan and Charlie divide up the tax dollars and throw a few crumbs to politician’s pet projects. So Gail Steele, Alice Lai-Bitker, Keith Carson, Nate Miley, and Scott Haggerty get to cut a few ribbons, do a few opening ceremonies, and fund a few non-profits. The county government has a responsibility to take care of the underserved, this means healthcare (for the uninsured and underinsured), behavioral health (the mentally ill), public assistance (welfare), public protection (courts and prisons) and general government in the unincorporated areas (this means municipal programs: schools libraries, sheriff’s and such.) They also do transportation, buses ect.

Here’s the rub, the poor, the sick, the incarcerated and the needy don’t vote much and they are not big donors to political campaigns either. So county supervisors spend most of their time sucking up to corporations, developers and non-profits that provide the services. Telecare, the biggest for profit mental health contractor in the county is a generous donator. Non-profits, lawyers, and consultants, now all of these people understand how county government works. They know how to support a campaign. Special interest groups and voter rich unincorporated areas also have lots of suction with the sups.

Every year Sheriff Charlie and Dave Kears duke it out over money and every year Charlie wins. Susan Muranishi’s primary contribution to the county is to create a budget and budget process so boring, complicated and convoluted that it would take a team of forensic accountants ten years to find an extra fifty cents. Meanwhile Dave or Susan can always find a little cash in the other shoe, should the need arise. So when political insiders need to get something done, they don’t go to a county supervisor, they go to Dave, Susan or Charlie.

Ok, enough of the civics lesson why don’t Dave and the Sups like the medical center. Well, Dave feels the county should be “purchaser not a provider” of healthcare services. It’s the greed is good philosophy. Besides bureaucrats prefer tidy little contracts with non-union organizations, keep the healthcare providers without a voice and employment protection.

Still what’s wrong with taking care of sick people? Well, here’s the real problem, you know those tidy contacts and neat little focused lean county programs: they don’t work. When someone doesn’t get enough general assistance to buy their medications and has a stroke, where do they go? The medical center. When Adult Protective Services fails to get a senior out of an unsafe home and they get hurt, where do they go? The medical center. When the Sheriff decides to compassionately release a felon who has cancer and can no longer walk, talk or take care of themselves, where do they go? The medical center. When a mental health case managed client has a psychotic episode and then withdraws, where do they go? The medical center. As Dave and Susan improve efficiency (cut services and ration care) more and more people fall through the cracks, the medical center catches them. The county supervisors and bureaucrats hate the medical center because it reminds them how miserably they have failed the people they are supposed to serve. They also hate the medical center’s staff who refuse to dump these clients back out on the streets without first addressing their needs, this costs.

So when the supervisors close the medical center where will people go? Well, for years the county prison system has enjoyed fat funding, infra-structural upgrades and political support. If the sick and needy become a nuisance or a political liability the police can just pick them up and take them to Charlie’s place, Santa Rita Prison.

Imagine if there weren't a county Medical Center

Well, today's Oakland Tribune opinion piece said it all.

To read "Imagine if there weren't a county Medical Center":

Click here

Managing Up

Well, Cambio Health Solutions changed their mind. They decided they had better not layoff 180 staff and maybe they should have a word with some of the employees or at least check in with the Service Employees International Union before completely reorganizing the medical center. Gee, it took them nine months and two work actions to arrive at the obvious. I hope these guys know how to do something besides layoffs.

Thank goodness for healthcare unions. Apparently they’re all that is left between patients and bad business decisions. Medical center employees have used their unions to manage up; they helped the Board of Supervisors to see the dangers of caregiver cuts. They have also pointed out that hospital workers feel demoralized and fatigued, and that getting a contract signed and removing the threat of layoffs is a necessary first step toward making the medical center work.

In spite of the rhetoric, the Cambio executives still have an aversion to speaking to working people. You need a suit or an MD to be heard at the hospital. Joyce Mc Glory, the Head of Human Resources, is the notable exception; she likes Highland and actually listens to employees. The Board of Trustees is still escorted by sheriffs, as are some Cambio executives. Come on guys, we’re overworked healthcare providers, no one’s going to hurt you. Shoot, if you got assaulted we’d just have to take you over to the emergency department and fix you up, and in case you haven’t noticed we have plenty of business already.

Look here’s the deal, this isn’t a good staff; this is a great staff. These are the people you want to take care of you, if something happens. We have an antique computer system, broken wheelchairs, no infrastructure and we make it work. The Cambio team spent a couple million on scab labor during work actions and probably fifty grand on a payroll goof, how about spending five hundred on donuts and coffee and trying to cheer up your worn out employees before more good people quit.

In and Out of My Mind

I’m born and raised in Berkeley so reality for me is negotiable, but I lost myself a little. I found myself crying in the behavioral health clinic. I couldn’t focus; I sat there just leafing through the magazines not even looking at the pictures. Did you know they have Guns and Ammo magazines in the psychiatry waiting room? I’m no shrink, but I think it might be a better idea to put the gun magazines in the dermatology or podiatry departments. I never heard of the acne or hammertoe defense.

I must have been pretty messed up because Kaiser told me take a week off, I thought you had to be bleeding from a major artery to get a week off from Kaiser. They gave me one of those little information sheets. It said I had post-traumatic stress disorder. I read the sheets, I think this stuff might be contagious and I definitely think it’s going around the medical center. It’s not like a different reality, just all the worst parts of your usual reality over and over again. You get stuck bouncing if the walls of your own mind. It comes from too many bad things happening in rapid succession. Since the upcoming presidential election could be ugly, we should all fortify ourselves with good news, multivitamins and extra sleep.

What’s Up?

What will happen? Did the board of supervisors know the medical center is in deep doo doo with the state and the feds or did they find out about it Sunday when they read the Oakland Tribune? They get those “secret briefings” with Cambio Health Solutions. Let’s hope somebody has a plan, November 10th isn’t that far away. Where’s Temporary CEO Mike and the spin doctors when you need them, a few lines would do, how about, “hope for the best, pray with us, or this might be a good time to tune up your resume.”

I just don’t get it, the medical center is about to be closed down over staffing and safety issues and the board of supervisors is still fighting for layoffs. I’m confused and well frankly annoyed; I should be spending my precious free time trying to get a Democrat into the White House. Instead, I’m stuck here struggling to explain the obvious to a bunch of Democratic supervisors that I voted into office. Sometimes it’s hard and well quite honestly embarrassing being a Democrat in Alameda County.

Rumor is that Cambio and the board of trustees may have finally come to their senses and that some kind of proposal to postpone layoffs and focus on the more immediate problems maybe forthcoming. This thanks to the tireless work of medical center employees and SEIU locals 250, 616 and 535. So anyway, things will happen this week.

The board of trustees is meeting:

Wednesday September 29
Highland Hospital
Classroom A
Public Comment at 6:00 pm

Medical Center Closing?

Well those fun loving Cambio Health Consultants and their spin doctor have done it again. There's so much dirt even the Tribune's digging into them.

To read Rebecca Vesely's piece, "Feds May Close Medical Center," in the Oakland Tribune click here:

www.oaklandtribune.com/Stories/0,1413,82~1865~2428356,00.html#

Good News At Last- Walkouts

I got a medical opinion at Highland about my consultant-induced situational depression. A physician I admire and respect told me quite candidly that it would take a lot of prescription medications and possibly recreational drugs to take the edge off the current situation.

The most popular conspiracy theory this week is that Cambio Health Solutions was brought in to close the medical center down, employees can’t believe they could make this many mistakes unintentionally. Personally, I’m a big believer in stupidity and incompetence. Besides if CEO Burroughs had a timeline to close the hospital he’d come to work more. According to his assistant Mr. Burroughs will be at an offsite conference this week. These Cambio Health Solutions guys are on the George Bush attendance plan. If you can mismanage a country working a couple of days a week, there’s no reason you can’t mismanage a hospital on the same schedule.

But I digress there is great news; we’re planning wildcat walkouts. That’s right union employees have begun planning multiple surprise work actions. Workers have basically given up on influencing hospital leaders. We’re going to picket the politicians. That’s right, picture a thousand healthcare workers picketing down at the county board of supervisor’s offices- dawn to dusk. They can’t just send their staff out to say they’re at important meetings- they’ll have to come out to eat or pee. It’s pressure and accountability my favorite approach to incompetent elected officials. Supervisor Alice Lai-Bitker and Gail Steele here we come.

I’m personally quite excited since lately when you come to work at the medical center you may or may not get paid and since our leaders have yet to acknowledge their “security problem” you may or may not get hurt. So cheer up folks, fun is on the way, and remember you don’t have to work at the medical center to come down and picket!

Let Your Fingers Do the Walking

I took my own advice had a cold one and cooled off. So let’s look at the situation objectively, what’s going on? Well, Cambio Health Solutions on the eve of what the press is calling a gang war, is still proposing to layoff a big piece of the emergency department staff. Nurses continue to quit citing safety, incompetent senior management, heavier patient care loads, and less support staff than other hospitals. The layoffs have been put off so long that many employees have begun to focus on the more immediate problems, like getting paid and avoiding friendly fire.

Our leaders continue unpaying workers, yep, you heard right, medical center employees with direct deposit get their paychecks sucked back and forth in and out of their accounts. Our leaders are pioneering a cutting edge direct withdrawal system. This results in headaches, bounced checks, delayed vacations and piles of overdraft fees. The problem is of such severity and magnitude that even management noticed it. They actually wrote about it, Cambio is busy fixing the “payroll goof.” Golly fellas, in California when you screw up a multimillion dollar payroll, we don’t call it a boo boo, we call it a mistake and since people’s money is being taken without their permission an apology might help.

Personal safety issues eclipsed the medical center’s ongoing problems with layoffs, short staffing, missing payroll and lack of leadership this week. Staff who witnessed the bullet riddled Lincoln crash into the hospital grounds and the dead, dying and shot up young people crawling out of the car, just keep talking about it. They tell you what they saw over and over again. When social work and the chaplain put together a debriefing, for traumatized workers they were scolded for holding an “unauthorized meeting.”

The numerous staff that called Claude Watts and Mike Burroughs about the lack of a preparedness and a security plan, have not gotten responses. Apparently Chief Operating Officer Watts and Chief Executive Officer Burroughs’s gang security plan was to leave early Friday and be out of town for the weekend. Until management puts forward a credible written security plan and shares it with those of us who might get hurt, the Dirt recommends that Highland patients and staff let their fingers do the walking and dial 911 at the first sign of trouble.

Meet the President of the Hospital Authority Board

Vote Health, the coalition of community groups and labor unions who have fought tirelessly and successfully to keep the medical center open is having its monthly meeting. The hospital authority board’s newly elected Commander and Chief Dr. Ted Rose will be the guest speaker. If you’re concerned about the way things are going, come down and give Dr. Ted a piece of your mind. He’s the man.

Monday September 20
7-9 pm
California Nurses Association Offices
2000 Franklin Street, Oakland

If you really must learn more about the medical center and the people and organizations fighting to save it, here are some fun links:

Vote Health : www.votehealth.net
CureACMC: www.cureacmc.org
Service Employees International Union (SEIU) local 250: www.seiu250.org/onthejob/hospitals/acmcupdate.cfm
Service Employees International (SEIU) local 616: www.seiu616.org

RIP Chivo

Rest in peace Chivo, gee thanks Cambio Healthcare Solutions, now we have gang tags (graffiti) on Highland’s sidewalks. Is this a part of that marketing magic we’re paying so much for or is this another “goof.” Did you know “memorials” are being removed all over Oakland because they become crime scenes?

I don't know what to say, I'm so upset.

I came into work today to find that three of my friends had nearly been killed when a car full of shot up young people crashed at Highland Hospital, according to the Tribune, probable victims of gang violence. I then was threatened by a group of six young men going up in the elevator to visit a “friend.” When I left the hospital at lunch there were four sheriff’s cars in front of the hospital, they had been called in to break up fights in the lobby.

All day the nursing floors of the hospitals were overrun with “friends” of the victims. I called Mr. Watts, the COO, he was in a meeting and his assistant didn’t know who was in charge. It wasn’t until the security, the sheriffs, and the Board of Supervisors had received dozen of complaints that we began to see security on the nursing floors and an attempt to limit visitors.

After five pm when I was leaving the hospital I saw a fight erupting in the lobby and had to go get security. More “friends” of the victims were parked in cars in the entrance to the hospital and still more were driving around the hospital.

I have worked at Highland for almost twelve years, I have seen a great deal of this kind of violence, but I have never witnessed such a complete failure of leadership and security. No administrator even came around to assess the situation much less manage it.

There are simple measures that can be taken to insure the safety of our patients and staff, since the Oakland Police Department feels this could be gang violence, maybe some executive could be torn away from an important meeting to work with staff on a plan to make sure that Highland does not become a crime scene.

Thank You

It is very saddening to have violence taking center stage again in Oakland, but I am so proud of the exceptional response of Highland's staff to yesterday's tragic shootings. Staff who were nearly killed by the vehicle as it crashed, ran to get gurneys to help out the injured passengers. Nurses and doctors from all over the hospital responded. I am very proud of my friends and co-workers.

“Why Can’t We Be Friends?”

Well, Cambio Health Solutions took another decisive step toward that cliff they keep flirting with. They had close to a thousand employees walk off the job. Those that didn’t walk out the consultants locked out. Negotiations, lay-offs, board meetings, everything except Cambio’s weekly paychecks has ground to a halt. Sure the Board of Trustees and the Alameda County Board of Supervisors are having closed, hot, sweaty, and unproductive meetings, but nothing is happening.

The medical center pays millions for leadership, PR and experts so what do you get when they put their heads together? That’s right, another memo, last week the medical center employees were treated to the, “why can’t we be friends memo.” Arg! Stop, already with the patronizing dribble, it just irritates people. Save a tree! Remember what your mother used to say, “if you don’t have anything good to say, don’t say anything at all!”

The problem with healthcare consultants is that they’re “experts.” Since they’re supposed to know more than the poor slobs they’re sent in to help, they don’t listen. The medical center’s employees have been valiantly trying to explain things to the consultants but they just can’t seem to shut up long enough to hear anything. They have a set game plan, never mind that they’re playing football on a basketball court with a bunch of gymnasts.

The thing about healthcare is that it’s both complex and regional. You cannot ignore the caregivers, the community, the politics, and the services around a hospital and understand your patient’s needs. After nine months the “experts” still don’t understand the medical center’s problems, so they can’t possibly implement a solution.

Simple Solutions for Supervisor Keith Carson

Caregivers have given up on trying to reason with Cambio Health Solutions. They have taken it to the politicians, hundreds of the medical center’s employees and patients have called, visited, or written the Alameda County Board of Supervisors. Supervisors Keith Carson and Alice Lai-Bitker hide in their offices and send out hapless staff members. The coalition of community groups, labor groups, patients and staff who passed Measure “A” are being ignored by the Cambio Health Solutions and the Board of Supervisors.

But don’t despair, the Dirt is listening, it feels your pain and frustration. More importantly it hears the leadership plan emerging from the many voices who fought for Measure “A” and want to see the medical center thrive. So Keith, Buddy, these are four simple steps that will stop walkouts, lockouts, bad press, bad medicine, and those pesky visits from hundreds of union employees.

First
Get a real CEO for the medical center someone with experience managing a public hospital by December 2004.

Second
Review Cambio Health Solutions performance and make the gruesome details available to the public who voted for Measure “A”.

Third
Delay the layoffs until a real CEO takes over and has time to develop a strategic plan.

Fourth
Continue to support the medical center financially. You asked the public to support this institution with a sales tax, so lead by example and make good on Measure “A” campaign promises.

I could say more but I don’t want to overwhelm our local leaders.

Consultants Pay Workers to Picket

Nurses called a work action in response to Cambio Healthcare Solution’s ignoring their input on patient care and safe staffing, they called for a one day walk out. The walk out was scheduled for Highland Hospital, Fairmont Hospital and John George Psychiatric Hospital. When workers at the county clinics showed up to their work on Friday, they were given a memo saying that the clinics would be closed on the day of the walk out and that clinic workers would be expected to report to the hospitals. When clinic workers showed up to work on Monday, August 30, they were locked out. So hundreds of additional paid picketers came to the hospitals and joined the protest.

Cambio Healthcare Solutions mismanages three hospitals and a string of community clinics. Most of their employees were standing outside today in front of the hospitals with signs that said “Safe Staffing Now”, “Don’t Close the County Hospital” and “Cambio Has Got to Go” and Cambio decided to play it coy. A Cambio representative at the rally actually told a reporter he didn’t know what this walk out was all about. Scary but probably true, Cambio and the executive temps don’t even show up to union negotiations anymore, they send a sub sub consultant and they do seem utterly befuddled by hospital management. They have however correctly identified that they have, well, a “situation.” So they’re doing what any patient centered quality minded management team would do, they’re getting more public relations. Cambio muzzled their millions of dollars worth of temporary executives, all of whom are vying for permanent positions at the medical center. Now Mike Brown, from Raleigh and Brown Public Relations Consulting, takes all the questions. Raleigh is apparently in Afghanistan trying to put a happy face on the Bush administration’s little problem over there.

A Reader's Response to "What Are They Hiding?"

Want to know what Cambio Healthcare Solutions is hiding? I can tell you. I am just an RN but I can tell you what I would hide from the politicos. I can't get food for my patients, everyday. I can't get my meds on time to my patients, everyday. I can't get basic supplies to take care of my patients, everyday. I can't get clean linens for my patients, everyday. I can't get charts from medical records for my patients, everyday. I can't provide safe and competent care to my patients, everyday. I can't get blood products for my patients, everyday. I can't get critical labs for my patients, everyday. I can't get x-rays or CT scans for my patients, everyday. I am forced to work with registry and travelers who could care less about our policies and procedures, everyday. I cannot and will not blame these problems on their various departments, as it is not the frontline providers who are to blame. Well, whom do you blame? That, I can tell you. Cambio and the executive team are aware of these problems, as I have spoken to several of them personally. The Board of Trustees is aware of these problems, as I have spoken to several of them personally. Supervisor Gail Steele is aware of these problems, as I have spoken to her personally. Our Chief Nurse Executive is aware of these problems as I have, along with others on many, many occasions brought these problems to her attention. We as frontline caregivers must focus our anger and frustration on those who perpetuate the persistent and very dangerous environment we are forced to work in. At least those of us who are left. I applaud my co-workers for the commitment they have to our patients. We are not the problem, we are the solution. WE ALL MUST BAND TOGETHER AND SUPPORT THE SAFE AND DIGNIFIED CARE OUR PATIENTS DESERVE EACH AND EVERYDAY!!!!!!!!!

Lynne Behr RN

Walking Out

Walk out! Actually, medical center staff just won’t walk into work on Monday August 30, 2004. Caregivers have tired of reasoning with absent executives and Cambio consulting.

The Highland emergency department (this includes the trauma center) is budgeted to have 126 full time staff. There are 29 vacant positions. When Cambio presented their lay-off proposal to employees they re-labeled the 29 vacant positions overage, cut them, and then decided they could lay-off an additional 12 people. It’s the, Eron school of accounting. Their proposal leaves 85 people to do 24 hours, 7 days week coverage of the emergency department. This kind of staffing won’t get us through a mild flu season, much less an earthquake or State hospital inspection.

Caregivers have decided to take their case to the public, the politicians and the private hospitals. After all Alta Bates and Summit Hospitals will have to take all the patients who will be turned away from the medical center because of staffing shortages.

What Are They Hiding?

Well just when you think things can’t get any stranger, they do. Today representatives from State Senator Figueroa’s office, and staff from Assembly Member's Ellen Corbet, Wilma Chan and John Dutra’s office along with County Supervisor Steele and staff from Supervisor Carson and Lai-Bitker’s office all came with union representatives to tour Highland Hospital and speak with hospital employees.

They were met in the lobby by the Cambio Health Solutions team, the temporary executive staff and Cambio’s attorney. The politicians were told they could not tour the facility without a Cambio escort. This resulted in a heated exchange between County Supervisor Steele and a herd of tall suited men. The consultants maintained that patient privacy would be compromised if politicians walked through patient care floors. Staff found this a little odd since they sent a documentary film crew through a couple months ago with just a PR guy. In the spirit of compromise and in an effort to get out of the lobby, the state and local politicos agreed to only visit outpatient areas and to do so under the supervision of a sheriff’s deputy.

Patients and staff were really disappointed when the standoff in the lobby broke up, and no one is quite sure what the consultants were trying to hide.

Rock Bottom

Well, the medical center has been around awhile, it’s seen some spectacular scandals, some flamboyant flops, but lately it feels like things might have sunk to a new low. Staff and supply shortages have ground many areas to a crawl if not a halt. Sure the consultants continue to forge ahead insisting that cutting 43% of the staff on a nursing floor that treats the critically ill won’t affect service or quality, but no one really listens to them anymore. They keep coming up with new bad ideas, but the consultant/executive team has become so dysfunctional at this point they couldn’t fix a sandwich, without 20 subcontractors.

The county supervisors hired them to “downsize.” The supervisors wanted a fast neat surgical strike, hundreds of annoying union employees gone in a single blow, leaving a budget surplus. The extra cash could be quietly moved back into the county supervisor’s pockets and used for Alameda County’s high priority projects like paying off Al Davis, building more jails, or granting fat contracts to big political donors. Well, things didn’t go as expected, that’s the problem with these “get rich quick plans.” The consultants couldn’t deliver the cash, but that’s the good news, the bad news is they don’t know how to run a hospital; things aren’t just staying the same they are deteriorating rapidly. It‘s time that we officially declare this situation a quagmire.

What has frightened staff and patients more then ridiculous lay-off proposals is the consulting team’s complete inability to manage the day-to-day operations. As my mother used to say when I would leave her home alone with my father and my brother, “I’m in a sinking ship with blind sailors!”

Cambio Health Solutions Attempts to Kill Free Money

In the last few years the medical center created the, better late than never, department of diversity affairs. Though good intensions count, funding has been lean, so the physician director of the department applied for $500,000 worth of grant funding to run programs for patients with low English proficiency. There’s nothing better than free money and most hospital administrators encourage their people to seek this kind of funding. Not so with Cambio Health Solutions. Temporary COO Watts contacted the grant agency and withdrew the proposal. This created a huge dust up, politicians, doctors and community groups all called foul, so Cambio backed down and allowed the grant to be submitted. No one can figure out if it’s the free money or the minorities that they don’t like.

Anonymous said... (from comments to "Rally Fever")

Anonymous said...
Well,well,well. Did Cambio get caught by suprise when the state inspectors showed up? Do you suppose that they actually thought their fine work would go un-noticed? Hey, speaking of work, what have they actually done since February 6th? That fabulous productivity report is garbage and unusable. You can't compare apples to hot dogs and get away with it. Perhaps they could generate some revenue if at the next rally they give us cups and signs to beg for donations. Hey, better yet they could charge us admission to rallies or board meetings. If we didn't do our jobs for 6 months (with pay) we would either be fired or offered a job in administration. The clock is ticking Cambio. How about earning some of those millions your sucking from our poor patients. Remember, we know where to post our part of your resume!!!!!!!!!

Thank You Jesse Jackson

On August 12, 2004 the Reverend Jesse Jackson came to Highland Hospital and spoke to the promises of Measure "A" and the need for healthcare in our community.

Thank you Reverend Jackson for keeping hope alive at the medical center.

Rally Fever

Our new leaders, Cambio consulting and the imported executives they flew in to put a kinder gentler face on downsizing have spent most of the week hiding from the hospital inspectors who have been ripping the hospital apart for the last four days. According to staff, the inspectors noticed the staffing shortages, the housekeeping rationing and the sloppy charting that results from lack of management and over reliance on outsourced providers. Ken Cohen, the CEO who the Board of Supervisors ran off a year ago helped the medical center sail through the last inspection with high marks. There was a coordinated effort to prepare the staff and the facility for inspection. Many of the employees Cambio ran off were hired to bring the hospital into compliance with state and federal regulations.

So did Cambio scrub the facility and fatten the staffing in preparation for the scrutiny? Well, no. In fact there had been no consultant or executive sitings for days. For 5 million dollars you don’t just get an empty suit, you get an empty desk, an empty limo and an empty suite at the Hilton. The only sign that most employees get that there is any management is the increased police presence and the weekly memos from Temporary CEO Mike, which contain mostly anti-union rhetoric and pious dribble about fiscal responsibility (as if overworked employees were flushing cash down the toilets on their breaks). It turns out that even Mike’s memos are outsourced to the $100,000 dollar a year public relations firm. So that’s two hundred words a week for a $100,000 dollars a year, that’s $2,000 dollars per memo plus the cost of Mike’s signature. And they’re talking to us about fiscal responsibility! Well, in the interest of teamwork and financial responsibility, the Dirt is officially offering to write the weekly memos for half the cost of our PR firm.

So no one expected the consultants or temporary executives to come out of hiding until the inspectors left, and they certainly did not expect them to attend the Stop the Service Cuts Rally called by the unions, the workers and the community. The fight to see that the spirit and the letter of the Measure “A” initiative is implemented has now attracted national attention. The Reverend Jesse Jackson came to Highland to speak out against the staff and service cuts and to the importance of the medical center, to our community. On August 12 at noon hundreds of healthcare workers, union members, patients, and community members rallied in front of Highland Hospital and chanted:

Hey Hey Ho Ho
Healthcare cuts have got to go!

Standing with the crowd was TCEO Burroughs, Cambio’s Chief Implementation Officer, Susan Crutchfield and Temporary Chief Operating Officer, Claude Watts Jr. Why, the union representatives even gave them sign-in cards and workers say when Jesse led the chant calling for more staff their lips were moving! At the next rally healthcare providers plan to invite them to hold hands.

Performance Review

Six months into rightsizing and re-organizing what do you get? The county of Alameda is millions of dollars deep into Cambio consulting. Cambio has consultants and interim executives flying into Oakland, riding to their executive suites, and living on unlimited expense accounts.

So what does the public get, besides a good show? Well we got a lay-off list filled with retirees and other ex-employees, we get lots of memos from Mike the temporary CEO, on the nice thick paper, we have four hour waits in the pharmacy, and patients stuck for days in the emergency department, and if things continue on the current path we will likely have a strike. Actually, Cambio has run-off, run over and retired close to a hundred employees, not necessarily employees the medical center could afford to lose but they are gone.

Cambio did produce a budget and the board of trustees did approve it. It contains the incredible shrinking lay-off list, which is down to 185 people; while there are 350 vacant positions, so it isn’t even clear that lay-offs are needed. Unfortunately the consultants can’t get their spread sheets lined up straight enough to determine if the employees slated for lay-off can all be moved into vacant positions. They have succeeded in revitalizing the health care labor movement in the East Bay. Hundreds perhaps thousands of healthcare workers outraged by the misuse of
Measure A funds and the wasteful consultant contracts have begun organizing. There is huge energy and momentum.

On Tuesday, August 03, 2004, workers at all of the county health care clinics walked out and went to 1221 Oak Street to meet with their County Supervisors. The County Supervisors sensing rightly that this was an unusually large crowd and that things have gotten well “out of hand,” took decisive action. They invited the labor unions and the board of trustees to a tea party. The labor unions, and the care providers are doubtful that their differences can be worked out over brunch, so it looks like a strike. The good news is service in many areas has deteriorated so badly that patients might not notice if workers left for a day.