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.

Public Information

Well all of a sudden the bean counters and temps running the medical center want to share information. The many million dollar “plan” is now public, available on CD. Digital documents, impressive! Well if you can’t save lives you can at least save a tree. Maybe Cambio Health Solutions consultants are closeted tree huggers.

“The plan” is not completely without merit but it is humorless. It consists of mostly numbers on paper. These guys can make some real contributions to getting bills posted and paid. It’s when they start to dismember patient services where they get kind of scary. But what about the “secret data?” Well, a nurse with a nose for numbers read through the whole report. According to Lynn, “consultants are like slugs, they leave a trail”, buried in the pages of electronic prose she found a reference to a book. The reference got her online where voila! She found that “proprietary healthcare data” could be purchased for $500 dollars. Five hundred dollars to 3.2 millions dollars (consulting fees paid by the medical center), in sales that’s called an excellent mark up.

What about the rest of the medical center’s brain trust, the authority board? Well they’re meeting away. The authority board is the county supervisor’s answer to Jerry Springer. In an effort to discourage public participation meetings are announced at the last moment and get crammed into small hot meeting rooms, Sheriff Plummer and his merry men flank the members. The last public meeting had 4 commanders, four uniformed sheriffs and Mr. P himself. County bureaucrats, the consultants and the executive temps try to fill the room so that community members and staff won’t fit. Board member Irene Weinreb does an excellent judge Judy impression, she wrestles the gavel from other trustees and threatens to clear the room and the president of the Alameda county board of supervisors, Gaile Steele power knits throughout the proceedings.

Though highly entertaining the authority board has no real power, the county supervisors get to make all the real decisions (most of them bad.) So what are these four fearless democrats doing about this mess? If you were a liberal democrat like Nate Miley, Keith Carson, Alice Lai-Bitker or Gail Steele what would you do? Clearly the public wants and needs a public hospital; in fact they’re willing to pay for it. Clearly there’s a vacuum of leadership the size of Texas and the supervisors and their staff are being flooded with concerned calls and letters about the dangers of implementing “ the plan.” Fortunately the real financial crisis ended with Measure, “A” which put the hospital quite close to break even, so the radical service cuts could easily be avoided. The supervisors could easily appoint some new board members, stop the service cuts, and move toward bringing in some permanent management, executives that understand hospital operations, as well as staff cuts and collections. So what have these dazzling democrats actually done? Well mostly they’ve been dodging phone calls and avoiding pulic meetings. The only decisive move taken recently has been to raise the medical center’s rent by close to two million dollars!

Petition Progress Report

Wow! Thank you. Thank you. Thank you, 171 signatures to state attorney general Lockyer and they aren’t all my relatives, in fact I don’t know most of them, but I sure like them. Here’s what some of them had to say.

I've needed and used services-don't cut! - Marie Kochaver

Thirty years ago, County Medical Centers from two thirds of California's 58 counties were privatized in a highly political battle for all of that public money. Alameda County survived those attacks from private corporate raiders. The Alameda County Medical Center is among the best in the world, providing the most efficiency, best outcomes, training for new medical & nursing professionals (who provide their exquisite technical skills to the voters working double their contracted hours essentially below minimum wage). What do you think will happen if we have a serious earthquake or terrorist disaster & no longer have a county medical center? Where are women going to go for prenatal care & birth of their babies? Do you really want the cost of the rise in births & birth defects you can expect from cutbacks to land squarely on this County's educational, welfare, &, potentially, criminal budgets? Ask yourself, as every voter & news agency soon will be asking you: Who stands to PROFIT from this attack? Someone does.
-Elyse Eisenberg MD

I voted to keep Highland open. What's going on? - Chris Knepper

If you haven't signed yet or want to read all the comments click on the link: http://www.petitiononline.com/SaveACMC/

Sign This!

Dear Friends,

The Alameda County Board of Supervisors are either unwilling or unable to ensure the competent administration of Measure “A” funds. In fact the Board of Supervisors are almost entirely occupied thinking up new ways to take funds away from the Medical Center and put them back in the county’s pocket ( a 1.7 million dollar rent increase being the most recent example.) So the Dirt is going to California’s top cop, Attorney General Bill Lockyer. Bill is rumored to have his eye on the Governor’s seat, so it is important that we see what he’s made of. Does he care about health care? Does he listen to the little guy or just his political cronies?

The Dirt needs you. Please sign the petition and send it to a friend, click here:

http://www.petitiononline.com/SaveACMC/

Thanks and yes my mom signed.

Ann Nomura

Jury Duty

Well the Grand Jury put out its final report on the Medical Center and its current management team Cambio Consulting, the Tribune called it “scathing.” The Dirt found it well reasoned and insightful in fact they made some very helpful suggestions:

Recommendation 04-02:
The Board of Trustees must carefully scrutinize Cambio Health Solutions recommendations, implementing those, which improve financial efficiency without sacrificing medical care. For those of us who don’t speak bureaucrat this says, “we know you really want to save money, but try not to kill anyone!”

Recommendation 04-03:
The Board of Trustees must carefully review any proposed increase in fees and payments to Cambio health Solutions. Translation, holly moley! Who negotiated these contracts? And what were they smoking? This is the biggest rip off since the Raiders. Don’t let this Board sign over another penny to these guys.

But hey, that’s just the highlights you can read the whole report online at:

http://www.acgov.org/grandjury/final2003-2004.pdf

The Dirt put a few questions to our legal advisor, Elvis the cat. What, for example do you need to do to get indicted by the grand jury? Does the Board of Trustees have to read this report or follow the recommendations? Will we get to see a politician or bureaucrat do the perp walk? Elvis, the cat refused to get out from under the bed.

The Dirt isn’t a low budget blog; it’s a no budget blog, so if you have free legal advice or opinions please post.

Meeting Matters

So many different groups of people are upset about the current management of the Medical Center and the mismanagement of the public’s trust and public funds, that they have banded together and formed a group, CURE Alameda County Medical Center (Citizens United for a Responsible ACMC.) They have decided to take a very pragmatic approach to our local elected officials, public pressure and political embarrassment. Sure it’s cheaper and faster just to buy a politician but this is so much more fun and so much more democratic. There’s nothing more frightening to a politician than a room full of focused angry voters, so in an effort to persuade the County Supervisors to do the right thing they are having a town hall meeting. Plan to attend, but if you can’t just visit your Supervisor in person.

Town Hall Meeting
Thursday July 22
6:00 pm
First Unitarian Church
785 14th Street
Oakland

For more information click on:

http://www.seiu616.org/action/cureacmc/