No More Suicides! Neoliberalism on the Kaiser Couch
By Cal Winslow
(Click here to see the story on CounterPunch)
It was unnerving, last winter, marching in downtown Oakland, to see placards, “No More Kaiser Suicides.” The march was a union march, hundreds of Kaiser Permanente workers, members of the National Union of Healthcare Workers (NUHW) demanding a contract. The workers, on strike, were therapists and social workers; suicides were on their minds, their concerns were all too tragically real.
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On July 5, Barbara Ragan, 83, jumped to her death. Dressed in bedclothes and slippers, she drove her car to the third floor of the parking lot at Kaiser Permanente’s medical center in Santa Rosa, CA. Ignoring the pleas of witnesses below, she let herself fall – the only identification she carried was her Kaiser membership card.
It was a “statement,” according to Denny Ragan, her husband. “She was very upset about them.” Barbara Ragan had worked for Kaiser in South San Francisco for sixteen years, before settling in Santa Rosa. She was being treated for depression. “It was a statement of what they’re doing there,” Denny Ragan told the press, “the way they treat people.”
Barbara Ragan had been taking Prozac for more than twenty years; increasingly, however, it wasn’t working. On June 15, in desperation, she asked her husband to take her to the emergency room; there it was decided she was not a threat to herself. She was not admitted, but was referred to Kaiser’s adult psychiatric center, where her medications were to be adjusted. After that she phoned the advice nurse several times, seeking guidance, only to be told she was scheduled for an appointment, August 27.
On the Fourth of July, she told her husband, “I can’t wait that long.” The next morning she left a note for her husband and her children, “I love you all so much,” and without further notice left her home.
She had wanted, above all, to see her therapist. Her medications weren’t working and, as she wrote to her children and her husband, “she couldn’t stand the pain.”
Kaiser, based in Oakland, is the largest Health Maintenance Organization (HMO) in the country with 10 million members, 38 medical centers, 175,000 employees and 18,000 doctors. In 2014 the “non-profit” Kaiser Foundation Health Plan and Kaiser Foundations Hospitals reported $3 billion in net income and $60 billion in revenues. Today, its CEO, Bernard J. Tyson, receives compensation totaling perhaps $10 million annually, not including half a dozen pensions.
Kaiser was founded in 1945 with a union-friendly, progressive mission – to serve working people in Northern California, most often through union-negotiated healthcare benefit packages.
Its reputation is now considerably soured, most notably as a result of patient “dumping,” a practice first exposed in Los Angeles more than a decade ago. This was a hospital policy of discharging homeless patients and dropping them off, often in hospital gowns and socks, onto the street. One shocking episode involved the case of a paraplegic man with a colostomy bag, crawling along the pavement of skid row. City investigations led to charges against LA hospitals, including criminal charges against Kaiser. The corporation was forced to pay fines and agree to a settlement that put in place specific protocols for tracking the homeless in its hospitals, assessing their mental stability and helping find them services and lodging after discharge.
Nevertheless, complaints continue, including class-action suits this year alleging that Kaiser strong-arms some of the most disabled psychiatric patients into canceling their insurance plans.
Few will deny that this nation is in deep crisis in treating mental illness. Perhaps most disturbing, according to federal officials 100 people a day take their own lives. Kaiser is not unaware of this. Dr. Mason Turner, the director of patient operations for regional mental health services at The Permanente Group in Oakland, writes. “No one yet has the answer to the best and most effective ways to do this…As an integrated system with thousands of mental health professionals in California, Kaiser Permanente has been well-positioned to lead in delivering high-quality mental health care – and, on behalf of our members and those in need of care, we will not rest until we have reached that goal.”
Kaiser to lead? Shirlee Zane is Sonoma County’s Supervisor in the Third District. She might dispute this. Her husband, Peter Kingston, “a very sweet man in his fifties,” hanged himself on January 18, 2011. Speaking at the 2014 Leadership Conference of the NUHW, Zane recalled how the health care giant “failed” her husband.
Andy Weisskoff, then Kingston’s therapist at Kaiser, also might dispute this. Kingston was financial director at Ursuline High School in Santa Rosa. He had become deeply troubled with financial problems at the school and just before Christmas, 2010, he sought help from Kaiser, using coverage provided through Ursuline. He had a brief screening then an hour-long intake interview a week later.
The problem? Zane contends that briefing was not enough. Kingston had attempted suicide once before; his first scheduled one-on-one therapy session, however, would not to be held for forty days.
Weisskoff (who hosts the blog 90daystochange.com) now in private practice in Sebastopol, agrees. Citing what he calls a Kaiser “scheme,” he writes, “This was a scheme developed to make it seem like we were providing two relevant visits in a short period of time.’ But the reality was “different.”
Kaiser apparently disallows criticism. In May, Weisskoff, who had participated in the public discussion that questioned Kaiser’s Santa Rosa practice, was placed on administrative leave then told he was no longer actively employed and escorted off the premises. He recalls that he had upgraded his diagnosis for Kingston – from adjustment disorder to panic disorder and major depression. He booked Kingston for an Introduction to Anxiety Disorders Group, then scheduled him for the next available appointment – in 40 days.
In retrospect, Weisskoff wishes he could have done more, he wishes he could have talked with Shirlee Zane about her husband. He wishes he could have said, “I have no idea what would have happened if I was able to meet with your husband weekly during his crisis. I wish I could have seen him more frequently, but had no time in my schedule to do so. We’ll never know, now, if more frequent individual sessions could have saved him”
Shirlee Zane has been more forceful: Speaking to a Santa Rosa audience of more than 400 in September 2014, she said, “My husband might be alive today but for Kaiser’s disregard for “patient-centered services.” And responding to Turner’s suggestions that Kaiser’s critics “exaggerated,” that their complaints were “misleading,” and to the allegation that behind this conflict lurked “a labor dispute,” she wrote,” “to blame a labor dispute for the deficiency in Kaiser’s delivery of mental health services is the lowest form of scapegoating I have ever seen. As the widow of a Kaiser patient who was so grossly undertreated for severe depression that he hung himself, I am literally sickened that you have concocted such a callous and unfounded defense for the broken healthcare system.”
In 2013, Kaiser patients filed a class-action suit against the HMO alleging that it failed to provide timely and appropriate mental health care and that this contributed to tragic suicides by patients.
As a result, California’s Department of Managed Health Care (DMHC) levied a $4 million fine against Kaiser, also referring to Kaiser’s care as “systemic” and “serious” violations of state law and ordered Kaiser to “cease and desist” from committing further violations of California’s mental health laws, including its practice of using a parallel set of paper records that concealed patients’ lengthy wait times for appointments.
The DMHC action was in part the result of a campaign initiated by NUHW therapists and social workers, the authors of the NUHW report, “Care Delayed, Care Denied.” NUHW represents nearly three thousand psychologists, therapists and psychiatric social workers, frontline mental health workers who provide day-to-day care for Kaiser patients with conditions ranging from autism, anxiety and bi-polar disorder to depression, schizophrenia and suicidal ideation.
The NUHW members have been joined by advocacy organizations, professional associations, and patients (but no other unions) in an ongoing campaign to improve Kaiser’s mental health services. The DMHC fine, which Kaiser finally paid in August 2014, is the second largest in the agency’s history.
“We cannot prevent suicide if we don’t talk about it,” Shirlee Zane told the full house in Santa Rosa. “This is a preventable death in most cases. We have to end the silence.”
This is certainly true; silence is often the result of shame, also misunderstandings, and quite rightly the wishes of family members and others for privacy. Silence is also, however, the policy of Kaiser management – it is in their interests, so it seems, to cover up discussion of this “crisis.” NUHW members refer to Kaiser’s policies as “gag rule.”
Kaiser retaliates against the whistleblowers. “We don’t want to reward your bad behavior,” a Kaiser Exec once remarked at the bargaining table. Andy Weisskoff is just one therapist dismissed by Kaiser for speaking up. In May, Kaiser NUHW members picketed facilities throughout California protesting the termination of Fremont psychologist Dr. Alex Wang, a target of Kaiser management since 2013 when he wrote “Patient should be seen sooner” on a patient’s chart. Wang had learned that the patient would have to wait more than three weeks for a first time appointment. Three thousand Kaiser workers face the choice – keep quiet or find their job on the line.
Kaiser resorts to collective punishment as well; it has denied all 4000 NUHW members a contract. The therapists and social workers, and all NUHW-represented Kaiser employees, have been engaged in fruitless negotiations since 2010; the workers have rejected countless Kaiser demands for concessions – in health benefits, pensions, and staffing, demands the company knows the workers will reject. So there’s more to it than concessions, says Clem Papazian, a therapist at Kaiser’s Oakland Medical Center, the elected President of NUHW’s Northern California U nit of Kaiser mental health clinicians. “They want to shut us up and they’re willing to break our union to do that.”
Papazian calls the Kaiser crisis “systemic,” one that is now exacerbated by the thousands of new patients flooding the system as a result of Obamacare. “There just aren’t enough of us to do the work. So many people have needs. There is a cascading effect. The system’s not pro-active. If a struggling patient could see a clinician regularly, she/he might not become so desperate. Unfortunately, there aren’t enough clinicians available to offer this routine follow-up service. When routine issues go untreated, by definition they become more acute. When more and more people are prevented from obtaining timely routine care the system becomes overwhelmed. And one result is suicides.”
Elizabeth White, a Licensed Clinical Social Worker at Kaiser’s West Los Angeles Medical Center, emphasizes life’s stresses: “You’ve got no job, you’re fired, your workload is too much, your wife is going to leave, your husband is having an affair – it’s everywhere but Kaiser doesn’t seem to care, stress disorder overwhelms people, dark thoughts follow. Patient calls are answered by clerks, workers who are forced to make what are essentially medical decisions, they who have no mechanism to pass the call on to the appropriate provider.
“We don’t have a system that allows the patient to connect with the caregiver, face-to-face. Our work is often about life and death, mental suffering that is stigmatized and marginalized in our society. At a time of ever-increasing need to address mental health issues. It doesn’t have to be this way. What’s happened in Santa Rosa and so many other places is preventable.”
And why is this happening? Papazian says, “It’s no secret: Historically psychiatric services are a money loser for these hospital corporations. Kaiser is acting as if it is losing money. On the contrary…they simply don’t want to pay the labor costs for high-quality service. The results can be significant; group therapy brings in huge savings, perhaps as much as 80% according to Kaiser accountants.”
This California story might be just another example of the state of health care in the United States; often shocking, but hardly news. It demands telling, however; it reveals after all the ongoing consolidation of neoliberal capitalism and market economy, in this case in today’s hospital and its deliverance of healthcare. It exposes ruling ideologies, principles and values, not simply in the abstract but in the lived experience of the ordinary working people upon whom this system is imposed. The irrationality of this system is seen from the vantage of these workers and their patients, the latter most often workers as well. It represents what the late E.P. Thompson might have called the sheer otherness of capitalism, that is, the gulf between, in this case, Kaiser, its “other way of life,” that is, its values and practices, its and ideas of time and discipline and morality, and those of its workers.
“In Kaiser, we follow orders that come straight from the top,” says, Papazian. “It’s the bottom line, never mind that it’s people we work with. Kaiser wants us to collaborate with them in the business of getting business, to turn our clinics and hospitals into mills. It’s a manufacturing mode; it doesn’t fit human beings. We need time with the patient, time for nuance, thoughtful consideration, relationship building.”
The National Union of Healthcare Workers was founded in 2009; it has since grown to 11,000 members, all in California, all healthcare workers. Its roots are deep, however, they go back to 1934, when in the aftermath of the great dockers’ strike, porters in San Francisco organized the first hospital union in the country. In the 1980s and 1990s it was revived as Service Employees International Union (SEIU) Local 250, then led by insurgents who championed empowering workers, union democracy, organizing and standing up to the corporations. It grew by tens of thousands of new members in the 2000s, merged with the big Southern California SEIU local, 399, becoming United Healthcare Workers-West, 150,000 strong, a powerful force in California. This at a time when organized labor nationally was in steep decline. It was militant, never afraid to strike; it preached and practiced solidarity, including with UNITE-HERE’s Local 2 in its bitter 2004 conflict with San Francisco’s hotels and with SEIU in Nevada, sending organizers there and coordinating contract campaigns with UHW unionized hospitals in California. UHW-W was a progressive union – its 5,000 shop stewards were elected, as was its executive board, it opposed the wars in Afghanistan and Iraq, and supported universal health care plans. Its elected president, Sal Rosselli, once served as Grand Marshall of San Francisco’s Pride parade.
This came to an abrupt end in 2008, when the former President Andy Stern’s SEIU “international” set out to wreck this “model union.” Why? Perhaps the story was not so clear then; it is now. SEIU national leadership in 2008 represented a one-party, top down corporate “union,” the country’s second largest union. SEIU allowed no dissent. When this developed, as it did in California, but elsewhere as well, the result was the hostile takeover, trusteeship. In January, 2009, SEIU seized UHW’s assets, fired its elected offices — 5,000 elected shop stewards included — and imposed loyalty oaths and a gag rule upon remaining staff and members.
The reasons for this? They are worth recalling. UHW members and leaders had refused to continue participation in the SEIU’s “Nursing Home Alliance” — a strategy that based organizing on partnerships with employers and “neutrality” agreements. These agreements typically allowed employers to pick and choose which facilities would be organized, they restrict workers’ rights, including the right to strike, they enforce the gag rule – even (as is so often the case in the nursing home) when the worker is the elderly, isolated patient’s one and only voice in an industry notorious for neglect and abuse. The Nursing Home Alliance enshrined long- term agreements (for example, a ten-year contract for home care workers in a Washington state), all in return for employer “neutrality” in an election. Workers frequently complained, “The boss brought me this union.”
The response was retaliation, the international leaders ordered UHW’s officers to transfer 65,000 home healthcare workers – without discussion, without a vote, relegating them, whether they liked it or not, to the scandal-ridden Southern California Local 3464, then led by Tyrone Freeman, now in prison, convicted of racketeering and embezzlement. UHW refused, trusteeship followed. In an appalling episode, a triumphalist SEIU unleashed “World War III,” established a “war room” in Oakland,” sent in many hundreds of “warriors,” Iraq talk, toy war talk with real war as background.
Is this important? It is not without reason that we hear that the organized labor movement is dead. It is easy enough to see why. Alas, stories like this nightmare in California ese do not pass unnoticed. At the same time, reports from the Bureau of Labor Statistics find that labor’s numerical decline continues apace; membership is now down to about 11% over all, and just more than 6% in the private sector, the lowest, we are told, since the turn of the past century, the 1900s that is. Still the Madison occupations revealed possibilities; the Chicago teachers strike raised hopes high. “Fight for Fifteen” is a work in progress, but “Our Walmart” appears to be fading.
Overall, the situation remains discouraging. The external challenges confronting unions today are massive. On the other hand, here in California, the state with the highest number of union members, 2.5 million, membership remains stable, and in places is growing – NUHW has grown from to 11,000 in just half a dozen years. The point is, importantly, that unions can grow.
There are factors that bode well for us – no Scott Walker here, the state is dominated by democrats; a right-to-work campaign then seems unlikely. We have some strong unions – the ILWU has held off the giant shipping companies again. It remains intact in the state’s three giant ports, occupying strategic, highly sensitive positions in the world’s commerce. The longshoremen’s demonstration supporting “Black Lives Matter” is a vivid reminder of labor’s potentials. The two big teachers unions seem full of promise. We have an increasingly large, restive and frustrated immigrant population. And we have the bitter, ongoing experience of the foreclosure crisis. Unemployment is chronic – while Silicon Valley enjoys another gold rush and San Francisco gleams, inequalities are staggering. How can unions not grow in conditions such as these?
There are reasons; apathy, disinformation, intimidation, fear, reprisals. The wrecking of the UHW is another, an object lesson for troublemakers and visionaries alike. Unions also don’t grow because they offer so little, they don’t grow because they can seem indistinguishable from the employer – they enforce rotten contracts, discipline troublemakers, their officers live lives that resemble the employers – they rarely experience unemployment, dismissal, harassing supervisors, the stresses that drive desperate workers to therapists like Elizabeth White.
Still, polls routinely show that workers see unions as positive. Indeed, they can grow, and do. “We’re doing it every day,” says NUHW President Rosselli, “and we’re on the defensive. We’ve got this fight with SEIU, we’ve got them between us and the employers. The truth is that healthcare workers today need a union now more than ever. The hospitals’ profits are unprecedented, still they attack.”
Today, SEIU stagnates, the suffocating arrogance of 2008 is long gone, its boy wonder, Stephen Lerner, architect of the grand plan, is past history. The leadership is factionalized, plagued with defections and corruption, its perspectives offer little for its dues paying members. When Mary Kay Henry, President of SEIU, recently came to the Bay Area to build the Fight for $15 movement (a worthy cause), nothing was said about the strike of the workers at Park Merced in San Francisco, SEIU members making just more than the minimum wage. Nor of the thousands of Fresno home care workers, also SEIU members, many of who take home less than the minimum wage (once union dues have been deducted). It is estimated that perhaps half of SEIU’s members make less than $15 an hour.
UHW-West is now half its former size, 65,000 of its members have just this year been bureaucratically removed to another local union, this despite the bitter protests of Dave Regan, its president, the Ivy Leaguer appointed in the wake of trusteeship. Today, Regan is perhaps as despised as any labor leader in California. The reasons are legion: his consistent policy on granting concessions, at Kaiser in health benefits, pensions and staffing. At a time when the hospital giants are intent on rationalizing, on cutting jobs, forcing what amounts to an electronic speed-up, Regan has suggested that the California Labor Federation (to the astonishment of its representatives) not stand in the way, even in defense of hard won staffing rules in nursing, the sacred cow of the California Nurses Association (CNA).
More recently Regan announced a grand plan: “We’re talking about working together on a scale that is unprecedented for unions and employers… We’re going to create a totally different paradigm for the way unions and employers deal with each other.” The “we” here is SEIU-UHW and the California Hospital Association (CHA), the organization that represents the big hospitals in Sacramento. “Working together” refers to the May 6, 2015 secret agreement that underscores the collusive relationship of the state’s largest hospital workers’ union with the industry’s CEOs.
In the agreement, the “new paradigm,” Regan has agreed to joint lobbying with the CHA in Sacramento aimed at boosting Medicaid payments to hospitals – by $6 billion a year. This will be, if successful, a boon for the industry, an industry already awash in cash. In return, the agreement is to enlist the hospital industry in the union’s organizing efforts; hospital executives have promised to make SEIU-UHW their union of choice. CHA will SEIU give it free access to 30,000 workers; then, if the joint campaign to increase the state’s Medicaid payments succeeds, another 30,000. Workers will be forced into pre-negotiated SEIU contracts that guarantee low wages and reduced benefits, prohibit picketing and strikes. Interesting here, the “partners” have agreed to no “negative campaigning” – that is, self-imposed silence on the conduct of the hospitals, including CEO pay, a “gag rule” on workers – a “Code of Conduct” that will eliminate the union’s watchdog role and prohibit workers from criticizing their employers in the media, the courts and even in the regulatory agencies. “Visionary,” says California Hospitals Association CEO Duane Dauner.
The workers’ who have remained in SEIU’s UHW have paid a big price; they are already the victims of Regan’s “new paradigm.” They have, in essence, no union. Contracts are pre-negotiated, concessions are routine, democracy is a four letter word. Workers at the Sutter Health’s Alta Bates Medical Center in Berkeley, strong union members since the 1960s, report that hundreds of jobs there have been lost on Regan’s watch – the result of dismissals, attrition, cutbacks, subcontracting and outsourcing. They’re just the latest of many to file to decertify UHW and join NUHW – they await an NLRB ruling and election.
Kaiser’s therapists and social workers were among the first to join the new NUHW; in this they demonstrated in practice the still contested but fundamental necessity of workers to have a union of choice. Since then they have been and remain the vanguard in the resistance to the Kaiser system and the HMO giant’s drive to dominate the nation’s healthcare systems. They have been on strike four times now, and not just for themselves. They have made patients interests their interests – central here, their demand that mental illness be recognized as just as serious as any other illness, to have mental healthcare receive parity with other healthcare issues. In doing this, they have forced into the open fundamental issues of healthcare and how it is to be delivered. They have exposed the great gap between themselves, their patients and the employers – the gap in principles and values, in contested views of what is and what ought to be. The have resisted, as, inevitably, workers must. They have revealed what a union can be, begging the question not just of why workers need unions, but that of what kind of unions as well.
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On October 10 in Los Angeles, NUHW held its annual leadership conference. There it was announced to the members that Kaiser had offered the Northern California therapists’ unit its “last, best and final offer.” The offer, the terms of which had been rejected before, contained one new demand, infuriating the therapists. Kaiser demanded the implementation of a system of quotas for therapists, and, more, that the quotas be enforced with discipline. Kaiser of course already has the right to discipline employees. The intention then was clear. The therapists responded by voting in support of an open-ended strike, with 88% voting in favor.
Should they strike, they deserve our support. As of now (exceptions including the honorable stand of the Courage Campaign and a growing network of rank-and-file workers and mental health activists), however, these Kaiser workers fight alone. This is unconscionable. Where are the unions? Where are Kaiser’s SEIU’s members, and nurses, where is the CNA, where is AFSCME? Is the NUHW model somehow deficient – a militant, democratic, organizing, anti-racist, multi-gendered organization that sets as its goal empowering workers? Where are the activists, the academics, the intellectuals? Where is the discussion, where are the debates?
Solidarity is not meant to be an empty word. Now is the time. Support NUHW and the Kaiser workers. No more Kaiser Suicides! An injury to one is an injury to all.
Cal Winslow is author of Labor’s Civil War in California,(PM Press) and an editor of Rebel Rank and File (Verso). His latest book is E.P. Thompson and the Making of the New Left (Monthly Review). He can be reached at email@example.com