Chapter 2. Hostilities - 1979
January Board Usurps Administration...................................... 51
February Terminations Rescinded................................................ 52
April Federal Budget Cuts.................................................... 58
May Maltos' Contract Rejected........................................... 62
June Conflicts Grow............................................................ 67
July Registration Closed.................................................... 72
August &
September Maltos Leaves............................................................ 74
October By-law Changes & Employees Organize...................... 75
November Birth of the Employee Organization........................... 87
December Employees Go to Court............................................ 105
Chapter 2 Hostilities - 1979
January 1979 - Board Usurps Administration
The events in 1979 had a profound effect on the future of the clinic. As the original vision gave way to some harsh realities, the employees sought mechanisms to protect themselves and the clients they served. A new and unique union emerged from the wrenching conflict that brewed throughout the year.
The board began to get involved in the day to day operations of the clinic. This insidious involvement started slowly. By the time the board hired Anibal Mejia as Chief Executive Officer (CEO), it routine got involved in management and no one at El Rio displayed the power to prevent this activity which ran counter to the original vision.
Membership on the board came from three sources: elections in the model cities districts, elections for people who resided outside that area or "at-large" and people with expertise who received appointments. Baldenegro, who served on the By-laws Committee in early 1979, had been elected by people living in the "at-large" area. That meant that his constituents were El Rio patients who lived outside the Model Cities area. Although Rosemary Diaz held the title of President of the Board of Directors, the center of power revolved around Salomon Baldenegro.
Pat Patton, El Rio's Executive Secretary, believed that during Baldenegro's time on the board he made all policy and major administrative decisions. She described Baldenegro as ruling over the board and dressing everything in a racial context even where no racism existed. Other employees expressed their concern about his involvement in the day to day operations of the clinic.
February 1979 - Terminations Rescinded
Earlier, Alice Hunter, a nurse terminated by the Nursing Director for excessive tardiness
and absences, brought the issue of her termination before the board. The Nursing Director, Jill
Bundy, tall, handsome, blond and romantically linked to Maltos, still enjoyed a reputation for
being very capable. While the board overturned the Nursing Director's decision, Hunter chose not
to return to work. The staff believed rescinding an administrative decision constituted
interference in internal affairs by some of the board. This had later repercussions.
February 1979
Mary Lou Gonzales' College Course Paper
Mary Lou Gonzales recalled that early in February of 1979 Lydia Sanchez, a registered nurse, turned in her resignation for the third time to Jill Bundy. Sanchez then tried to rescind her resignation.
"Because of problems on the unit, the Nursing Director refused to accept her rescindment.
Because she [Sanchez] had resigned, she had no right to grievance procedures. She filed a
grievance directly with the Board and was reinstated by the Board."
For Sanchez, known to be Baldenegro's great friend and the godmother to one of Baldenegro's children, the concept of a godparent had a special meaning. So the relationship between Sanchez and Baldenegro went beyond friendship and involved the spiritual and general welfare of one of Baldenegro's children. Whenever Sanchez had problems at El Rio, she could go to Baldenegro for relief.
While compelling reasons not to rehire Sanchez existed, Maltos' decision to uphold the termination could easily be seen by Baldenegro as tied to Maltos' special relationship with Bundy. This special relationship eventually resulted in marriage.
Patton, the Executive Secretary, believed that Baldenegro and Maltos initially worked well together but the incident involving Sanchez changed the working relationship. When Maltos let Sanchez go, Patten remembered Baldenegro threatening Maltos when he said "I am going to get you for that."
According to Yolanda Coronado, an El Rio LPN, when Bundy refused to take Sanchez
back, Sanchez first tried to get legal assistance. Then she went to the board where she "got her
job back." Baldenegro made it possible, through actions of the board, for Sanchez to regain her
job. This event triggered the anger of many employees. As the results, Maltos and many
individual employees expressed their complaints to the federal Project Director about the board's
action of rehiring terminated employees against the will of the administrator. Several El Rio
employees disliked Sanchez. Josie Guerena, whose employment at El Rio started 1976 and who
later become very active in the union, characterized Sanchez as "mean." Guerena understood that
"people were afraid of her." But, the employees who worked in the suites with Hunter and
Sanchez expressed the most anger at the board's decision.
February 13, 1979
"Incident Regarding Lydia Sanchez" as reported by Mary Kalish, FNP
Mary Kalish, a buxom woman originally from Texas, wrote a letter outlining some of the
problems she had with Sanchez. In this letter, she claimed Sanchez used loud abusive language
when Kalish conferred with a family health worker about a patient who had an abnormal
mammogram. A second incident involved two employees, where one abused the other in
Sanchez' presence. Instead of intervening, Sanchez merely laughed and walked off. Kalish also
argued that Sanchez had harassed her for several months and that Sanchez denied her cooperation
with patient care. In addition, Kalish claimed that Sanchez threatened her position at El Rio.
Isabel Abalos, a family health worker who worked in the suites, felt that Sanchez had an instant dislike of her. Sanchez had no knowledge of Abalos yet Sanchez constantly"nit picked" and bounced Abalos around to the different suites. According to Abalos, Sanchez acted ". . . generally negative, condescending and mean spirited." Abalos believed that many employees feared Sanchez. Sanchez made Abalos work with the more difficult physicians; the ones considered "high pressure," the ones with the biggest patient loads.
Abalos believed that some of the physicians liked Sanchez and they even thought highly of her skills. Others saw right through her.
"When we saw a physician saw through Sanchez, we felt comfortable talking to them."
February 14, 1979
Memo from Robles to Jill Bundy, RN
Celina Robles, who had earlier worked as a family health worker, requested a rehearing concerning her termination. Robles claimed that she received an unfair termination by Sanchez for: (a) giving a patient 15 minutes instead of a half hour appointment with the physicians, and (b) double booking.
Her request for reconsideration began:
"As you know, I was terminated from employment at El Rio Santa Cruz Neighborhood
Health Center on the 3rd of April 1978. In view of recent events concerning my supervisor,
Lydia Sanchez, I request a new hearing regarding my termination. I am requesting this
because I believe that I was denied a proper hearing at the time. Only two members of the
board were present at my hearing, and they would not let me speak other than to answer
their questions which had little to do with why I am told I was terminated."
February 15, 1979
Letter from Mary Lou Gonzales, FNP
"I have never been personally involved with day to day activities in Suite 3 [where Sanchez
worked], but have been aware of the tension whenever I have gone there regarding patient
care."
February 16, 1979
Letter to Rosemary Diaz Supporting Termination of Alice Hunter and Lydia Sanchez
"We, the undersigned members of the Medical and/or Nursing Staff of El Rio Santa Cruz Neighborhood Health Center, hereby advise the Board of Directors of the following:
a. That we work on a daily basis with the Director of Nursing Services, Jill Bundy, and are in a position to evaluate her performance as to her support in providing services for the public we serve.
b. That Ms. Bundy has carried out her functions in a thoroughly professional and competent manner, to the betterment of the clinic.
c. That we have never questioned the propriety of her administrative decisions with regard to her personnel, and are confident that her decisions are made in the best
interests of the clinic and public it serves.
d. That we are aware of many incidents which for various reasons have not been made public until now specifically concerning Ms. Alice Hunter, LPN, Ms. Lydia Sanchez, RN.
e. That we fully support the actions taken by Jill Bundy as Director of Nursing Services as to her termination of the employment of Ms. Alice Hunter, LPN, and as to her acceptance of the resignation of Ms. Lydia Sanchez, RN.
f. That we request that the Board of Directors lend its full support to the Director of
Nursing Services with respect to the termination of the employment of the two
individuals concerned.
cc: Jose A. Maltos, Executive Director
Jill Bundy, Director, Nursing Services
Signed by five nurse practitioners, eight physicians, two licensed practical nurses, and one
registered nurse.
Last Week in February 1979
Letter from an Anonymous Employee to the Board
"I am deeply concerned with two decisions made supposedly by the board which involves
two employees [Alice Hunter and Lydia Sanchez] . . . " "I feel that Jose Maltos, Dr.
Epstein, and Jill Bundy should have been given preference as to whether or not these two
employees should remain on our staff . . . " "Please note that I am not doing this for
pleasure. I thought mighty hard because I don't want to get into any trouble. I love and
cherish the seven years I've worked in this organization."
Letters from an Administrative Secretary, Three Family Health Workers, a Nurse Practitioner and a Mid-Level Manager to: the Board of Directors.
One letter stated that board's decisions regarding Hunter and Sanchez amounted to "a direct affront to administrative authority." A second letter writer expressed her concern about the well being of the clinic and mentioned support for the Nursing Director, Jill Bundy. A third letter supported Bundy and rejected Hunter and Sanchez. A fourth writer discussed problems with Hunter and Sanchez and also her dismay at the board's overstepping its authority. A fifth employee wrote:
"Since Alice Hunter has been dismissed, Suite 1 has been functioning efficiently, quietly
and peacefully."
Finally the remaining employee wrote:
"Recent decisions of the Grievance Committee in reinstating one terminated individual
[Hunter] and one who resigned [Sanchez] represents a major set back in the progress that
has been made."
April 1979 - Federal Budget Cuts
April 9, 1979
Letter from Senator DeConcini to Dr. Warren regarding Region IX Community Health Service Budget Cuts for Fiscal Year 1979
Two major factors affected the allocation of funds to the regions in the country: what percentage of funds were used for administrative costs within the whole region, and the number of patients per physicians within the region. El Rio sat in Region IX. Other health facilities, which did not perform as well as El Rio, also existed in the Region. In both categories, El Rio functioned far above required amounts. However, the average for Region IX fell below required amounts. Because of regional statistics, all facilities providing Community Health Services in Region IX felt a reduction in federally allocated funds. So El Rio suffered funding cuts because of problems outside of the clinic and beyond its control.
In response to this situation, Dr. Warren wrote to Arizona Senator Dennis DeConcini to seek relief. DeConcini's response to Warren regarding the financial crises follows.
"Thank you for writing me regarding Region IX Community Health Service budget cuts for fiscal year 1979 and more specifically how these cuts will affect the El Rio Santa Cruz Neighborhood Community Health Center.
A member of my staff has spoken with administrators in both Region IX and at the Bureau of Community Health Services Administration in Washington to determine the reasons for the budget cuts which concern you. As you may be aware, there are a number of criteria involved in determining budget allocations for the ten regions. Major factors are the performance indicators used to judge the projects in the entire region. [Budget allocations were determined by region-wide performance and not by individual project performance.]
Two of the primary indicators used to judge a project and the region as a whole are: (1) the percentage of funds spent on administrative costs; and (2) the number of patients encountered by each physician. The Community Health Services Administration has set a 20% ceiling on administrative costs in each region and set a target level of 4200 patients encounters per physician. In Region IX the administrative costs have consistently surpassed the 20% mark; additionally, physician/patient encounters have been below the level prescribed. Because this condition has prevailed for the past few years, the decision was made by the Bureau to cut the allocation as they had warned in the past.
While I support the efforts of the Bureau to control these factors, I am also sympathetic to the needs of the El Rio Santa Cruz Neighborhood Center. For that reason, I have written to Dr. Edward Martin, the Director of the Bureau of Community Health Services, to express my concern. I am enclosing a copy of that letter.
Be assured that I share your concern for the ability of the Santa Cruz
Neighborhood Health Center to continue to provide its much needed and important
services. It is my hope that Region IX will be able to correct its shortcomings and return
to full funding in the near future."
After responding to Warren's letter, DiConcini's office also contacted Dr. Edward D. Martin, Director, Bureau of Community Health Services in Rockville, Maryland.
"I am writing you because of my deep concern for the ability of the El Rio Santa Cruz Neighborhood Health Center in Tucson, Arizona to continue to provide its much needed services.
It has come to my attention that Region IX of the Bureau of Community Health Service has been dealt a serious allocation cut from FY [Fiscal Year] 78 to FY 79. This decrease will inevitably lead to a cut back in services at the El Rio Santa Cruz Neighborhood Health Center.
I understand that Region IX's budget has been cut due to poor performance indicators in the areas of administrative costs and physician/ patient encounters. While I support and applaud your efforts to control these costs through an incentive system, at the same time I would hope that these temporary negative statistical indicators would not lead to the demise or limitation of such an outstanding program. Furthermore, in the case of the El Rio Santa Cruz Neighborhood Health Center, statistics show that they have consistently performed above Region IX and national average in the area of mid-level practitioner/ patient encounter rate. Additionally, El Rio Santa Cruz's administrative costs have shown evidence of a serious decrease.
It is my hope that funding for the El Rio Santa Cruz Neighborhood Health Center will not suffer due to this temporary condition. I am convinced that they are making a serious effort to combat the aforementioned problems.
I hope you will give this matter your personal attention."
April 19, 1979
Letter from Mark Raven, JD to Rosemary Diaz
This letter explained that NHC by-laws did not permit a change in the membership of the
Grievance Committee each time a grievance arose. One can only speculate on why Diaz wanted
to have the ability to change the members of the Grievance Committee at will. Perhaps, if she
could control the make up of the Grievance Committee then she might also control the expected
outcome of the Committee's decisions.
April 22, 1979- Estimated Date
Tucson Citizen News
Manuel Alvarado, a long time associate of Salomon Baldenegro, went before the board in an executive session to allegedly talk on behalf of some employees. Some days later, in response to inquiries, Alvarado said:
"Those people who came to us were concerned that everything settles down and get back to
the business of caring for the sick . . . They didn't know what or who was causing the
unpleasant environment at the center and that really wasn't their concern. They wanted the
name-calling and letter-writing to outside agencies to stop. They wanted things to get back
to the basics--the principles upon which that center was founded."
Although the words came from Alvarado, Larsen heard Baldenegro speaking. Rather than cool down the situation, Larsen believed that those words further inflamed many employees.
Gloria Gonzales recognized Baldenegro had some employee support, but she also
observed an overwhelming distrust and fear by the very people for whom he especially wanted to
be an advocate.
May 1979 - Maltos' Contract Rejected
May 1, 1979
Notification from Rosemary Diaz to "All NHC Employees"
This notification announced that employees would be invited, one at a time, to speak before the board in an executive session. They could speak about, (1) favoritism in the Center, (2) quality of care, (3) ethics and professionalism, (4) objectivity in application of policy, and (5) other areas of your own choosing.
Mary Lou Gonzales recalled that employees did go to the meeting. The board went into an executive session and employees had to wait a long time before they could speak. Many got tired and left.
Patton, who had the responsibility to take minutes at the board meetings remembered the
executive sessions usually functioned as strategy sessions.
About Mid May 1979
The board president claimed a vote of eight to six against the renewal of Malto's contract. The disputed vote had been preceded by intensive lobbying by both the Baldenegro and Maltos' camps and eventually landed in court. Pat Patton, the Executive Secretary who took the minutes of that board meeting, also challenged the board's claim.
For many of the employees, the termination of Maltos came as a shock and wake up call. According to board president, Rosemary Diaz, Maltos caused low morale among the employees. While some employees expressed concern about Maltos' reputation for womanizing, most employees saw it the other way around - that the board's actions were responsible for low morale.
Coronado, the nurse who worked in Suite 1, the same suite as Sanchez, thought that the general opinion of the staff toward Maltos showed lack of respect due to his love affairs. Still, far more important to Coronado loomed both her situation of being a subordinate to Sanchez and her concern for job security.
According to Reece, at the time that Maltos held the position of top administrator the clinic prospered. Many other employees also believed this. So, with Maltos' termination for false reasons, lots of employees felt that if the board could get rid of Maltos, then they could do it to any employee.
About the end of May 1979
Many Employees and Some Board Member Phone the Department of Health, Education and Welfare (DHEW) in Defense of Maltos
The board members Juan Araujo, Lee Breast, Jose Cuesta and Daryl Thorpe MD phoned the DHEW. Among the employees known to have contacted DHEW were three physicians, one nurse practitioner, three family health workers, one dental hygienist, the accounting manager, an accountant, three executive secretaries, a Marketing Director and the Nursing Director.
The exceedingly short telegrams, all directed toward support of the outgoing CEO, Jose Maltos, were sent to Ray Auker at the DHEW office in San Francisco.
One said:
"Strongly feel that DHEW should not ratify the El Rio Board of Director's decision to not
renew contract of Jose Maltos."
Another read:
"Do not ratify the action of the Board of Directors of the El Rio Santa Cruz Health Center concerning Jose Maltos' contract. Please investigate."
Only two letters were found: one from a former employee and the other from the accounting manager, Shirley Fish.
A copy of the letter from the former employee, dated March 25, carbon copied to Representative Udall and Senator DeConcini, outlined her aborted attempts to bring her concerns directly before the board. She indicated in her letter that at least one board member, Bautista felt:
"...genuinely concerned over the fact that an individual had been denied access to the board
after following procedures."
The letter from Shirley Fish urged DHEW to investigate the situation.
"I wish to go on record as urging that HEW will refuse to ratify the El Rio Board action of firing Jose Maltos as Executive Director of the Neighborhood Health Center. At a minimum I respectfully request that ratification be delayed until such a time as HEW might thoroughly investigate the methods, procedures, and information used by the Board in making its decision.
From my personal observation and involvement, I would claim this action is simply the most recent--and culmination--of a series of events in which the Board has used violation of its own by-laws and policies, lack of due process, and downright refusal to consider available evidence pertinent to their decision.
More specifically, it can be demonstrated that the Board relied heavily on an invalid valuation instrument, and that some of the reasons given for the terminations are themselves proof of the Board Members' incompetence to make judgments.
It would be well if you might see fit to include in an investigation personal contact with every member of the Board, together with numerous professional and supervisory personnel whose performance has been handicapped by Board incompetence [in policy formulation] and by Board interference. I would be happy to contribute to the documentation of the above, drawing from my personal experiences.
Initial reaction of the majority of staff members seems to be one of shock and
anger, an anger which some of us are trying to keep from reverberating beyond the
institutional walls. Some of us fear detriment to the further development of the HMO, as
well as further demoralization of the staff. We find no indication that the real needs of the
Health Center were taken into consideration in the decision that was made.
In all, forty-three people phoned DHEW, five sent telegrams and two wrote letters. Of the five sending telegrams, three also phoned. Twenty of the people who phoned did not leave their names. Among those who contacted DHEW were Mexican-Americans, African-Americans, Jews, and Anglos. Because so many of the Mexican-American employees had expressed fear of retribution from Baldenegro, most of the twenty unknown callers were probably Mexican-American.
Auker from DHEW in San Francisco, however, claimed his office received about twenty
phone calls and fifteen letters or mailgrams from Maltos supporters. Auker further said that as
long as the funds and services were dispersed properly, DHEW could not interfere. He expressed
concern over the difficult situation and pointed out that the Center had been ". . . held as a model
health center . . . "
May 30, 1979
Memo from Dr. Vivian, the New Medical Director to All Personnel re.: Close of Registration
Many physicians, especially those who had contractual obligations to service indigent patients demonstrated significant concern. This had been done before, but it had been a temporary measure and did not include dropping patients who could not pay their bills. This new ruling dictated that those who had not already established themselves as El Rio patients would no longer be eligible to join during the close of registration. Additionally, the poorest people from the neighborhood who had illnesses and could not pay for prior services were also vulnerable and could be denied services.
When patients were dropped from the register, Gloria Gonzales wondered what happened to them because they did not have too many options. She wondered if they would be treated with dignity elsewhere.
Reece remembered that registration closed many times because of crowded facilities and overworked staff.
But closing registration concerned others as well, especially those employees who
understood, from Model Cities days, El Rio's ideal role. For Tovar, the closing seemed like a
direct contradiction of the purpose of the clinic. Closing registration indicated an early warning
about the developing financial problems.
June 1979 - Conflict's Grow
June 28, 1979
Board Minutes
Rosemary Diaz requested and received information from DHEW under the Freedom of Information Act. She did this believing board member, Dr. Thorpe, reported to DHEW that she wanted Jose Maltos' job. Thorpe denied the charge. The minutes reflected Baldenegro's support of Diaz,
"...what bothered him [Baldenegro] was that a certain group of staff people are going around with untrue things, rumors, lies, falsehoods accusing the board of things that are not true that they cannot document and will not document."
Baldenegro added,
"...they are making comments like this even if it means closing the center." Many of the employees believed that Baldenegro's statements exaggerated and distorted the content and intention of the employees' communications.
But Tovar distrusted Thorpe as she saw him as Maltos' ally and therefore she believed that he could not be employee friendly. Later, Baldenegro played a major role in getting Thorpe off the board.
In a bold act of defiance, the board went out of its way to schedule the next board meeting when one of the two health professionals, Nichols and Thorpe, would be out of town.
"Doctor Nichols stated that he would not be in Tucson on the 16th of August but he would be here on the 23rd, the regularly scheduled date . . .[Almost immediately after that statement] Mr.Baldenegro moved and it was seconded that: The Board meeting be changed to August 16, 1979." Dr. Ava Wolfe, an NHSC pediatrician, demonstrated a strong advocacy for and support of community boards. With the closing of registration, she came before the board to express her concerns. In addition to Wolfe's interest in her patient's well being, especially those at high risk, she believed that board friends or relatives who lived outside the service area benefitted from enrollment. She expressed her greatest concern, however, for the difference between the HMO patients and the community patients. Still, the Yaqui contract, an HMO plan which serviced the Yaqui Indian community in and around Tucson, enjoyed her support. Wolfe felt bothered by the situation where the community people were denied health services at the clinic while the El Rio management marketed the HMO outside of the target neighborhoods. Wolfe went to a meeting of the board to talk about the disenrollment of her patients. She remembered telling the board:
"My high risk children were disenrolled without any information about where they might be - without a last visit with their physician to pull things together."
Wolfe came away from that board meeting with the general feeling that the members thought the board served as their personal power base.
June 1979
Neighborhood Health News, Vol. 5, No. 6, June 1979
This newsletter had been mailed monthly for several years to all active registered patients of El Rio including the employees. This edition introduced the new Medical Director.
"The Neighborhood Health Center [NHC] is pleased to announce the arrival of our new Medical Director, Dr. Donald Norman Vivian. Dr. Vivian is a retired Brigadier General who served in the U.S.A.F. for 35 years. . . ."
Also in this edition, an article pointed out how well El Rio had done in meeting some earlier goals:
End of June 1979
Letter from National Health Service Corp Providers at El Rio to Dr. Charles Hofsteder, Director of Region IX, NHSC "We, the undersigned NHSC providers at El Rio NHC in Tucson, are deeply concerned over recent events which have transpired at the clinic. We bring these to your attention because we feel they not only outrage our personal senses of integrity but reflect on the integrity of the Corps as well. Whereas we understand that we have been sent here to supplement the services being offered by existing providers, we find our federal salaries being used to facilitate the layoff of employees at the clinic who have been longtime providers of heath care to the community. Recognizing the reluctance of the Corps to intervene in local decision-making, we nonetheless feel that the intent of the Corps in providing physicians to underserved communities is being abused by these decisions.
Over a year ago a Certificate of Need was prepared documenting the need for 11 NHSC providers to augment the existing staff to enable the NHC to adequately provide health care services to the large, medically under served, South-West Tucson community. Currently we comprise ten of the approximately 30 full-time providers at the clinic. The administration contends that there is an oversupply of providers at the clinic, but we feel this is an erroneous assessment based on artificial criteria.
The following points are crucial to consider in this respect:
1) Since June 1979, the clinic's registration has been closed to new [non-HMO]
patients. The initial decision to close registration was based on an under supply of
providers. Since then it has remained closed despite the addition of six new physicians,
five of them NHSC, ostensibly for financial reasons relating to the provision of ancillary
services. An obvious result of this is that the number of encounters per provider has gone
down. This does not imply that there was no need for additional providers; rather that
large numbers of people in the community are denied access to health care because
registration is closed at the clinic.
2) An Urban Health Initiative grant has been given to El Rio for the purpose of
establishing a full-time satellite clinic in the South Tucson area. Providers for this site are
to be drawn from the existing staff, which will mean a minimum of two providers less at
the parent clinic.
3) There is a natural attrition process among non-NHSC providers, and it is to be expected that a minimum of two full-time providers will be leaving the clinic staff by July.
Notwithstanding the above recognized facts, the El Rio administration has just laid off two providers, both of whom have many years of service at the clinic. The reasons given for these firings are the ostensible "oversupply" of providers [questionable at best in terms of the above] coupled with budgetary constraints.
Budget problems at El Rio are real, but not new. It is to be recognized that this is a sine qua non of a clinic, set up for the express purpose of providing health care services to those who cannot pay the market rate. Various proposals for solving the budget deficit, revolving largely around attempting to collect some portion of the money owed the clinic by those who can reasonably be expected to pay for some portion of their health care expense [which has been totally ignored in the past] and from the County for providing services to indigents, have met with favorable responses and are presumably about to be implemented. However, firings of providers and other staff directly involved in patient care preceded any attempt to implement those or any other mechanism for solving the clinic's financial problems.
We take seriously the clinic's financial problems. It is our understanding that we, as NHSC providers, with federal salaries, were sent to allow the clinic to provide care desperately needed by the community without incurring additional budgetary deficits. We find it unconscionable that we are being used to replace rather than to augment the existing providers. These are people who have given many years trying to serve the needs of the community who now find themselves fired because the clinic finds it cheaper to use the 'free' NHSC workers to do their jobs. We find this intolerable vis a vis our colleagues.
We believe the Certificate of Need, as filed, was valid. There is a need for health care by far more people in the community than the clinic was seeing before NHSC providers arrived. But rather than meeting that need, we are being used by the clinic administration in a calculated effort to save money without expanding services. This seems contrary to the Corps' intention in sending us to El Rio.
We are asking the El Rio's Certificate of Need for NHSC providers be reexamined in the light of the current situation. We trust that this investigation will show that we are needed in addition to the pre-existing providers; but there is no legal or moral basis for asking for any NHSC support while laying off providers long engaged in service to the community. If any of these salaried people could be spared, there was no need for our additional help.
We as individuals believe we are needed at El Rio and feel that we should stay here. On moral grounds we feel the current conditions are intolerable, but will not, as specific individuals, request reassignment so that other NHSC providers, unmindful of the events which have transpired, can replace us. We therefore feel that this issue must be addressed by the Corps itself. Our convictions are sufficiently strong that if an investigation is not undertaken at a regional level we will feel compelled to bring it to the attention of the national NHSC office in Washington.
We urge you to give this matter your prompt attention, and to be in contact with
us as soon as possible."
July 1979 - Registration Closed
July 18, 1979
Memo from Jose A. Maltos, Executive Director to Department Heads, Social Services and Providers Regarding County Eligible Patients
"This memo will serve to reinforce our existing policy regarding the handling of County
Eligible Patients who need to be referred outside the Center for specialty services. The
Policy of El Rio has always been that patients needing some type of service that cannot be
provided in-house will be referred to Kino Hospital for that treatment. Again, this has
been our policy in the past and I want to make sure that it is enforced across the board.
Recently, we have had many referrals of County Eligible Patients to outside specialists for
which we have to pay. These County Eligible Patients should have been referred to Kino
as per our policy for any services that we cannot provide in house."
End of July 1979
Neighborhood Health News, Vol. 5, No. 7, July 1979, Two Articles by Jose Maltos.
"NHC will no longer pay for emergency room visits . . .
Effective July 1, 1979, El Rio Santa Cruz Neighborhood Health Center will not be responsible for any more referrals to emergency rooms at any of the hospitals in the City of Tucson.
In the past the NHC had covered these referrals to emergency rooms within
Tucson because of the special rates that we had with these hospitals. We no longer have
these arrangements with the hospitals therefore we can no longer pay for these referrals by
the Center . . . "
"Registration closed to new patients. . .
The Board of Directors of El Rio Santa Cruz Neighborhood Health Center at its regular meeting on June 28, 1979 passed a resolution that:
'Given the reasons advanced by Administration that we close registration to all patients for a period of ninety days with the exception of those patients to whom the Center had made specific commitments or to those who have been approached or are prospective enrollees of the HMO and that Administration be encouraged to open enrollment prior to the end of the 90 days if conditions warrant it.'
This means that no new patients, except those delineated above will be taken care of prior to October 1, 1979. The closing of Registration for a 90-day period will allow Administration and Staff to reassign patients of physicians who have left the Center and to allow us to implement the sliding fee scale which was approved at the same board meeting."
August & September 1979 - Maltos Leaves
Toward End of August 1979
El Rio established a Medical Executive Committee (MEC). The Medical Director
maintained control, although health professionals representing different areas sat on the
committee.
August 31, 1979
Although Maltos' contract expired May 31, the board requested that he stay on until the
end of August.
September 1, 1979
Memo from Diaz to "All Staff, Neighborhood Health Center"
Notification went out to inform the staff that the board appointed Robert Snyder to serve as the "Acting Executive Director beginning September 1, 1979."
Robert Snyder had been the head of the Marketing Department. The Marketing
Department existed for one major purpose, to enroll groups in the El Rio HMO. From the areas
where Snyder worked in administration, employees liked him. As Acting Executive Director,
Snyder probably functioned in an uncomfortable position.
October 1979 - By-law Changes &Employees Organize
October 1979
Events in this month had a profound effect on the future of El Rio as minor conflicts
between employees and the board gave way to the board's attempt to alter fundamental
provisions in the by-laws.
October 2, 1979
Memo from Donald N. Vivian, MD, Medical Director to Providers and Medical Supply Operations: regarding Patient Supplies, Equipment and Prostheses
"We will no longer purchase or rent patient supplies, equipment or prostheses. Any
exception to this must have prior approval of the Medical Director."
October 17, 1979
Memo from Salomon Baldenegro, Chairman of the By-laws Committee to NHC Board Members
"Enclosed are proposed By-Law revisions that the By-Laws Committee is submitting to
you, for your consideration. These will be voted on at the next Board meeting, 10/25/79.
Please note that, in accordance with the present By-Laws, these are being mailed on
October 17, 1979, eight days prior to the meeting."
October 25, 1979
Board Vote to Change By-laws
Changes to the by-laws required a two-thirds vote of the full board and therefore it required the vote of fourteen members.
Board members Juan Araujo, Carlo Bautista, Turk Humphrey, Mary Loya and Daryl
Thorpe voted against the changes. Voting for the by-law changes were Salomon Baldenegro,
Rosemary Diaz, Fernando Fajardo, Richard Gonzales, Aurelia Leyva, Jennie Lorona, Carrie
Pryor, Miguel Rojas, Donald Shelton, Charlotte Vega, William Wills, Lucy Wilson and Jesus
Yanez. Emilio Elenes, Bess Morris and Andrew Nichols were absent. Rosemary Diaz, as of the
board, should have only voted if a tie existed. After the formation of the new employees'
organization, employees discovered that there had not been the necessary two thirds votes for the
by-law changes. To pass the by-law changes, there needed to be thirteen votes without the vote
of the board president, Rosemary Diaz.
Accepting those changes in the by-laws meant:
1. Employees no longer had the right to vote at the Annual Meeting.
2. Members of the Board of Directors were no longer limited to two consecutive terms of office, but could run for as many terms as they desired.
3. A simple majority of the board could dismiss another member of the board after three consecutive absences and have the board chair appoint someone to fill the vacancy.
4. Any board member could become an employee of El Rio after he or she had been off the board
for three months. (Previously the waiting period had been six months.)
Virginia Bishop remembering the board's attempt to change the by-laws and take away the voting rights of the employees commented,
"We thought this was very un-American. We all thought that it was terrible."
Patton believed that the board, at this time, viewed employees' support as a negative and so they tried to take away the employees' voting rights. But not all board members felt this way. Board member, Juan Araujo, representing Unit 1, who voted against the by-law changes resigned from the board because of the changes.
Larsen, who had not been there at the beginning of El Rio and who did not appreciate the full implication of those changes, still felt offended because she saw it as a blatant attempt by a few people to gain absolute control over a clinic that theoretically belonged to the community. For Larsen, the by-law changes proved very upsetting and it became difficult to remain passive and uninvolved.
Mary Lou Gonzales, a long time employee, believed the changes violated the founding concepts and principles of patient involvement in running the clinic. She understood that not only the employees but also the full community suffered disenfranchisement.
Blanca Gaxiola, a young woman working in El Rio's laboratory, told her husband Fernando, a law student at the time, about the events. It appeared to him that the board tried to override El Rio's corporate constitution by changing the by-laws. To the young law student, it seemed like the conflict involved employee rights and labor issues. He became interested in the affairs at El Rio and sympathized with the majority of employees. Eventually, he played an important role in the future events that unfolded.
Reece remembered this as an awful time because she saw some employees who had been friends for years being torn apart.
After the changes in the by-laws, more employees began attending board meetings.
Guerena recalled going to those meetings and found that everyone, it seemed, wanted to give the
board a piece of their mind. The changes in the by-laws, on top of earlier actions by the board,
galvanized the angry employees.
October 26, 1979
Arizona Daily Star - November 4, 1997 Edition
Jill Bundy, the 28-year-old Director of Nursing, resigned.
"It's something I've been thinking of for months. There are so many problems going on
there, a real threat to me doing my job. I just felt it was time to get out"
Meanwhile, Baldenegro claimed that the troubles at El Rio could be traced to a small group of employees "maybe number 10 or 12". He also claimed that Jill Bundy directed this group. Yet, Bundy, according to newspaper accounts, "rated a superb administrator by former Medical Directors" and not likely to plot a rebellion. For Bundy, Director of Nursing, the board's by-law changes meant the "last straw" and she resigned.
Baldenegro, according to Tovar, probably saw the conflict between the board and the employees as a brown and white issue. Tovar believed that Baldenegro thought the people in power among the employees involved the white males and that the white male professionals propelled the issues. Tovar thought that Baldenegro did not take time to look around at the events that happened and that he seemed to take the conflict personally.
Joe Maready, a San Francisco-based DHEW project officer for El Rio, at that time, had high praise for Maltos. Maready reportedly said:
"Jose Maltos is one of our best project directions . . . We have high respect for him
(Maltos), and are disappointed at his leaving."
Ray Auker, another DHEW project officer for El Rio, apparently felt disturbed by the flow of events. According to the newspaper accounts, Auker sent board president, Rosemary Diaz, a letter expressing his dissatisfaction and questioning;
". . . the legitimacy of the Sanchez grievance hearing and the motives of the participants in it. He [Auker] charged that due process was not followed, proper notification was not given, and Maltos' right to appeal [the board's decision] was denied"
Baldenegro disputed Auker's claims.
"Your assertions relative to my actions and behavior are without basis, and, I submit,
totally lacking in substantiation,"
According to Mary Lou Gonzales, Ray Auker flew out from the San Francisco regional office of DHEW to investigate. He did not enjoy what he had found. Gonzales wrote,
"In a letter to Mrs. Diaz, the Chair of the Board, he [Ray Auker] questioned the legitimacy
of Sanchez' grievance hearing and the motives of the participants in it. He charged due
process was not followed, proper notification was not given, and Maltos' right to appeal
was denied."
Some board members who supported Maltos' termination claimed El Rio's financial condition suffered. Although El Rio had suffered some federal funding cuts, those cuts were not based on El Rio's administrative performance. Additionally, the clinic still functioned well. But, in the board's evaluation of Maltos, he received low marks for financial management. This infuriated the employees in the Accounting Department who knew this to be an erroneous depiction of the financial situation of the clinic. According to El Rio's annual audit, El Rio enjoyed "superb financial health." A local newspaper quoted the certified public accountant, Richard Sainz, as saying "about as sound as I've ever seen."
The accountants felt upset about the board's use of financial problems to justify dropping Maltos. Larsen credited this rationale with further compounding her distrust of the board and this led to her joining with many other employees in establishing the Neighborhood Health Center Employee Organization (NHCEO).
Reece recalled that Patton, Maltos' Executive Secretary, appeared to be very upset when Maltos' contract had not been renewed.
"It was sad to see her--she put in so many hours and she really caught it after Jose left.
We were expecting her to be laid off any time and were surprised at how long she stayed."
But disillusionment with the board also affected some of its own members. Lee Brest said:
"I became so disenchanted with the board when they began to make a decision regarding
the renewal of Jose Malto's contract,"
About the end of October
Board member, Lee Brest, known to be very honest and articulate, suffered a severe
physical disability. He generally supported employees. Shortly after speaking out in opposition to
Baldenegro, Brest endured dismissal based on an accusation of breaking a confidentiality rule.
After he voted against the by-law changes, he found himself in trouble. Alicia Tovar, a friend of
Baldenegro, successfully accused Brest of breaking confidentiality and this provided the basis for
removing Brest from the board. According to Brest, he never received a fair hearing to determine
if he had violated any rules. Several employees remembered Brest as a "nice guy." Tovar, who
later remembered Brest as part of the "crowd in power," lost credibility among some of the
employees.
October 30, 1979
Memo from Julia Soto to Employees
"Letters of intent" to run for seats on the board had to be submitted by September 30. By
the time the employees received this memo, nominations had already closed. (The memo claimed
that earlier notifications had been distributed and that might have been the case.) It also
delineated other rules governing the process of becoming a candidate which were also moot
because nominations had closed a month earlier. The memo further announced dates of the
election to be from November 19 to November 20. This did not happen as the board postponed
the election several times.
Leaflet Posted in the Employees' Lounge and Elsewhere
That first meeting of the employees, in response to by-law changes, would be held at the home of Dr. Rick Voakes. In large underlined words the leaflet said: "Everyone Please Attend" and "Que vengan todos los empleados" The decision to form the NHCEO came out of this first meeting.
Mary Lou Gonzales remembered this meeting:
"...over 40 employees representing a cross-section of professional, para-professional, medical, non-medical and multi-ethnic backgrounds met . . . The purpose of the meeting was to get the by-law changes rescinded. Different tactics were explored: (1) was to meet with the board, this failed. ( 2) Petitions to schedule a special membership meeting,
( 3) the next alternative was legal. The organization called NHCEO Neighborhood Health
Center's Employee Organization filed a class action suit and sued the board."
Tovar also remembered this meeting as one with a great mass of employees. She recalled sitting around and discussing strategy:
"We discussed what organization we wanted to represent us, the American Federation of
State, County, Municipal Employees (AFSCME) or the United Food and Commercial
Workers (UFCW)."
As much as Tovar wanted a union at El Rio this proved to be a very difficult time as it marked the beginning of her break up with Baldenegro. She must have felt caught between her visions of having a union at El Rio and her long time friendship with Baldenegro. Tovar and Baldenegro had been involved in demonstrations together, both at her high school and in advocating for the neighborhood center. While she hoped that the rift between Baldenegro and the employees could be mended, Alicia, in the end choose the union route.
Larsen did not remember any discussion of unionizing at that meeting and, at that time, she certainly rejected that kind of a commitment. Although annoyed at the actions of the board, Larsen understood that bringing in a union could significantly change El Rio.
The group decided that Tovar should talk to Diaz to see if she could arrange a special meeting for the purpose of working out differences. Tovar later recalled,
"Diaz had agreed to meet but then she backed out. At that time we were not yet in out-and-out conflict with the board. We were still trying to mend fences. This happened
before the annual meeting."
Under the umbrella of the NHCEO, Employees, from all areas of work at El Rio, stated their goals:
(1) To safeguard their right to vote in El Rio elections,
(2) To demonstrate a democracy among themselves by allowing a time when all employees could come together and voice their opinions,
(3) To demonstrate a unity among the employees, and use this strength to maintain a recognizable membership within the corporation, and
(4) To encourage the corporation to keep the number of members (patients) at such a
level as to maximize each employee's talents and productivity.
Another issue that remained critical to the health professionals and to many of the employees who came out of the El Rio's neighborhood dealt with patients' service rights.
For Dolores Elenez, a lot of the problems that arose grew out of employees' concerns that
patients no longer enjoyed a top priority. She remembered when they started closing at a specific
time no matter what health problem arose. Earlier, they had been more flexible in response to
patient needs.
The establishment of the NHCEO paved the way for consideration of unionizing.
October 31, 1979
Letter from Four Employees to All Employees
The Board of Director's attempts to change the by-laws had caused an immediate response. A letter, developed and distributed to the employees, explained the previous nights meeting and the establishment of the new employees' organization.
"On October 30, a meeting of the Neighborhood Health Center Employees was held to discuss actions taken by the Board of Directors on October 25. More than 40 employees attended the meeting. Those attending represented a cross-section of professional and para-professionals, medical and non-medical employees and was representative of the ethnic make-up of the Clinic's staff.
We are authorized to make the following statement on behalf of the employees who attended the meeting:
We unanimously support a Community Board to run the Center and set policy. We wish to improve relations and communications between the Board and the Employees.
Our immediate objective is to regain the right to vote in Board elections and at Annual Meetings of the Corporation on issues other than personnel policies.
We strongly oppose the Board's action in changing the By-laws to permit members to serve an unlimited number of consecutive terms.
We seek to establish permanent representation in some form for employees on the Board.
An overwhelming majority of the employees present also expressed strong opposition to the limiting of "notch group" population [the low income, non-County eligible population] registration as this was seen to be counter to the original goals of the Neighborhood Health Center.
We are in the process of forming an employee's organization to deal with these issues. We hope to include all the employees and to insure individual employee job security in relation to participation in this organization. We are actively investigating the legal and regulatory factors involved in these issues and we are seeking legal representation."
End of October
Letter from Neighborhood Health Center Employees Organization and Some Patients to El Rio Patients
"If you and your family are patients at El Rio Santa Cruz Neighborhood Health Center, the following concerns you:
On October 25, 1979, the Board of Directors of the Center "passed"--by less than
the required two-thirds vote and without the required approval of the Department of
Health, Education, and Welfare--several changes in the by-laws of the organization which
will drastically reduce the voice of the total community in the operation of the Center:
1) Employees [who are also patients of the Center] were deprived of their membership in the Corporation including their right as patients to vote in Board elections and at the Annual Meeting.
This means that employees--the doctors, nurses, health workers, and other staff
who provide your health care and carry on the day to day operations of the Center--will no
longer have the rights enjoyed by all other patients to participate in the election of the
Board which governs the Center.
2) The limit of two consecutive two-year terms that any individual can serve on the Board of Directors was abolished.
In other words, a member of the Board was now able to stay on the Board
indefinitely--as long as he or she could be re-elected. In previous elections voting by
non-employee patients has been very small. In effect, then, this change means that
individual Board members, by getting a small number of friends and supporters to vote for
them, could stay on the Board forever.
3) The requirement that a Board member be off the Board for six months before seeking employment at the Center was reduced to three months.
This means it will be easy for Board members to exploit their positions on the
Board in order to become employees soon after leaving the Board and thus maintain their
control over the operation of the Center and use this control for their own benefit.
4) The Board voted to allow a simple majority total freedom to dismiss or keep on the Board any Board member who misses three consecutive meetings.
This makes it possible for a majority on the Board to get rid of a Board member
who opposes them while keeping a member who supports them when each has missed the
same number of meetings.
The above changes will inevitably lead to a concentration of power among a small group on the Center's Board of Directors and less responsiveness of the Board to the concerns of all elements of the community. The only way to prevent this from happening is for the patients of the Center to make their opposition to these changes felt. We urge you and your friends and family members who are patients at the Center to come to the Annual Meeting, Friday, November 30, 1979 at 3:00 p.m. at the Hilton Inn, . . . and make your views on these issues known. We ask your support of resolutions which will be introduced opposing these by-law changes.
The Health Center belongs to you, the patients. Make sure policymaking remains
open and democratic and includes all elements of the N.H.C. community. Come to the
Annual Meeting on November 30. Exercise your rights!"
The response to the employees pleas appeared overwhelming. Possibly several hundred
patients came to several annual meetings held in the winter of 1979 til March in 1980. The
attendance soared well above the normal of a few dozen people.
November 1979 - Birth of the Employee Organization (NHCEO)
November 6, 1979
Meeting of the Neighborhood Health Center Employee Organization (NHCEO)
Thirty-four employees attended the first official meeting of the NHCEO. Kay Bauman, MD presided as acting chair. It had been decided not to elect officers for this organization. Committees would be established to accomplish the work of this organization, and these committees were to report to the membership. Employees volunteered to work on each of the following committees: Membership Committee, Legal Committee, Media Committee, Tactics Committee and Planning Committee.
With earlier NHCEO approval, Tovar approached Diaz in the hope of mending the rift between the employees and the board. While the NHCEO, at this time, took no position for or against Maltos, they strongly opposed the by-law changes.
Tovar reported that Diaz called for a special meeting of the board to be held November 20, 1979 and she had asked the group to submit a written request of their demands. Diaz, possibly with Baldenegro's support, later backed away from having this meeting. By doing this, Tovar fell firmly and unequivocally into support for the employees.
NHSC physicians discussed a major dilemma that continued to plague them. At this meeting, Dr. Eric Cramer, a popular pediatrician, again raised the central question,
"Should we employ NHSC physicians to care for HMO patients?"
Alice Gallardo expressed her concern about the by-law change which allowed unlimited terms on the board. She felt that if new people were not incorporated into the board, some people would stay forever. Gallardo's sister-in-law and an El Rio employee had made fun of the NHCEO at first.
Bill Bemis, who headed a grant funded program for teenagers, reported on his solo attempts to reach the media. Bemis had contacted a reporter and an editor of the Arizona Daily Star and a reporter at the Citizen News. Bemis expressed disappointment that his press releases had not been printed, then he received authority to try again but this time with the backing of the employee group.
In short time the work of providing minutes of the NHCEO expanded into the production
of a newsletter. Tovar remembered the NHCEO Newsletter as having a lot of credibility. She
remembered that at first the newsletter dealt with patient issues and then employee rights. For
Tovar, "The newsletter gave our perspective."
About 2nd Week in November
Anibal Mejia assumed the job of Executive Director of El Rio and Snyder resumed his position as Marketing Director. Although Mejia had been working in Nogales, Arizona, he came originally from Honduras so many of Mexican-Americans did not see him as part of the community. For some, however, that did not matter because their loyalty belonged only to Hispanics and not to the community. Elenez believed that Mejia had some favorite employees whom he treated differently than the rest. She observed that Mejia shunned Suite 2 and that, unlike Maltos, Mejia performed as an administrator who did only administrative paper work. Many employees speculated about the choice of Mejia for the top administrative position because he did not appear to be the best candidate nor, according to some, did he have the qualifications that were listed for the job. Reece liked Mejia but thought that he seemed to be "in over his head." The board's Executive Committee chose Mejia.
This rumor about Mejia's questionable credentials received some substantiation in the board minutes of a meeting of the Executive Board on March 6, 1980:
"Regarding the Executive Director's Job, Mr. Mejia stated that the latest criteria from
HEW would pertain to future applicants for the position. Copies of the Qualifications and
Experience requirements, as directed from Mr. Maready, were distributed to the members
present."
The board showed some suspicion of employees' intent and this led to attempts by the board to change the by-laws. After the vote to change the by-laws, the suspicions heightened and the board increased their use of secret meetings under the guise of "executive sessions." Patients and employees were increasingly denied access to what had once been open meetings. Those closed meetings were often used as strategy sessions on how to control the situation.
November 13, 1979
Meeting of NHCEO: Kay Bauman, MD Presided as Acting Chair
The Membership Committee reported and recommended the establishment of a $2.00
annual membership fee. Because of fear of retaliation, the confidentiality of the membership
remained a major concern of this committee. The employees agreed to abide by the
recommendations of the committee and with the aim of establishing confidentiality.
The Legal Committee reported that Blanca Gaxiola's husband, Fernando, and some of his fellow law students had volunteered to do some legal research. The attorney retained, Debra Hillary, described at this meeting as a former patient of El Rio, had a legal speciality in employees' rights. She had been active in Model Cities and appeared familiar with the westside political scene. She expressed a willingness to charge a reduced rate and not charge for preliminary meetings. Employees present at this meeting pledged $500.00 to facilitate legal action if it is necessary.
The Tactics Committee reported on attempts to meet with Rosemary Diaz with the hope of solving the conflict outside of the courts. Despite attempts by Alicia Tovar, Diaz refused to recognize nor meet with NHCEO. Discussion took place about the up coming election of board members and resulted in the decision to attempt to have candidates meet with the clinic staff before the election. The committee also raised questions about the legality of the votes to revise the by-laws as a 2/3 majority of the board remained necessary for any by-law revisions. The contention arose that there had been less than the necessary 2/3 votes for the by-law changes.
The Media Committee told the membership that Channel 13 had shown a significant
interest in "the employees' plight."
November 16, 1979
Memo from Rosemary Diaz to Julia Soto
"Based on conversations with the Regional Office in San Francisco over the recently approved by-law agreement between the organization and DHEW, the elections are to be deferred for the time being . . . "
"In the meantime there is to be NO voting of any kind by any person until further notice."
cc: Regional Office DHEW and Anibal Mejia, Executive Director.
In retrospect, the delay worked in the employees' favor. The NHCEO began to organize its resources, meet with candidates and eventually supported the election of five of those candidates. Their efforts would be very successful and the employee backed candidates would win seats on the board. But the election initially scheduled for November 19 to November 29 actually occurred in March of 1980.
Julia Soto began to be seen by the NHCEO membership as the board puppet. Soto had a free hand to do as she wanted as long as she complied with the board's instructions. But to many of the employees and also much of the community Soto remained the super mother who could do nothing wrong.
Guerena believed that Diaz and Soto were good friends as they ". . . defended each
other."
November 20, 1979
Memo from James Heermance, HMO Enrollee to Board
Many patients had displayed a strong interest in the unfolding events. One active patient, a friend to the employees, and a soon to be a board member expressed his view in a letter directed to the board.
"As an enrollee since this past April [1979], I have gained increasing respect for the unfailing courtesy, expertise, and proficiency of this great institution's entire staff at all levels. It is these persons whose observations and judgments about what's needed for both the patients and this Health Center itself are most valued.
For that specific reason alone, to disenfranchise any one of them from our election process is as much a disservice to this Center and the community of patients it serves as it is to the staff.
And there is a broader reason that makes me, as an enrollee and as a future member of this Board of Directors, oppose such unnecessary and potentially harmful disenfranchisement . . .
In a world already crowded with anti-democratic forces -- from well entrenched South America dictators to Iran's latest tyrant -- forces that deny or strip away a citizen's right to vote -- it seems strange, even frightening, that within a darkening little pocket in this nation's southwest -- a pocket located at 839 West Congress Street in Tucson -- voting rights are also being stripped from the very persons whose specialized knowledge, based on their day-to-day working experiences, makes their opinions absolutely invaluable.
These rights, I submit respectfully, should be restored."
Minutes of NHCEO Meeting Chaired by Jane Berry, FNP
Ed Espinoza, a former employee and candidate for the board came to the meeting and employees sat around and chatted with him. Espinoza expressed his support for community participation on the board, support for both the HMO and for employee voting rights.
Someone provided a list of how board members voted on the issue of employee voting rights. The list did not clarify the issue. The list indicated that only 12 board members voted for the changes, six voted against and two were not present. (See October 25, 1979) The list, however, suffered probable flaws. At least one person absent that day, Bess Morris, materialized as voting against the changes. On the other hand, the by-laws and Robert Rules of Order required a two-thirds vote of the FULL Board. Since there were 21 board members, if you included Dr. Thorpe, a two-thirds vote required 14 votes to accomplish the change.
The Tactic Committee had been informed by Rosemary Diaz that the elections "had been frozen by HEW" and therefore she (Diaz) canceled the special board meeting. The committee contacted Diaz and requested that even though the elections had been frozen the special board meeting could still be held. Diaz rejected this request. The NHCEO minutes indicated that Diaz had met with an official of DHEW and that she stated that no voting or business be conducted at the annual meeting, but the meeting could still be held even though the special board meeting remained canceled.
Because of significant differences between the impression obtained from Diaz and the intent of DHEW, the membership of NHCEO decided to obtain future information directly from DHEW.
The Legal Committee's report came from NHCEO Attorney, Debra Hillary, who stated the legal options:
--The situation had been changing rapidly. NHCEO may take court action to force the board to hold elections and allow employees to vote. Employee ballots could be put aside until a final decision on voting rights is made.
--DHEW could not prevent business from being conducted at the annual meeting. Legally, they had no control, but were caught in the middle.
--A State Court had the jurisdiction to make the final decision on the legality of by-law changes.
--A majority of the membership can change the outcome of by-law changes.
--Legally, neither the board nor the Executive Director could fire employees for involvement but, in truth, employees might be vulnerable.
After completion of her report and some discussion, the NHCEO membership voted unanimously to go to court ". . . to force the board to hold elections and allow employees to vote."
The Tactic and Media Committees reports and New Business were discussed and where appropriate, action taken.
After NHCEO meetings, minutes of those meetings were frequently distributed throughout the clinic. Most employees, even some in administration, generally received a copy of the latest edition.
November 21, 1979
Notice to all El Rio Employees from the NHCEO
"On October 25, 1979, the NHC Board of Directors 'passed' the following changes in their by-laws:
1. Patient-employees will no longer have the right to vote in annual election for
the Board of Directors or at the Annual Meeting.
2. Members of the Board of Directors are no longer limited to two consecutive
terms in office, but can run for as many terms as they desire.
3. A simple majority of the Board could dismiss another member of the Board
after three consecutive absences and have the Board chairperson appoint
someone to fill the vacancy.
4. Any Board member can become an employee of the center after he/she has
been off the Board for 3 months; previously the waiting period was 6 months.
These by-law changes were 'passed' without the required 2/3 vote of the members and without their review by HEW as required.
The right of employee members of the corporation to vote was established from the very beginnings of the health center. This stripping away of voting rights of one group of members of the corporation sets a dangerous precedent. Will other patient groups lose their rights as voting members too?
By cutting out input of employees, the corporation loses the perspective of those people who provide the services, have to implement any changes and have the day to day responsibility of operating the health center. Many health center employees are the very community residents for whom the clinic was set up to serve. The significance of the by-law changes is that they permit a small group to establish and maintain control of policy-making power. It was precisely to prevent this happening that a community Board of Directors was originally set up to run the Center.
The NHCEO was formed to fight these by-law changes and to make sure employees will have input into policy-making and the elections of Board members. We believe in serving the community with high quality care. We also strongly support a community-run Board that is indeed representative and responsive to the community. We do not wish to control the Board or the Center, but we do wish to keep our rights to have an independent voice in non-personnel policy decisions and in the election of Board Members.
The NHCEO contacted the president of the Board to arrange for a special Board meeting to be held to reconsider these by-law changes. However, this meeting was canceled by Ms. Diaz on November 16. A few days prior to this cancellation, our HEW project officer sent a letter to the Board of Directors recommending that the Board act under the old by-laws since the new ones were of questionable legality [HEW did not review them before the Board action]. On November 16 we were told that the election process was be frozen, although neither the Board nor HEW has the legal authority to postpone the election.
Faced with the above facts the NHCEO felt it necessary to file a special action suit to make sure the Board election was be held, that business was to be conducted at the Annual Meeting and that employee-members would be able to vote. This special action suit will be filed in court on Friday, November 23. A press conference will be held Friday, November 23 at 12:15 at LaPlacita.
If you are in support of the goals of the NHC Employee Organization, please join
and/or come to our meeting Tuesday, November 27 at 5:30 p.m. at "A" Mountain
Neighborhood Center. We want to know how you feel about what is happening--even if
you disagree with us."
Class Action Suit Order No. 184388 Signed by 32 Employees Against the Board of Directors
Thirty-two employees signed an affidavit leading to a class action suit. Of those employees there were one African-American, nineteen Hispanics, three Jews, one Native-American, and eight of undetermined race or ethnicity. Among the thirty-two employees there were three physicians. The other 29 employees came from diverse job classifications and work site locations in the clinic. The 32 who signed had no prior knowledge of the affidavit until the actual day they signed. Someone parked a trailer in front of the clinic on Congress St. and employees were approached and asked to sign within a very brief time period, a few hours at most. If there had been a preplanned effort to maximize the number of signatures, many more employees would probably have signed.
Excerpts from the affidavit laid out the employees' position.
"VII. That certain Plaintiffs [employees] sought a reconsideration by the Board of
Directors regarding the amendments of by-laws; and that the Defendant DIAZ
scheduled such a meeting for the 20th day of November and then on the 16th day of
November did cancel the scheduled meeting.
XI. The By-laws do not permit the Board of Directors to alter the annual meeting or
the election process, and that in so doing, the Defendants as Board of Directors
have acted in excess of their jurisdiction and legal authority, to the detriment of the
Plaintiffs, other employee/members, members and candidates for Board vacancies.
XII. That on November 19, 20 and 21, 1979 election voting had not commenced,
constituting a failure by the Defendants to perform a duty as required by law.
XIII. That on the 8th of November, the Department of Health, Education and Welfare did issue directions to the organization and specifically to the Defendant DIAZ, recommending that the organization proceed as if the By-laws had not been amended, and indicating that the By-law amendments had not been duly adopted . .
XIV. That the Defendant DIAZ's disregard for the Department of Health, Education and Welfare's direction as to employee/members was an arbitrary and capricious act and constituted an abuse of discretion.
Attached to the class action affidavit was an affidavit from one of the plaintiffs, Hugh
Young, an employee tucked away in El Rio's Data Processing Department. His statement
presented a personal reaffirmation of the claims of the other 31 employees. Young, the
supervisor for his department, would be fired shortly after. A subordinate replaced Young.
November 24, 1979
AZ Daily Star
The local newspaper reported that the El Rio employees' lawsuit stood scheduled to be heard in Superior Court the following Tuesday, November 27.
The article claimed that the employees tried to force the El Rio board to hold an election which would result in the choosing of ten members to the Board of Directors. Balloting to fill the ten seats on the 22-member board had been frozen. The employees also sought to erase the by-law change which prohibited them from voting.
Diaz, asserted that the elections had been frozen by mutual agreement with DHEW so that government officials could review the recent by-law changes that prohibited employees from voting. This statement seemed disingenuous.
The board's decisions put the clinic's financial status in jeopardy. The article asserted,
"After the amendments were adopted, HEW contacted board officials and said that
under the by-laws, HEW had the right to approve them. Failure to allow a review of the
changes could affect the amount of HEW money spent on the center, which is almost half
of the center's $4 million budget, the agency said."
In the newspaper article, Diaz is claimed to have said that only 334 votes were cast in the board election last year. She used this rationale as an argument to disenfranchise the employees and their families.
"The unspoken issue is whether the employees are going to run the center or whether a
community-based board is going to run the center, as was originally intended."
November 27, 1979
Jane Berry, FNP, Acted as Chair of the NHCEO Meeting
Thirty-eight employees attended this meeting.
Events were moving quickly and so the first order of business involved an "Update since last meeting" one week earlier. There included a report on the status of class action suit. After filing the suit, the NHCEO presented its case in a well-attended press conference at LaPlacita. Both newspaper and television news produced coverage. Some employees expressed concern that the press focused only on the by-law changes involving voting rights rather than the whole issue of all the changes.
The Membership Committee reported on its work of developing a roster of members with their phone numbers and committee assignments. They also reported that a central file had been established for press releases, notes correspondence, and any other such needs.
The Media Committee composed a letter to the editor. After some discussion and changes, sixteen employees signed the letter. The letter laid out the by-law changes, briefly discussed their implications and concluded:
"This makes it possible for a majority on the board to get rid of a board member who opposes them while keeping a member who supports them when each has missed the same number of meetings.
The changes will inevitably lead to a concentration of power among a small group on the center's Board of Directors and less responsiveness of the board to the concerns of all elements of the community."
The Tactic Committee reported on the distribution of flyers urging people to get out the vote and also presenting the position of candidates.
Under "New Business" there had been a discussion about employees who had felt threatened and who had been told not to join NHCEO. The employees present took these fears seriously. NHCEO members were cautioned not to discuss the issues or do any NHCEO work during working hours.
A new committee, the Agenda Committee, received the responsibility of studying Robert's
Rules of Order for the annual meeting.
November 28, 1979
Arizona Daily Star
A local reporter described the court hearing as being filled with
". . . contradictory and often confusing testimony and argument."
He wrote that extensive and conflicting testimony prevailed over whether the by-law amendments were actually approved by the necessary two-thirds votes of the entire board.
In court, Patton had testified that Diaz incorrectly counted the votes to change the by-laws. Diaz broke the tie but Patton contended that no tie existed. The board's attorney tried to discount Patton's information. Patton later lost her job and many employees thought that her testimony acted as a direct contributing factor to her job termination.
While in court, Raven frequently raised the question about how the employees' attorney, Hillary, obtained her information. Hillary, very well informed about board and administrative actions, appeared always able to disclaim any knowledge of how information got to her. She said only that it was left at her door. Finally, the judge told El Rio's attorney, they have all the information and you are not going to find out how it got there.
In the same edition, the letter to the editor from members of the NHCEO appeared in the newspaper. The employees disputed Diaz' claim that the central issue focused on whether the employees or the board ran the board. The employees asserted that a small group on the board had taken control and were inhibiting the democratic processes. They wrote:
"A study of the recently 'passed' by-law changes makes clear that the real issue is whether the community board which governs the center will remain open, democratic and representative of all elements of the community or whether a small group will succeed in taking control of the board and maintaining their power on the board."
November 29, 1979
AZ Daily Star
Judge J. Richard Hannah ruled that the changes in the by-laws were not in effect because the DHEW had not approved the changes. DHEW required approval of changes in the by-laws and this had not yet been secured. The Judge further ruled that although the full board could, the Executive Committee of the board did not have the authority to change the dates of the annual meeting, as had happened.
When later questioned about the Judge's ruling, Debra Hillary, lawyer for the employees said "My clients are treating patients with grins on their faces." She added that her clients expressed joy over the court decision.
In defense of his position that Baldenegro claimed that the employees could stack the vote at the annual meeting, Hillary responded that 11,000 newsletters announcing the meeting had been sent out.
"If a hundred and something employees will stack the vote, there's something wrong."
Per an Earlier Memo from Julia Soto to ALL Employees
A reception, held this day in the auditorium, introduced Mejia, the clinic's newly hired
Executive Director. Many employees speculated about the background of this new director and
whom did he know to get the job.
November/December 1979
Neighborhood Health News - Vol. 5, No. 11
One of the last editions of the Neighborhood Health News featured a brief biographical background of the new Executive Director, Anibal Mejia. Many employees believed that Mejia just worked in accordance with direction by the board in general but more specifically by Diaz and Baldenegro.
Also, featured in this edition of the newsletter, were two relatively new NHSC physicians, Cathy Kallal and Josh Freeman. They were married to each other and had a young son. Both supporters of the employees, Freeman and Kallal actively participated in the NHCEO. Freeman's primary concern seemed to have been the introduction of the HMO at El Rio. It appeared to Larsen that Freeman saw his role as an NHSC physician as in direct conflict with an HMO profit making venture.
From E. Larsen's Notes Regarding Unannounced Board Meeting
"At about ten minutes to 5:00 p.m., I learned that the Board of Directors was holding a
special board meeting. It seemed as though none of the employees knew about this
meeting. I also believed that the public in general and the employees specifically had the
right to know of the meeting. Since it was so close to 5:00 p.m. when many of the
employees left work, the fastest way of notifying the employees was thru the loud speaker
system. It had been my experience in the past that use of the speaker did not require prior
approval from administration. I had used the speaker to reach specific people and I had
seen it being used to announce employee baseball games. When I noticed no response over
the loudspeaker, I went to administration and first asked the secretary if the meeting could
be announced. She said that she did not know about the meeting. Then I saw Mr. Mejia
and received confirmation of the meeting so I asked him if it could be announced on the
loud speaker. About this time, Mr. Kaplan [the chief financial officer] appeared and
chastised me for using the loud speaker without authorization. Mr. Mejia said that he had
to check with the president of the board, left and a few minutes later returned with
authorization. The announcement was made about 5:05 p.m."
Special Board Meeting
It did not take long to understand why the board did not want employees or the public
present at this meeting. The board voted 12-0 to disregard Judge Hannah's order and to postpone
the annual meeting and election until later in December. The board members now faced a possible
contempt-of-court charge.
November 30, 1979
Arizona Daily Star
In an article written by Bob Levin, he claimed that Diaz appeared:
"...before 145 patients and employees yesterday at the Hilton Inn, where the annual meeting was
to have taken place, and said it was being postponed."
Immediately after Diaz postponed the annual meeting, Bill Bemis called to order a membership meeting of the corporation. According to El Rio by-laws and Arizona statutes, 50 members of a corporation made a quorum and a simple majority of a quorum may repeal an act of the board. The members of the corporation, patients and employees present then went about the business of rescinding all the by-law changes that the board had tried to impose on the El Rio community. After rescinding all the by-law changes, they scheduled another session of the annual meeting.
Before too long, Bemis lost his job at El Rio.
Another AZ Daily Star article suggested that the attempt by the board to postpone the annual meeting until December 27 established a possible challenge to the Superior Court order. This article indicated that Debra Hillary, attorney for the employees, said the board's vote to postpone could be in contempt of the court's earlier decisions.
.
November 30, 1979
Memo from Anibal Mejia, Executive Director to All El Rio Employees Regarding: Postponement of Annual Meeting, Elections
"This is to confirm the statement I made during the General Staff meeting
regarding the new Annual Meeting date [December 27, 1979, 7:00 p.m., at a place to be
announced] and Elections for eight members of the Board. The form and procedures for
elections will most likely be revised in order to provide for consistency within the
Corporate By-laws, State Laws and Federal Regulations.
I believe that these changes stem from Board reactions to an employee group law
suit and Board interpretation of the court order therefrom. The law suit pertains to
Corporate By-law Changes affecting the Center's ability to vote during elections and at the
annual meeting. While I recognize that this issue, like most, has two sides to it, I would
like to commend all Center employees for maintaining the level of health care services
without permitting any interference from these emotionally loaded matters.
A meeting will be held at the Hilton Inn but it will not be the Annual Meeting. In
view of the action taken by the Board last night [At a special board meeting the board
voted 12 to zero to disregard Judge Hannah's orders], I am hereby revoking the
memorandum providing for closing the Center today at 2:30. The Center shall remain
open until the ordinary closing time for unscheduled health care services, recognizing that
the patient care load will be diminished I would encourage Center staff to concentrate on
catching up on administrative and other paperwork.
Needless to say you should maintain the most excellent professional decorum exhibited during these last trying days."
One way to keep the employees from attending the annual meeting involved scheduling
the meeting during working hours. The new top administrator did this.
December 1979 - Employees Go to Court
December 4, 1979
Tucson Newspaper
Superior Court Judge Hannah set December 13 as the date for a hearing to determine
whether or not the El Rio board stood in contempt of court. The board attorney had appealed
Judge Hannah's earlier decision in support of the employees.
December 5, 1979
A Meeting of NHCEO: Kay Bauman, MD Presided as Acting Chair
The financial report showed that the organization had in both the general fund and a legal fund less than $100.00 so raising money became a high priority activity. The report indicated that anonymous donations had been received from people at El Rio who wished to support the organization but did not wish to be recognized as members. All the money collected so far had been spent on photocopying and legal fees. Many of the expenses of the organization had not been reported because individual employees put out money for expenses themselves.
Two candidates for the up coming board elections approached the membership of NHCEO to solicit their support. They wanted to know employee issues and to meet with the employees to discuss those issues. The employees decided to have such a meeting but to invite all candidates.
The Media Committee reported that several people met with Arizona Daily Star reporters to discuss issues and bring out major points of what had happened, but avoiding the legal issues.
An "Update on Court Actions" recounted how the Court of Appeals threw out an appeal made by the board's attorney. Additionally, it stated that all board members should come before Judge Hannah on contempt of court action on December 13, 1979. Other findings of the court were reported.
Under "New Business" employees received a warming that not all had full protected from the National Labor Relations Board. The employee group needed to be recognized as a formal organization. From this discussion, employees decided to explore the possibilities of unionization. A motion passed to reactivate the Planning Committee which could then investigate the possibility of obtaining a union or several unions to represent them.
Dr. Barbara Warren, a woman of strong convictions, expressed honest opinions even when they went against the common thinking of the day. The idea of obtaining union support provided one possible way out of the dilemma, so Warren joined the Planning Committee and went shopping for union representation. Her contribution to the consideration of unionization for physicians played a vital and positive role.
Bishop, not active in the NHCEO, believed that Warren performed as an excellent physician but politically, could see no grays. Bishop believed that Warren saw things as either black or white.
Before adjournment, employees discussed the DHEW and their role vis-a-vis El Rio employees. Employees learned that San Francisco and Washington, D.C. had been receiving copies of all legal actions.
December 11, 1979
A Meeting of NHCEO, Ethel Larsen Presided as Acting Chair
A media report explained how employees' views had been presented on the Mexican-American Radio Station KXEW. The station had presented the board's views through an interview with Rosemary Diaz and planned to grant the employees some time.
As of December 11, the legal fund contained $415. Additional funds had to be raised because they expected two hearings. The employees established a Fund-Raising Committee as they estimated they needed about $500 per court hearing.
A "Get Out the Vote Committee" report on the completion of planning and also that a list of volunteer services which would be needed.
The "Board Committee" indicated that all candidates had been contacted except for one
who could not be reached. The candidates received packets which stated the employees' goals,
and philosophies.
December 13, 1979
The issues came to court.
December 19, 1979
NHCEO Minutes - Kathy McGlone, the Health Educator, Presided as Acting Chair
Legal Committee Report. Attorney Debra Hillary updated the membership on the court proceedings. The hearings had been postponed until December 28. Hillary strongly urged that the NHCEO consider some type of out-of-court settlement between NHCEO and the board. The cost of continuing litigation had become substantial and she expressed fear of jeopardizing health care due to continued public laundry washing which she recommended be avoided.
Employees voted to accept proposals for the negotiation of a settlement:
1. Provisions specifying no reprisals were not negotiable.
2. New elections to take place on or before Jan. 30, 1980, with open agenda and elections at that time. (Date, time & place are negotiable.)
3. Safeguards for elections and balloting to be made.
Looking Back
Reece believed that 1979, a year of conflict, constituted an awful time. "Employees who
had been friends for years had been torn apart."
Matchmaker, Matchmaker . . .
In the turmoil at El Rio, romance and marriage also had a place. Through the years, at
least a half dozen couples met at El Rio and later married. A few couples came to El Rio as
husband and wife. So the relationship between Maltos and Bundy was not unique. In time they
too cemented their relationship by marriage.