Chapter 4. First Year Under Contract - 1981
January Contract Fully Ratified!................................................... 258
February Elections, Union & the Board.......................................... 262
March And Still Elections........................................................... 265
April After Contract, Maintenance........................................... 274
May Marketing the H.M.O. increases...................................... 278
June A quiet month................................................................. 288
July Grievance......................................................................... 289
August New Accounting Manager, New Problems..................... 292
September More Grievances............................................................... 297
October "Tuesday Morning Fracas"................................................ 301
November Another Annual Meeting.................................................. 304
December Management Still Penalizing Union Membership............... 305
Chapter 4. First Year Under Contract - 1981
January 1981 - Contract Fully Ratified!
January 5, 1981
Tentative Final Agreement Reached
At the next general membership meeting contracts were made available. The next day
copies were also available in the employee's lounge.
January 19, 1981
Union Newsletter
Negotiations with the board and their attorney were completed on January 5. The board would vote for or against ratification on January 29. If the board did not ratify the contract, then the employees would have a strike vote. If the board ratified the contract, the employees could still reject or accept the contract.
On the hopeful assumption that the board will choose to accept the contract, the union tentatively planned a celebration party to be held at the AFSCME headquarters.
January 21, 1981
Union Notice
The next union meeting would be held at in the El Rio auditorium where the major agenda
item discussed was "Contract Ratification."
January 28, 1981
Letter to Patients from the Board of Directors Regarding the Board Elections
"The elections of the El Rio Santa Cruz Neighborhood Health Center for the Board of Directors seats, which are vacant, will be held in the last week of March.
Those persons, who are interested in running, may submit in person or mail in a letter of intent, and also, may obtain their petitions for obtaining the required number of patient signatures needed to qualify you as a candidate.
The closing date for receiving letters of intent will be Friday, February 20th at
5:00 p.m. and the closing date for receiving petitions with signatures will be the 13th of
March 1981 until 5:00 p.m. All postmarked letters showing these dates until 12:00
midnight will be accepted. . . ."
January 29, 1981
Memorandum to Union Stewards and Negotiation Committee from Ethel Larsen Chair
"Tonight the Board of Directors will meet. Board members Baldenegro and
Fajardo were involved in the final phases of negotiating the revised contract. At the close
of negotiations we were led to believe that there would be a ratification vote of the revised
contract by the Board of Directors at tonight's monthly meeting . . . THIS WILL BE A
CRUCIAL VOTE . . . If the Board votes ratification then we can have our ratification vote
tomorrow and Saturday. If, however, the Board either delays the issue or denies
ratification then we will be forced to have a strike vote. . . .
The board voted - For Contract Ratification
January 30 & Saturday, January 31, 1981
Employees Vote to Ratify Contract
The El Rio employees approved the first fully agreed upon Labor/Management Contract.
PARTY TIME! Saturday night the union members, friends and families honored this first
contract and victory over adversity with a second celebration, this one at the union hall.
MEC Provisions Strengthened
Of continuing major importance to many employees were the problems that many patients faced. In an attempt to open a mechanism to deal with some of those problems, the union had been successful in getting into the contract some language that allowed for the development of a Medical Executive Committee (MEC). In August of 1979, by-laws for the MEC had already been established. But the Medical Director had no obligation to comply with those by-laws. Having the MEC in the contract meant the Medical Director would have to comply so that provision became a powerful tool to enable the MEC to function properly.
The committee, made up of health professionals, could make recommendations to the
Medical Directors. The administration needed to make a good faith effort to implement those
recommendations. Additionally, the MEC called for the monitoring of various committees under
El Rio's medical by-laws and then reviewing complaints of competency against providers. In
response to this language, Dr. Vivian announced the health professionals who were to serve on
the first Medical Executive Committee.
End of January 1981
Management published the last edition of its newsletter, "El Rio Update."
February 1981 - Elections, Union & the Board
February 3, 1981
Arizona Daily Star and Citizen News
In a press release, the board opened their doors to people who might be interested in
running for a slot on the El Rio board.
Saturday, February 7, 1981
From 10:00 a.m. to 4:00 p.m., steward's training for potential stewards took place.
February 9, 1981
Union Newsletter
Elections for positions on the board were scheduled for March 20. Employees received reminders of the February 20 deadline for nominees to file their "Letter of Intent" and their signed petitions.
The issues surrounding the board and its policies remained powerful themes to many of the employees, but they never again held the emotional level of the year before.
Almost everyone already knew about the most potent news, the successfully concluded the negotiations.
"WE HAVE A CONTRACT! The contract was ratified on January 31st by a vote of 2/3
of the employees, following a vote to ratify by the Board of Directors on January 29th.
The contract should be in effect NOW. Dues deduction at the rate of 1% of the base
salary will begin with the next paycheck. Deductions shall not exceed a maximum of
$150.00 per year for any individual employee. Printed copies of the contract should be
available for each employee shortly."
The newsletter went on to solicit employee participation on two committees, the Board/Labor Communications Committee and the Health and Safety Committee.
When dealing with national issues little or no conflict existed at El Rio. The
overwhelming number of people at El Rio believed that the government had an obligation to
support the delivery of health care through community centers. The newsletter solicited support
to bring a medicaid program to Arizona. Arizona remained the only state in the union not
receiving medicaid financial support. The newsletter also expressed concerns about the new
federal administration that came to power in Washington, D.C. Employee feared sizeable cuts in
the funding of Community Health Centers and those fears unfortunately turned out to be true.
February 10, 1981
First Labor/Management Contract Signed
The two sides agreed on a 18-month contract calling for a 7 percent wage increase in
October, for binding arbitration of employer-employee disputes and for a survey of other major
employers in the area to make sure that El Rio was paying fair wages.
February 18, 1981
Union Meeting Notice
The issues discussed involved questions about implementing the contract and the formation of committees. Attorney Debra Hillary came to speak about the Annual Meeting and the employees' voting rights.
All though we had only six slots plus the Chief Steward, we had 13 employees who had
expressed an interest in serving as Shop Stewards so stewards were elected.
February 27, 1981
Election for New Union Officers
Those selected were: Ethel Larsen as Chair, Isabel Abalos as Vice-Chair, Maria Betancourt as Secretary and Alicia Tovar as Chief Steward.
This election, for temporary positions until the regular annual union elections, took place in May.
Both committees, Health & Safety Committee and the Board/Employee, were formed. Two health professionals were on the Health and Safety Committee. While employees were willing to serve on the committees, this would change through time.
About this time El Rio hired a new pharmacist, Ed Celaya, from the small Arizona town of Florence. Celaya had planned to work at El Rio only temporarily because he knew he could get a substantially better income at a commercial pharmacy. Because he considered the job temporary, he did not mind the low wages. Three months after he arrived, he joined the union, fought for and won better wages and working conditions for the employees in his department and then decided to stay at El Rio. Celaya recalled that when he first arrived, the other pharmacists were making plans to leave El Rio. The union benefits stabilized the employment in that department.
March 1981 - And Still Elections
March 1981
Neighborhood Health News, Vol. 7, No. 1
The union supported Isabel Garcia, JD, as a candidate representing Unit 1. Excerpts from the official publication of El Rio introduced Garcia in this edition:
". . .She presently works as a trial attorney with the Pima County Public Defender's Office. . . .
Isabel believes that health is and will continue to be one of the most critical issues
facing our community. She is committed to keeping El Rio a strong neighborhood health
center."
March 1981
Neighborhood Health News, Vol. 7, No. 1
Fernando Gaxiola, also supported by the employees, ran as a candidate to represent the at-large area. Excerpts from the write-up in the El Rio newsletter about Gaxiola said:
"Fernando Xavier Gaxiola was born in Los Angeles, California, but he was raised and educated in Mexico until the age of 19. He is now 32 years old, married [to Blanca], and the father of three children [Magda, Adrian and Tanya]. He is a second year law student and active in matters of community concern. He is president of the Minority Law Student Association and Secretary to the Student Bar Association. . . .
'I want to serve the patients of El Rio to keep our clinic as the best in Tucson. My
experience, education, and effort would all be used to provide everyone high quality health
care.'"
March 2, 1981
Correspondence Between Larsen and Dr. Weinstein
Larsen, on behalf of the Union members and also all other El Rio employees, appealed to Sheridan Weinstein, MD at the San Francisco Regional Office of the DHEW, that ". . . our right to vote (at Annual Meetings) be restored . . . " Dr. Weinstein responded,
"...after careful review, we concluded that we could not say that the revised method of selection, viewed as a whole, will not ensure the selection of a representative El Rio board."
The federal government would not protect the employees' voting rights.
March 4, 1981
"Meet the Candidate" Meeting
NHCEO/AFSCME held this meeting for people who sought election to the Board of Directors. Later that evening, El Rio employees selected a slate of candidates to back.
Gaxiola and I. Garcia, two of the candidates supported by the employees, distributed a leaflet written in both English and Spanish which stated their platform. The leaflet entitled: "Quality Health Care for All" said:
"Quality health care is the highest item on our agenda. We are Committed to keeping El Rio a true neighborhood health center.
Continued funding is essential for the survival and future growth of our clinic. We commit ourselves to work toward securing funds from the county, state and federal governments.
Unity between directors, administrators and employees forms the foundation of a good health center. We will promote this unity."
In the elections for membership on the board, four out of five employees backed candidates won seats.
Because of changes at the national level, the problem of funding worsened as
conservatives advocated and succeeded in slashing funds for social programs.
Saturday, March 7, 1981
Union's Committees Meet
Election Committee met to determine a strategy on how to support their candidates for the positions on the board.
Later in the day, because of the critical work of the stewards in the process of upholding
the contract agreements, a special stewards' training was held and all new Shop Stewards
attended.
March 9, 1981
Union Newsletter
The result of the election for Shop Steward and their perimeters of responsibility were delineated. Alice Gallardo became the steward for Suites I, II and the Health Education & Nutrition Departments. Maria Betancourt serviced Suites III, IV and Triage. Ed Celaya, the new pharmacist, had responsibility for the dental and pharmacy areas. Lynda Cooley serviced medical records, lab and x-ray. Jim Cooley had the responsibility for central supplies, social service, transportation, switchboard, home health and UHI. Angel Moreno represented maintenance and the night crew. Alicia Tovar, in addition to being Chief Steward, had responsibility for accounting, accounts receivable, insurance, data processing and registration. Stewards were not locked into those areas and could represent employees from other areas.
Tovar comported herself well with most stewards. Celaya, as a relatively new employee and as a new steward, enjoyed working with Tovar. Celaya believed that there were many employees who did not like Tovar, but he had seen that she fought for people with almost reckless abandonment. Tovar reminded Celaya of the movie about Norma Rae, the union activist.
Copies of the new contract were made available to all the union employees shortly after this date.
The newsletter urged all employees to attend the next Annual Meeting scheduled to take place on March 20 at the El Rio Neighborhood Center. Contrary to the by-laws, the voting sites for candidates would be spread throughout the city, making it difficult to monitor. Additionally the dates and sites for voting were not well known to most patients.
The newsletter advised employees:
"Since you and your immediate family have been disenfranchised, we urge you to inform your family, friends and neighbors to participate in this year's election. If you do not know which Unit you are in, you can call either the AFSCME office or El Rio's Community Relations Department."
The employees were informed about a CLUW workshop on sexual harassment and
discrimination in the workplace.
About March 9, 1981
Special Union Leaflet
Employees and their families were urged to attend the Annual Meeting of the board to be held on Saturday, March 20.
A listing of the problems with the board pointed out what the by-law stated and next to that "What has happened." The words of the by-laws were in quotes. Beneath the quotes, indented areas told of some of the actual events that took place:
"'The annual meeting of the membership of the corporation shall be held on the 30th day of November . . . '
The Annual Meeting is scheduled for March 20th.
'A notice of the meeting, together with an agenda thereof, shall be mailed to the members not less than 60 days prior to the meeting.'
The time of the meeting has not yet been posted.
No agenda has been mailed to the members.
'The Board shall have the obligation of informing and encouraging residents of
the service area to use the medical and social services provided by the corporation.'
The Center's Newsletter has been discontinued and registration
for the community has been closed for over a year.
'The membership of the Board shall be made up as follows: (a) Twelve (12) elected members from the Model Cities Area of Tucson, Arizona, provided, however, that there shall be two (2) members elected from each of the six (6) original units of said Model Cities area.'
Emilio Elenes represented Unit 6 but lived At-Large.
'Seven (7) appointed members from the following agencies: The Pima County Medical Society, The Tucson Academy of Pharmacy, The Pima County Osteopathic Assn., The City of Tucson, The Pima County Legal Aid Society, The Pima County Board of Supervisors, An institution of higher education in the health field, Organized labor unions, Southern Arizona Hospital Council, Arizona Nursing Assn-District II, Tucson Chamber of Commerce, Pima County Dental Society, Other organizations in the health care field.'
The Board has made the following appointments:
...Pascua Yaqui Tribe,
...Chicano Consortium,
...New Pascua,
...Pima College.
'Not less than 120 days prior to the annual meeting of the membership, the President with approval of the Board of Directors shall appoint an Election Committee consisting of 5 members.'
There was no Election Committee 120 days prior to the annual meeting.
Initially the Election Committee consisted of only three members:
Rosemary Diaz, . . . , & . . .
There is doubt as to whether or not there was approval of this selection by the full Board.
'A person seeking to be placed on the election ballot shall submit a letter of intent to the head of the Community Relations.'
Notification to the membership of the deadline for the letter of intent
(February 20th) was not mailed out until February 18th.
'Vacancies occurring on the Board shall be filled by election by the remainder of the Board and a person so elected shall fill the unexpired term of the person replaced.'
Unit 4 - . . . was appointed. His seat should be up for re-election.
'Absences from three (3) consecutive Board Meetings shall automatically create a vacancy unless excused by the Board. In no case shall the absences, excused or unexcused exceed four (4) in any one calendar year.'
[One board member]. . .absent over 4 times.
[Another] . . .absent over 4 times.
[A third] . . .absent over 4 times.
'The President will notify all members of the Board of Directors of problems that may arise concerning the corporation operations.'
The President claimed that he was unaware of the problems that led to
the NLRB charges and of the contents of union negotiations. The
first Contract negotiated by Administration was rejected by the Board.
[Apparently the first communication between the board and administration
regarding the negotiations occurred after the NLRB charges were filed.]
'The Secretary shall Prepare and distribute the agenda pursuant to these By-Laws.'
Agendas for meetings have not been evident in any public site for the past year.
'Amendments [to the By-Laws] shall be subject to the approval of the Department of Health, Education and Welfare . . . '
Letter from [D]HEW dated 11/8/79 'Since the Board has voted for approval of changes in the By-Laws without the Regional Office participation, I wish to inform all members of the Board of Directors that such action could seriously affect the outcome of the annual election scheduled for November 30th. More importantly, actions that are contrary to Regional Office policy and procedures could impact future funding of El Rio.
'The following persons are authorized to sign checks: Executive Director, Business Director, Chief Accountant, President of the Board and Treasurer of the Board.'
The Personnel Manager, Jorge Garcia, has been empowered to sign checks."
The board's Election Committee contacted the League of Women Voters to count the ballots. Because of previous irregularities in the voting process, the League would only consent to participate if they could be involved in the whole voting process. They were denied that, and so the League of Women Voters declined to participate.
Additionally, both the Pima County Superior Court and the El Rio by-laws required that the elections be held at the Annual Meeting. Instead, the board set up voting sites at several different locations.
These were part of the myriad of problems that plagued the election process.
March 10, 1981
Special Edition of Union Newsletter
The union put out a plea for people to again get involved in the elections for board members. AFSCME supported four candidates:
It had been difficult finding candidates for the open offices. We fortunately found two
well-qualified people but backed four candidates. The other two, while not of the same caliber,
were backed because they would do no harm.
March 16, 1981
The effective use of parliamentary rules precluded discussion and decisions from being
made at this Annual Meeting.
Memo from Anibal Mejia, Executive Director to Alicia Tovar, FHW - Re: March 13, 1981 Request For a Meeting
"I am hereby responding positively to your request for a meeting regarding verbal
warnings. To this end I'd like to set an appointment in the Conference Room at 9:00 a.m.
on Friday, March 20, 1981. However, I feel compelled to notice that your area steward is
Ms. Betancourt, not Ms. Gallardo, and to suggest that she would be the appropriate
steward if we are to take the contract, elections, and the institution of the local seriously,
Mr. Showalter is welcome to attend."
March 19, 1981
Memo from Larsen, Union Chair, to Mejia- Executive Director
"It has consistently been the division's position that any employee within the bargaining
unit has the right to request the aid of any of the seven area stewards. It is expected that
most often an employee will choose the steward of their area, however, there is no
obligation to do so. While the contract refers to 'area stewards' it does not specify
limitations. Because we take the decisions of our membership seriously, we will continue
to allow all employees to work with the steward of their choice."
Among the first disputes over the interpretation of the contract involved the use of
stewards. Article IV, Section 2 of the contract had the provisions which most clearly related to
the problem. But the contract did not clearly deal with the issue raised by the correspondence.
Sometimes, in negotiations both sides wish to have some wiggle room on issues so they often do
not want the contract to be absolutely precise. This provides some degree of flexibility for both
the union and management. But generally, whether they want absolute precision or not, achieving
such precision generally requires dealing with all unforeseen events and so it can be
extraordinarily difficult.
March 20, 1981
Board Elections
The election of board members to fill some of the slots took place at several polling
places. The election proceeded in a calmer, than might be expected, atmosphere. Gaxiola and I.
Garcia, two employees supported candidates, won their seats. Also, both Diaz and Baldenegro
had completed their terms so they would no longer serve on the board. While those four changes
did not cure all the problems, they were sufficient to begin the healing process between the board
and the employees. Because this election took place so late, the next election for board members
would take place in November of this year.
April 1981 - After Contract, Maintenance
April 6, 1981
Showalter and Larsen met for the second time with Jorge Garcia to discuss a salary
survey.
April 9, 1981
Agenda for Union Meeting
The agenda for this first formalized union meeting included the activities of: introduction
of the officers (Chief Steward, Chair, Vice-Chair and Secretary), a discussion about the contract
negotiations, a report from Chief Steward Tovar, a report from the Chair Larsen on AFSCME's
board meeting, a discussion of the AFSCME/NHCEO relationship, and an announcement of the
time and place for future monthly meetings.
April 13, 1981
Union Newsletter
Originally, AFSCME Local 449 had been made up of four divisions. El Rio gave the Local its fifth division. Local 449 held their elections for officers yearly. Members were reminded that Local 449 elections for Chair, Vice-Chair, and Secretary would be held on Saturday, May 9. In addition to the Local officers, the El Rio division, would also elect a Treasurer. At the next union meeting, employees would nominate Local 449 officers and the El Rio Treasurer. Gloria Gonzales of dental would serve on the Local 449 Election Committee.
The Health & Safety Committee began developing a survey of work place hazards and employee health services.
A salary survey, which had been in progress, and which involved the comparison of jobs at El Rio with similar jobs elsewhere continued.
One article expressed concern over the absence of an Arizona medicaid program. In conjunction with other local groups, the union passed out petitions to circulate and get signatures urging Arizona legislators to develop a medicaid program for Arizona.
In a schedule of up coming events, employees were invited to go hiking in the Santa Rita
Mountain south of Tucson in the Madera Canyon area.
Union Representatives Meet With Mejia
Showalter and Larsen met with Mejia to discuss retirement benefits.
April 14, 1981
Memo from J. Garcia, Personnel Manager to Larsen, Union Chair
"In response to your memo dated 3/19/81, it was my understanding at the time Article IV Section two was being negotiated and throughout contract negotiations that area stewards were to represent employees working in specific geographic areas. The recent area steward elections are an added reinforcement to my belief. To do as your memo proposes serves only to defeat the aims and purpose of the recently executed Labor Management Agreement.
Because the intent was for area stewards to represent individuals employed in a
specific geographic area, management will require that employees desiring union
representation be represented by his/her area steward."
Still, the union could use the stewards that employees wanted but in reflection, they might
have been better off complying with managements' position in this instance. It the end, very few
employees were effective stewards possibly because they did not learn while the effective ones
handled all the grievances.
April 15, 1981
The Tucson Citizen
"El Rio employee dispute settled."
April 16, 1981
Minutes of Board Meeting
The new board president, Miguel Rojas, called the meeting to order. After the presentation of awards, the board discussed which agencies should be invited to send representatives to serve on the board. A motion passed that both Fernando Fajardo (JD) from the Legal Aid Society and Dr. Andy Nichols from the University of Arizona be appointed to serve on the board again.
A motion passed that two new appointees be invited to serve on the board, Sister Maria Teresa from Catholic Social Services and Tony Apodaca from the Health Systems Agency.
Larsen, with the support of Mejia, came before the board to seek support for state legislation Bill 1196 which permitted nurse practitioners to write some of their own prescriptions. A motion passed supporting the legislation. Isabel Garcia wrote the resolution to implement the motion.
After announcing a board retreat for May 8 and 9, the meeting ended.
April 29, 1981
Memo from Personnel Department to Personnel Committee of the Board
El Rio had 12 Comprehensive Employment and Training Act, (CETA) employees as of
the first of April this year. On the 2nd of April, El Rio received notification that the CETA funds
were to be terminated on April 29. El Rio absorbed seven of the twelve employees into its
permanent work force. By the end of April, there were 188 people on the El Rio payroll. Four of
the employees were on leave, five of the people were NHSC employees and two were MOP
trainees.
May 1981 - Marketing the HMO Increases
Sunday, May 3, 1981
Several El Rio union members gathered together and spent the day hiking in the Santa
Rita Mountains in the Madera Canyon. Although planned for the pure joy, the hikes served to
further tighten bonds between hikers.
May 4, 1981
Tony Stringer Hired as Accounting Manager
The Accounting Department at El Rio had been an effective and cohesive department under the jurisdiction of the Accounting Manager, Shirley Fish. She had been a hard-working task mistress and expected the same from her subordinates.
After Fish left El Rio, the work of the Accounting Department began to suffer and this played a major deleterious role in undermining the whole clinic. Most competent accountants and Accounting Managers that were hired did not stay long. The HMO, which had been started with such high hopes, would be a major victim. El Rio would come within a hair's breath of failing. But all of this was yet to come.
On May 4, El Rio hired a new Accounting Manager, Tony Stringer. Stringer, a young man possibly in his early to mid thirties, had a slender build and gentle voice which belied a powerful potential for anger.
Elizabeth Yang, one of the accountants hired by Fish, had been good friends with Larsen
and they maintained that friendship well beyond the years of their employment. Even though
Larsen strongly advocated for the union and Yang never joined, their friendship thrived. But
Yang left shortly after Fish resigned.
About May 4, 1981
El Rio News Update from Larsen
"This past month has been relatively quiet at El Rio.
El Rio employees are preparing for the May 9th election. We hope to have a contest for each office. This year's [Union] officers have declined to run again but are expected to remain active in union affairs. Dr. Barbara Warren will head the Health and Safety Committee and Ethel Larsen plans to serve on the Board/Employee Committee. Alicia Tovar will remain as Chief Steward.
Some El Rio employees have been studying their contracts and are fast becoming experts on the extent and limits of their contractual rights. This will, of course, help in conflicts over contract interpretation and in grievance processing. But this knowledge will become invaluable next year when we consider our next round of negotiations.
Recently there have been NLRB settlements. Leigh Roth, our nurse midwife, who was laid off last year has accepted a $3000 settlement. The charges against management for failure to bargain were brought to court by the NLRB. The charges have been dropped because contract negotiations were completed.
The new Board of Directors of El Rio has been seated, officers elected,
appointments made and committees formed. Because of the new make up of the Board,
issues can now be openly discussed. Board meetings might become vital and interesting
events. But El Rio employees must not forget that we and our immediate families are still
denied the right to vote."
May 7, 1981
Nursing Director Report on Status of the Nursing Division
The Nursing Director reported on the new make up of the nursing division which now included a full range of complementary positions: one Director of Nursing or Clinical Manager, one Nursing Administrative Secretary, six Registered Nurses team leaders, three Licensed Practical Nurses, twenty ½ FTE family health workers, two MOP family health worker trainees, a ½ time immunization clerk, one triage telephone coordinator, four appointment clerks and five secretaries.
The nursing staff's role included complementing medical staff services and providing services to the patients at the suites, in the Triage Clinic and at the new South Park facility.
Registration to the notch population, to be closed for three months, had now been closed for over a year. The Nursing Director put out a short study that raised the question "What impact does NHCP (HMO) have on the operations of the Neighborhood Health Center? The study did not address the persistent concerns of the NHSC physicians, yet it still gave some ideas about the source of the clinic's funds. Basically, she reported on income sources from 1979 to 1980, but the 1980 figure covered only ten months of the year:
Year Income Source Amount Percentage
1978 DHEW $2,135,582. 68%
1978 HMO 224,274. 7%
1978 All Others 757,799. 25%
1979 DHEW $2,583,742. 69%
1979 HMO 520,045. 14%
1979 All Others 617,004. 17%
1980 DHEW $2,435,127. 54%
1980 HMO 1,315,807. 29%
1980 All Others 782,625. 17%
While the HMO dollars increased dramatically and the payment for services also increased,
no effort was made to provide staff to process the additional bills. Several times, Larsen pointed
out and documented this problem, but she was largely ignored. Attempts to get additional staff to
process the claims were also ignored. The problem would increase, and with that growth both
patients and outside providers of service began complaining. Through time, the dissent
multiplied.
May 8, 1981
National Association of Community Health Centers, Legislative Update
"The House overwhelmingly passed the Reagan (Gramm-Latta) budget resolution
calling for some $37 billion in budget cuts. The Senate is expected to follow suit prior to
May 31st. For health centers, this assumes a 25% reduction, although that decision will
be made some time next month by the Appropriations Committee. What is certain is that
some significant cuts in overall domestic spending are certain."
May 9, 1981
Union Newsletter.
This edition focused on the election of union officers both for the AFSCME Local and for the El Rio Division.
AFSCME, Local 449 held its annual elections. Only one candidate from El Rio, Larsen, ran for any position and she became the Local's new Recording Secretary.
Those elected for El Rio positions included: Lynda Cooley, Chair, Isabel Abalos, Vice-Chair and Maria Betancourt, Secretary.
Lynda Cooley had been employed at El Rio for six years. She had been active with employee concerns and had served as the Chair of the employee's Hospitality Committee, a joint Employee/Management Committee, and as a union steward for her area. In this edition, Cooley's goals were stated.
"...[to] work toward unity among the employees and better communications between
stewards and rank and file membership. She [Cooley] plans to encourage employees to
gain knowledge of the contract so that the employees can make the contract work for our
mutual benefit. Ms. Cooley would also like to see better working conditions, better
compensation and better relations with management."
The newly elected Vice-Chair, Isabel Abalos, worked in Suite III as a family health worker. She had been at El Rio for about two years and had been very active in community affairs. Her background and goals were also expressed in the newsletter.
"[Abalos] . . . is presently a spokesperson of her Barrio, Barrio Sin Nombre. Ms. Abalos is also President of the Barrio Corporation. In the coming year, Ms. Abalos would like to see the El Rio Administration and our Union work together for the benefit of the employees. She would like the Administration to be more responsive to the needs of the employees. Ms. Abalos plans to work toward the establishment of regular noon meetings for union members and employees in the bargaining unit. These meetings would involve discussions and explanations of our union contract."
Maria Betancourt had only been at El Rio about one year. Like Abalos, she worked in Suite III as a family health worker. She had been active as a Shop Steward.
". . .Ms. Betancourt would like to see more unity among union members, not only during
crisis but in productive situations. Ms. Betancourt believes that the duties of the Secretary
will keep her better informed and that this will aid her ability to perform as a steward."
May 13, 1981
Letter to Mejia from Office of Grants Management
In May, El Rio received notification that it would again receive the grant award. This year's grant, to cover the time from December 1, 1980 to November 30, 1981, amounted to $2,751,143. Jorge Garcia announced the award and attached conditions. All of the conditions had been met with the excepting of grant condition number four. El Rio requested clarification of this grant condition which stated:
"Within 60 days, grantee shall submit a copy of the new procedures for selecting Board
members. In addition, grantee shall provide a plan for resolving issues relating to each
revised By-law approved by the Board October 25, 1979."
Minutes of the Board's HMO Committee
The board elected Ed Espinoza to serve as Chair of the HMO Committee. A motion passed which recognized the HMO as a subsidiary of the health center. For the purpose of qualifying as an HMO subsidiary, this motion meant that a separate entity had been established and that the entity had:
". . .an interlocking Board of Directors including membership of the existing El Rio
board."
Because of a possible conflict of interest, Dr. Nichols abstained from voting on a motion involving the University Family Practice Clinic. The motion, involved the contracting of outpatient care, directed Snyder to pursue further negotiations. This allowed people to use the Universities Family Practice Clinic while using El Rio as an HMO option.
Board members discussed El Rio's public image and the potential of hiring a public relations person.
Gaxiola recalled that at several different board meetings, they discussed the issue of closing registration. He understood the conflict involved budgetary problems verses the needs of the community. Gaxiola later observed that the problem had not been resolved during his tenure on the board. Gaxiola further noticed some problems become so acute they cried out for immediate attention. One such problem involved patients waiting, up to six months, for appointments in dental.
As before, community people were increasingly locked out of El Rio, the build up of the HMO meant more people from outside the community were utilizing the services. But to get the HMO, Gaxiola recalled, El Rio often under bid the competitors. To Gaxiola and to many employees, federal funds intended for the neighborhood were used instead to make possible low bids for HMOs.
Still, Gaxiola believed that the community board, with all their problems, remained the
best way to go because in the long run, the people on the board did try to represent the interests
of the community.
May 20, 1981
Union Agenda
The agenda consisted of a Negotiation Committee Report, Chief Steward Report and
discussion of union dues.
May 21, 1981
Minutes from Board's Executive Committee Meeting
Mejia gave an "Executive Director's Report" that indicated that the cuts in the budget from the Reagan Administration were expected to amount to about one million dollars. He mentioned a new triage service policy that would be effective in June, attempts to upgrade the Central Appointment System, the aging problem of the x-ray equipment, discussions with the University of Arizona School of Nursing, a "Fun & Fitness Fiesta" and a wellness campaign.
The committee gave Snyder the authorization to start negotiations with the University of Arizona, Community and Family Medicine. It also supported the efforts toward seeking qualification of the HMO at El Rio.
The board agreed to send Mejia and Espinoza to a meeting in Washington, D.C.
Baldenegro contacted the El Rio HMO Committee and sought coverage for 50 Cuban refugees. The board discussed the issue:
"HMO's are fixed at regulated community ratings, therefore, we are obligated to offer the same package to all agencies, except for federal governmental groups. With these we tend to meet the needs of the particular group. Mr. Mejia mentioned that Robert Snyder did some research on the rates around the country and arrived at a reasonable rate to be reviewed within a year of service, depending on the conditions of these patients . . . "
The board ultimately took no action on Baldenegro's request.
The committee agreed to requests that changed Jim Lynch and Jorge Garcia's titles, although there would be no change in pay. Lynch would be "Assistant Director for Planning," and Garcia would be "Deputy Director" It also agreed to a request which separated the Nursing Department from the Medical Department.
As part of an affirmative action plan, the committee requested information on the status of recruiting Native Americans, African-Americans and Chicanos for the medical and dental staff.
The Marketing Department offered the committee a proposal costing $30,000 to improve
public relations.
May 22, 1981
Memo from Mejia to Kaplan, Snyder, Stringer and Larsen, Regarding Payables - Turn Around Time and Patient Complaints About Late Payments
The HMO kept expanding along with growing delays in the payments of the medical bills.
Mejia finally pointed to the legitimate problem of unpaid bills. No provisions had been made to
add staff to deal with the added obligations. On the contrary, efforts were made to reduce
support staff for this function. Larsen's attempts to bring the mushrooming problem to the
administration were consistently ignored and most discussions involving the problems were done
without Larsen's presence or input.
May 27, 1981
Letter from Employee/Board Committee on AFSCME Stationary to Anibal Mejia
" In accordance with our contract, Article VII, we have a concern which we are now submitting to you.
Questions have arisen among the employees about the cost effectiveness of the developing collection policy.
Therefore, we are requesting an accounting of the costs of collections against the amounts collected within the past six months."
May 28, 1981
Medical Director's Report
This report introduced four new physicians to the staff, two internists and two pediatricians. One internist, Dr. Kris Olson, eventually joined the union but before long she had to drop her membership when promoted to the position of Medical Director, replacing Vivian.
Executive Director's Report
The Reagan Administration cuts might result in a reduction of funds up to a probable million dollars. The board discussed possible strategies in response to this dire situation.
"The strategy for the time being can be summarized in terms of (a) transfer of revenue
dependency and (b) improvements in efficiency and productivity."
While the ideal of accomplishing improvements in efficiency and productivity constituted a
worthy goal, it seemed an unrealistic strategy for saving a million dollars.
June 1981 - A Quiet Month
June 5, 1981
AFSCME holds an open house for all who wish to visit the office.
June 25, 1981
Management Report
El Rio received a "Notice of Grant Award" for the budget period ending November 30, 1981 in the amount of $2,751,431. Because they already received some of the funds, $1,297,438 was the actual remaining amount. This major grant, which financially sustained the clinic, came from the federal government. Still, as a normal requirement, a number of conditions existed involving minimum number of physician encounters and percent of administrative costs. As El Rio's financial condition worsened, it became more difficult to meet those conditions.
The clinic had earlier established a sliding fee scale for patient payments of El Rio services. Families paid according to two major factors, family income and number of people in the family supported by that income. The new pay scale resulted in poor people having to paying more.
July 1981 - Grievance
July 3, 1981
Letter from Larsen to Stringer Regarding Job Evaluation
Larsen, who had always received strong, positive job evaluations, now received a poorer evaluation from the new Accounting Manager, Stringer. Excerpts of her response to that evaluation asserted:
"You stated that the 'Quality (and Quantity) of work is limited to an inadequate
and unsatisfactory system in use.' Although I am held responsible, decisions affecting that
system thru out the year have often been made without consulting me and against my
recommendations. Conversely, my requests for support have often been poorly met. In the
past year, I have generally been excluded from information which was fundamental in the
development of an effective, interlocking system. My correspondence to deal with specific
problems or to improve the flow of information has consistently been ignored. I believe
that my performance in the past year, given the obstacles stated, has shown extensive
initiative and has been both professional and of the highest caliber."
July 14, 1981
Letter from J. Garcia, Deputy Director, to Cooley, Union Chair
This letter claimed that management fulfilled their contractual obligation to conduct and
implement a salary and fringe benefit survey. The union disputed that claim.
About Mid July 1981
Memo to All El Rio Employees from Ethel Larsen
Larsen posted a bulletin in the employees' lounge inviting any interested employee to join a group that planned to go hiking on the Sabino Canyon Trail until Hutch's Pool, an estimated 7.2 mile round trip hike. Several women, who signed, ultimately went hiking together.
The trail began at the end of the road in the Upper Sabino Canyon Recreation Area. Switchbacks could easily be seen from the road. High desert plant life with lots of mesquite trees dominated the trail. As you climbed higher, the vegetation began to change to higher altitude trees and grass lands. It is an extraordinarily beautiful area that maintained an ambiance of primitive nature although in reality a heavily-traveled trail.
Future hikes would also be posted as it quickly became evident that they also played an
important role in deepening the bonds between the employees who participated.
Shortly after July 14, 1981
Letter from Tovar to Vivian
Tovar disputed J. Garcia's claim that management had adequately implemented the survey, and filed a grievance based on violations of the contract. The grievance claimed that,
"Management has not exhausted all available means to obtain the necessary data, nor did they share with the Union any of the data they did collect. Because of these actions I, on behalf of the Union, grieve management's violation of Article V, Section 5 paragraphs 1 and 3."
Tovar maintained that the list of employers did not reflect the agreement with the union. She pointed out that the Yaqui tribe had not been the sole comparable agency for the salary of drivers and that "special needs drivers" should also be used for the comparison. Also, Tovar argued that Kino's dental clinic was comparable with El Rio's dental clinic and Kino had not been used.
Because J. Garcia's work, in conducting the survey, omitted these important elements, the union submitted a grievance which stated that there had been a violation of the contractual agreement.
They resolved the grievance after the completion of a final survey, acceptable to both the
union and management.
July 24, 1981
Larsen received her anniversary raise about two weeks late. While this issue on the surface seemed superficial, it affected all the employees and showed how seriously management took the new contract. Larsen filed a grievance and unknown to her, two other employees, Mary Bojorquez and Jim Cooley, filed complaints on the same issue. Because the two had filed earlier, management requested that Larsen's complaint be dealt jointly with the other two and Larsen agreed.
Mejia responded to the 3rd level grievance on August 10.
July 28, 1981
Six-Page Union Brochure
Lynda Cooley, as union Chair, put together a brochure for new employees. It outlined
(1) the History of the El Rio Union, (2) Issues at El Rio, (3) Current Union Officers, (4)
Information about AFSCME Local 449, and (5) Information about Meetings and Events.
August 1981 - New Accounting Manager, New Problems
August 10, 1981
Memo from Mejia to Larsen
Mejia's solution to the problem proved unacceptable.
"... [In reference to the] resolution to the systemic grievance before us, I, therefore proposed to make the Cost of Living increase effective on September 20th rather than October 1st for you and your representative's agreement to continue the Center's practice of merit increases becoming effective the pay period following an employee's anniversary date."
This proposal negated the portion of the contract dealing with anniversary increases. The
union, unwilling to unilaterally negate a portion of the contract, went the next step to the board's
Grievance Committee. On August 25, the committee would present its decision.
August 13, 1981
Management Meeting
J. Garcia and Mejia gave a presentation on "Staff Re-orientation." They laid out four steps. The fourth step included issues that needed to be discussed and this had on its list "Mis-information."
The Federal Bureau of Community Health Common Reporting Requirements (BCRR) report, formally done by the Accounting Department, was now assigned to the Assistant Director for Planning & Development. Larsen, a major contributor to this report when working under Fish's supervision, no longer participated in preparing the report.
"Based on need for timely submission of the BCRR , [the Assistant Director for Planning & Development] suggested that a staff evaluation of the El Rio BCRR reporting system be made as Federal BCRR indicators are bases for funding, timely submission and the need to meet indicators is critical."
Problems of completing the BCRR continued and at times seemed to mushroom. Still,
management did not consider bringing Larsen back to the process. On the contrary, there
emerged, what appeared to be, a planned attempt to reduce her contribution to the clinic.
August 19, 1981
Communication between Stringer and Kaplan
On this date Stringer turned in an inaccurate cash report, about which Kaplan
complained.
About August 20, 1981
Memos from Stringer, Accounting Manager to Kaplan, Finance Director
In the first memo, Stringer wrote a stinging explanation for the inaccuracy of the report. It began with an attack on Kaplan and introduced the subject with the following statement,
"The only misunderstanding that exists lies wholly in a lack of communications, understanding, and cooperation."
Stringer went on to complain about inadequate support and lack of control in providing the 1980 Audit of December, the Monthly Financial Statements and the BCRR report.
The second memo listed reasons for an inaccurate cash report.
Shortly after August 19, 1981
Memo from Stringer, Accounting Manager to Kaplan, Finance Director
In a terse note to Kaplan, Stringer wrote:
"But Mr. Kaplan
When you are up to your ass in alligators, it's difficult to remind yourself that your initial objective was to 'Drain the Swamp!'"
In time Larsen learned that only one major alligator existed and she was that alligator.
Bauman and Stringer formed an unholy alliance using Larsen's subordinate, a claims clerk,
as their foil. The clerk, with appropriate direction, could be a hard and capable worker. But she
found herself the focus of benevolent but suspicious management attention. Larsen believed that
Jorge Garcia the Personnel Manager, now called the Deputy Director, orchestrated this alliance of
maladroitness involving Stringer, Bauman and the clerical worker. Only with J. Garcia's help
could such a tripod of incompetence be allowed to persist. And persist they did, because they had
one thing that endeared them to the Deputy Director: they were out to get Larsen. It took time
before Larsen came to fully understand this, but by the end of October, with the harassment in
full swing, Larsen had no doubts about her position and little doubt why Stringer had been able to
maintain his job.
August 24, 1981
Management Meeting
The board's Executive Committee asked Mejia to prepare a study of the outside referral
contracts and services. This study aimed at developing an alternate plan for payment of
purchased medical service. This being Larsen's area of expertise, she again was not consulted
about the project.
About the End of August 1981
Management Extends Stringer's Probationary Time
Normally, extensions indicated that management had problems with the new employee and
wanted to see if those problems corrected themselves within the next probationary period. If the
problems were resolved, the employee received full status as a permanent employee. If the
problems were not resolved, they further extended either the probationary time or the employee
lost his job.
August 25, 1981
Letter from Isabel Garcia, Grievance Committee Chair to Ethel Larsen
"The Grievance Committee has instructed Mr. [Jorge] Garcia that merit increases
are to be effective on the anniversary date, and to rectify any loss suffered by employees
since January 1, 1981."
Stringer's Letter of Resignation
Stringer resigned from El Rio and his letter of resignation to Martin Kaplan, Finance Director claimed:
"In as much as I would like to remain at El Rio Santa Cruz Neighborhood Health Center, Inc. as the Manager of Accounting I find it difficult to have to make the decision to resign.
The accounting department and the accounting system suffer from malign neglect. I had hoped that I could have remedied that but without your support and an apparent lack of understanding I feel that this objective is a futile one.
I find it appalling that you think that you come before the preparation of such immediate reports as the BCRR, Medicare and Monthly Financial Statements."
Stringer resigned only to decide that he wanted to remain at El Rio. For the Accountant,
Ethel Larsen, Stringer provided a new and nightmarish challenge.
August 27, 1981
Memo from Stringer, to Mejia-Executive Director, Kaplan-Finance Director & Garcia-Personnel Director
Although there had been conflict between Stringer and Larsen, up to this point, Stringer had not mentioned Larsen as the source of his problems. His letter was an unusual statement of the problems as he saw them. Excerpts from his letter said:
"If the accounting manager could function as a department head with control over the systems he/she is responsible for these areas could be improved."
"If the accounting manager had the cooperation, understanding, and confidence of executive management to proceed with improvements, you would find that reporting would be more timely and accurate."
"If the accounting manager felt some security in his/her position and in proceeding
with improvements the system could operate more smoothly but with the added burden of
extraneous use of time these improvements may never occur."
September 1981 - More Grievance
September 1, 1981
Union Newsletter
This edition reported on grievances, membership, negotiations and the next board elections.
There were two major grievances, affecting the entire bargaining unit, that were in process. The first dealt with anniversary increases and the second involved a salary survey.
Although difficult to report, the newsletter stated that membership had declined. The reasons causing this decline involved both the large turn over among El Rio employees and a slow down of union activity.
Before too long, the union had to again prepare for negotiations.
Finally, the newsletter informed the employees that an Election Committee had been
established for the purpose of preparing for the up coming board elections.
September 4, 1981
Stringer tentatively returned to El Rio. He negotiated the conditions of his return with management. In Stringer's stead, Martin Kaplan, the Financial Director resigned. What happened between the two men is not known.
The new Finance Director replacing Kaplan, Ben Bogy, probably faced a confusing array of financial and social problems. While at El Rio, he provided a measure of protection for Larsen due to his innocence when first hired. But Bogy would not remain long at El Rio.
A few years later, when the environment in El Rio's management changed substantially,
Kaplan returned as a consultant on a temporary assignment.
September 18, 1981
The Southwest Conference on Working Women at Pima College
Close to two hundred people, mostly working women, attended this very successful conference put on by the Coalition of Labor Union Woman. While women from many unions participated in putting on this conference, a lot of the direction and help came from El Rio women.
The conference had workshops, plenary sessions, films and information booths. Prominent
women in education and labor participated. The conference provided a marketplace of ideas and
those ideas, at that time, were new and innovative.
September 24, 1981
Management Meeting
Top management informed their team that both the Health and Safety Committee and Medical Executive Committee recommendations were to be submitted directly to management personnel, Mejia, Vivian and J. Garcia, for discussion and approval.
Board elections were discussed. Soto reported on the meeting of the board's Election
Committee. The board approved The El Rio Neighborhood Center as the site for the next Annual
Meeting and moved to publicize the elections in local newspapers.
About End of September 1981
Labor/Management Agreement
Negotiations were completed.
A Medical Executive Committee (MEC) enacted by-laws in August 1979, before the union contract had been established and in negotiations. The MEC Committee and its by-laws remained outside the contract but on this date, those 1979 by-laws were changed. These new by-laws took some of the power away from the absolute control of the Medical Director and put more responsibility in the medical community at El Rio.
The changes in the by-laws involved:
The selection, Term of Office and Responsibilities of the Chief of Staff.
The composition and duties for appointments and reappointments.
The composition and duties of the Medical Executive Committee.
Meeting Times, Attendance, Chair, and the Purpose and Procedures of
Meetings.
The contract language required the MEC:
To establish the committee and designate its make-up.
To review the quality and quantity of health care provided.
To oversee and monitor MEC committees
To review complaints of competency against providers and make
recommendations to the Medical Director.
September 30, 1981
For those who wanted to run for a seat on the board, this was the deadline to file.
September 31, 1981
Auditors Report
According to a financial report put out by the accounting firm of Turigliatto, Bitner and
Palm, El Rio received $180,571 from CETAfrom October 11, 1980 to September 30, 1981. The
CETA Grant provided 22 CETA positions for the next fiscal year. Because these jobs were
grant-funded, they were considered temporary positions. Therefore, CETA employees were not
eligible to be represented by the union.
October 1981 - "Tuesday Morning Fracas"
October 1981
Management's "Employee Newsletter"
Management put out a special edition of a new newsletter directed toward the employees in the bargaining unit, for example:
"Mary T. Bojorquez, a Family Health Worker in Suite 3 was selected as the
employee of the month for September. Ms. Bojorquez was selected for her
cooperativeness in helping throughout the medical areas and expressing enjoyment in
gaining additional experience and knowledge by working with different providers."
October 15, 1981
Larsen's Notes
On this date, the first of many overt hostile acts by Tony Stringer, the new Accounting Manager, toward the union activist, began.
"Tuesday Morning Fracas"
Early this morning, Stringer asked Larsen if she had work to give to the bookkeeper trainee. Larsen replied 'yes' and proceeded to give work to the young fellow. Shortly afterward, Bauman disrupted the work Larsen had given and instead assigned his own work to the bookkeeper trainee. When Larsen learned about this, she went into Bauman's office to express her concern about not being informed of the disruption of her work assignment. Rather than discuss the issue, Bauman blurted out that Larsen was not his superior, took his work from the trainee and then proceeded to run to Stringer's office. Larsen followed. Seeing Bauman's extreme agitation, Larsen decided to try to take action
which might positively improve the strained relationship and claimed, 'I want to apologize
for . . . ' but before she could say more, Bauman dashed from the office exclaiming that he
" . . . did not want to talk about anything."
In response to this event, Stringer sent a memo to Larsen informing her that Bauman had the basis for filling a formal grievance against her,
." In as much as I was preventing him from performing a work assignment given by his supervisor."
Stringer, not an unbiased observer, apparently did not understand the nature of grievances under the Labor/Management Contract. A grievance could only be filed if there had been a breach of the Labor/Management Contract and this had not happened. No specific section or sentence or part of the contract had been violated.
What this incident awakened Larsen to the worsening and chilling reality of her work situation.
Years later, Guerena who worked in the Accounting Department during Stringer's time, maintained that she got along with Stringer but added that she, "thought he was a crook." Although she did not trust him, she got along with him. Guerena also thought that Stringer did not have the appropriate accounting credentials.
There were lots of derogatory nouns that Larsen could easily use to describe Stringer, but "a crook" did not fit Larsen's perceptions.
After Elizabeth Yang left El Rio, a graduate from Rutgers University who had a degree in Economics and five years work-experience in a variety of business positions but also had no accounting degree came to El Rio and assumed the position of accountant. He would leave El Rio within a few months of being hired. But before he left, he wrote a report about his work assignments at El Rio and his perceptions of Larsen's understanding of that work. Basically, this document praised Larsen's skills. After laying out his responsibilities as an El Rio accountant he wrote:
"You have always impressed me with your professional abilities and conscientious
approach to your work. It is my considered opinion that you could have performed the
duties outlined above as well as anyone."
Saturday, October 17, 1981
Since the first organizational meeting that led to unionization, employees celebrated their
third anniversary at the AFSCME office.
October 30, 1981
Special Union Meeting at Noon
This meeting dealt with the up coming elections, on November 30, for positions on the El
Rio Board of Directors. Ballots, containing the names of people who are running for seats on the
board, were presented to the membership.
November 1981 - Another Annual Meeting
November 14, 1981
Special Union Meeting at AFSCME Office
The employees prepared for the Annual Meeting of the Board of Directors and especially
for the elections to that board planned to hold later on November 30.
November 19, 1981
Annual Meeting of the Board of Directors
Employees described this as a bland and uneventful meeting.
As dictated by the by-laws, the elections for board members were held, putting them back
in their proper tract, in November. Once the new board was in place, they elected Fernando
Gaxiola to serve as their new president.
November 23, 1981
Letter from Abalos, Larsen and Tovar to "Fellow Union Members"
This letter encouraged members to urge their family, friends and neighbors to get out and vote for positions on the Board of Directors. Excerpts from the letter argued,
"...employees have been denied the right to vote. It is necessary that you urge your family, friends and neighbors to get out the vote."
"We have attached a list of the candidates that we feel will be responsive to our
needs as well as the needs of our patients."
December 1981 - Management Still Penalizing Union Membership
About December 23, 1981
Education leave meant that Larsen could be able to take unpaid time off to attend a specified class that could help her eventually advance her position at El Rio. She had requested leave to enroll in a Master in Public Administration Program class. Her supervisor did not response to this request. Instead, Larsen found Stringer's explicitly titled "Shit List" with her name and the name of another employee. Next to the shit list laid Larsen's unanswered request for education leave along with copies of the contract governing education leave. On December 30, Larsen received a rejection of her request. Larsen filed a second grievance. She would file several while working under this tyrannical and mean spirited Accounting Manager.
In response to Larsen's request for an informal meeting scheduled January 4 per the contract's grievance procedure, Stringer acknowledged the request but added:
"I have no objections to your having your shop steward, Alicia Tovar, present if you have no objections to my having, Miguel Guzman, present as an observer."
Larsen thought the statement strange because management can generally bring whomever
they wanted to such meetings and also because Guzman was so uninvolved with any of the
conflicts. Additionally, Guzman had no particular skills in conflict resolution.
Sometime in December 1981
Two of the employee-backed candidates, Fernando Gaxiola and Isabel Garcia, won a
second term on the Board of Directors. The board then elected Gaxiola to serve as board
president.
December 31, 1981
For Larsen, there had been a complete reversal of problems. Where before the major
problems stemmed from the board in general and Baldenegro in particular, now the board seemed
more friendly but there were problems that were specifically directed at her and they came from
administrative staff, primarily J. Garcia and Stringer. But Larsen believed Garcia kept close
communication with Baldenegro, so to some degree the source of her problems remained.
About the End of the Year
Two Notes Lying Around Found in Accounting Department
The first note exclaimed,
"Ethel Larsen, Accountant
The Title
The Recognition
but not the responsibility
...too social"
The second note complained,
Carp! Carp! Carp!
The results of my review of the Accounts Payable processing of Purchasing Medical Services over the past six months indicate that you are unable to handle
the responsibility therefore an additional change in procedure is warranted, i.e.,
Reclassification - accounts payable clerk
Reassignment - [clerk who sought the upgrading] will control processing
of invoices."
End of Year Reports
Promotions and Reclassifications - 1981 Bargaining Unit Employees
This union document demonstrated how management still penalized union employees.
Among union employees, only one person received a grade increase and one person a step
increase. In contrast, 14 non-union members received grade increases. Two union members
received step increases while eight non-union members received step increases. Still, most eligible
employees clung to the union.
El Rio's Report to the Public
The report covered several areas but only patient services and the HMO will be mentioned here. The Community Relations Department had been renamed the Patient Services Department. This reflected the shift from servicing a neighborhood to marketing throughout the city. This department provided information on patients' rights and services as well as offering a means to register complaints.
The HMO doubled in 1981 and by the end of 1981 had 5,000 enrollees. While most of
those numbers reflected Yaqui enrollment, they also included employees at IBM, University of
Arizona, State of Arizona, Arizona Data Products and Arizona Business Supply. It appeared as
though El Rio had established a very effective marketing strategy.
Management's Report on Departmental Goal Achievements
This report produced by management looked at different departments and presented glowing achievements for the year. For the Accounting Department they wrote:
"The Director of Finance, with the Executive Director, has been restructuring the
accounting system due to important changes. First is due to a change in the mix of patient
population - a result of the increase of HMO enrollees. This has required the development
of special reports for fiscal control and cost containment and to meet State and Federal
reporting requirements. Secondly, with Data Processing, the automation of many
accounting functions has begun. Finally, the turnover in personnel within the department
has led to restructuring of work assignments and culminated in the hiring of a new
accounting manager on May 4th."
Insufficient physicians to manage the new incoming patient population caused a slow down in HMO enrollments.
El Rio had originally been built with Hill-Burton funds which mandate that facilities using such funds must service some indigent population until a certain dollar amount has been expended. The original mission of El Rio agreed with this concept. This report suggested future changes when it wrote:
"...As a Hill-Burton facility, El Rio is required to provide health care to zero pay and
sliding fee scale patients based on a formula set by the Department of Health and Human
Services. This formula will continue until the obligation is met by the Center."
1981 In House Annual Report
This report included "Revenues and Expenses" and showed a zero deficit at the end of 1981. In an attempt to rally the employees' support, the report concluded:
"Let's make this year count! With your financial and moral support, we can make 1982 an even better year."
The figures in the annual report conflicted with a report by federal site inspectors. In a June 15, 1982-memo between federal site inspectors, El Rio's financial standing ominously depicted a serious deficit.
"Unfunded deficits at December 31, 1981 were $857,383 including Depreciation and Amortization of $135,418. Average deficit per month of $71,448. [857,383 divided by 12]."
An even worse financial situation would develop in 1982. In the first four months of 1982, the rate of deficit spending dramatically increased creating a four-month unfunded deficit of $598,532 and an average monthly deficit of $149,633. This meant that the deficit's rate of increase, within that four-month period, escalated more than 100%.