Chapter 6. Hostilities Recede - 1983
January Ending the Grievance................................................. 367
February Union Prepares for Negotiations........................................ 370
March Mejia is Gone................................................................... 374
April Novice Administrators' Reports........................................ 375
May Union Changes & Medical Director's Report.................... 379
June/July New Administrators......................................................... 384
October Medical Executive Committee Report............................... 387
November AFSCME Considers Health Care Issues........................... 390
December New Union Field Representative..................................... 392
Chapter 6. Hostilities Recede - 1983
January 1983 - Ending the Grievance
January 6, 1983
Memo: From Jorge Garcia to Ethel Larsen Re.: Proposal to Resolve Grievance
Larsen believed that Garcia had originally been a major instigator of the conflict that arose between Larsen and Stringer, but now he had to offer a resolution to the problems. In this memorandum, Garcia submitted a proposal which might potentially resolve the grievance. His proposal took Larsen, her subordinates and her responsibilities temporarily out of the Accounting Department and placing them under the immediate supervision of the HMO Operations Manager. Outside consultants would study her responsibilities and make recommendations to the administration. Larsen acknowledged this temporary solution and that she might be reassigned to another department after receiving the recommendations. Since she no longer had to work with Stringer, Larsen agreed to these arrangements. With that mutual agreement, the resolution to this long and bitter grievance, Larsen was finally free of harassment.
This resolution resulted in Larsen moving back to the main clinic and being given some claims clerks as support. Because Larsen did not gain the right to hire or fire employees, her job of supervising remained limited and allowed her to stay in the union. Larsen's subordinates, at this time and for the rest of the time at El Rio, were very supportive, whether or not they joined the union. Most did, but a few did not and that posed no problem. Never again did Larsen have the need to file another grievance. The annual assessment of her work, by her new supervisor, returned to "excellent."
The reprisals against Larsen had lasted less than a year and a half. There would still be
problems but they were financial problems. During the time of reprisals against Larsen, the
medical accounts payable were growing along with the growth of HMO enrollments. But the
system to deal with that growth remained inadequate. The administrators, unfamiliar with the
medical accounts payables and the problems that normally occurred, attempted to manage the
situation but did it poorly. Additionally, the financial situation at the clinic seriously declined. So
El Rio's ability to pay for the medical accounts payable declined as the medical accounts payable
grew. Where El Rio had developed good relations with outside providers of medical care, those
relationships were undermined and in some cases destroyed. Larsen regained full charge of a very
wounded medical accounts payable.
January 1983
CLUW Newsletter
This edition reported that Dr. Warren would be writing a monthly column on Health and Safety issues for the "Clarion," a widely distributed local feminist newspaper.
The NLRB held a conference in Phoenix. Most people attending this valuable conference represented management perhaps because the costs were considered prohibitive for most unions. While unions are often depicted as huge and powerful, more often than not they are small and struggling to survive. Issues discussed at the conference included:
"Organizational Campaigns-A Legal Perspective"
"Safety in the Workplace"
"The Boards Investigation and Decision Making Process"
"Employee Participation in Management Affairs"
"Collective Bargaining Agreements"
"Employee Rights versus Employers Rules"
"Boycotts, Picketing and Jurisdictional Disputes"
"Collective Bargaining Process and Contract Enforcement"
"The Duty to Furnish Information"
"Current Issues in the Health Care Industry"
Several people from El Rio attended the conference. The management people had their
way paid by the clinic while the union people had to pay out of their own personal resources.
Early 1983
Tucson Program for Affordable Health Care
About this time, the union community asked Larsen to represent them on a new board, the
Tucson Program for Affordable Health Care, which would look for health care cost cutting
approaches to health care delivery. Except for one other union person, the participants were
CEOs or top administrators from local hospitals, HMOs, the Health Systems Agency and other
health care facilities or programs. After successfully securing permission from El Rio's
administration, Larsen assumed this new responsibility.
February 1983 - Union Prepares for Negotiations
February 10, 1983
Interim Executive Director Take Charge
An Interim Executive Director, James Lynch, took over Mejia's job. He remained at this
position for about five months. Many employees believed that Mejia, after leaving El Rio, went to
another HMO in South or Central America.
Labor/Management Ground Rules Established.
After the first year's negotiations, very few changes were made in the basic ground rules. So this year's ground rules were very similar to earlier ones.
"1. Negotiations Chief Negotiator Labor Jon Showalter
Alternate Negotiator Labor E. Larsen
Chief Negotiator Mgmt J. Lynch
Alternate Negotiator Mgmt J. Garcia
2. Observers 3 each
3. Negotiations Teams: Labor: Celaya, Cooley, Godoy, Larsen
Mason (MD), McSweeney,
Showalter, Tovar
Management: Lynch & Garcia
4. No press while in negotiations.
5. ½ on clock and ½ off. (This meant that ½ of the negotiations would be done during working hours and ½ would be done after working hours.)
6. Negotiations Friday & Wednesday after 5:00 (Next week only-Thursday)
7. MOU [This referred to Memorandums of Understanding.] When there was agreement on some portion of the contract, that language would be written down and signed by representatives of both Labor and Management. This would be called an MOU.
8. Shared Clerical - starting with Union.
9. Place 1st choice -- El Rio Auditorium
2nd choice -- AFSCME Office"
February 15, 1983
Negotiation Committee Meeting at AFSCME Office.
After the ground rules were established, the union's Negotiation Committee met and started their meeting by outlining an agenda:
"1) Briefing on Financial Situation
2) Retroactive pay - what proposals are we going to make.
3) Specific categories reviewed with special concern for employees who have topped out. [Those were employees who had sufficient seniority to go beyond eligibility for step increases.]
4) Who has been hired recently? [The Secretary, Isabel Abalos was to write to management requesting a listing of employees hired within the last six months the high wage earner.]
5) Entry level wages.
6) Wage raise -- the concept of mixed % and $ wage raise. [The mixed percentage raise generally benefitted the higher wage earner. For example 5% of $40,000 would mean a $2000 increase, while 5% of 4,000 would be $200. In contrast, a fixed dollar raise of $500.00 would be far better for the low wage earner and conversely poorer for the high wage earner.]
Letter from Jorge Garcia, Deputy Director to Jon Showalter, AFSCME Director
"Enclosed is the Center's proposal for negotiating a successor to the agreed upon Articles. In addition some changes have occurred in our classifications system which you should know about. The groundskeeper, which is not part of the Bargaining Unit, has been deleted. The Junior Accountant classification was renamed "Bookkeeper," the Accountant I position was renamed "MAP Coordinator." The Community Relations Aide/Subscriber Services Representative was renamed "Patient Services Representative," likewise if the position of Community Relations Assistant is reestablished it will be as a Patient Services Representative. The Subscriber Services Representative/IHS position was upgraded by IHS to that of a Social Worker.
I look forward to a speedy mutual agreement in our negotiations."
February 16, 1983
Letter from Isabel Godoy to Jorge Garcia
"On behalf of the Negotiating Committee, I am requesting that a list of employees hired within the last year [February 1982 - January 1983] be made available to the labor negotiating team by our next negotiating session, Thursday, February 17, at 5:30 p.m.
Please inform me of any problems regarding this request."
[Below, in handwriting ] "Please include starting pay for the above, also."
February 17, 1983
Letter from Jorge L. Garcia, Deputy Director to Isabel Godoy, Vice-Chair, Union
"I am in receipt of your letter of today requesting a list of all new hires during the period of February 1982 through January 1983.
Even though I do not see a connection between your request and negotiating wages
and benefits, in good faith, I am submitting to you the positions which had a new hire
during the period in question. I'm afraid, however, that I cannot give you the starting
wages paid to individuals hired. May I suggest you review the monthly report submitted
by our Department to the Union on pay increases if you feel this information is needed."
The newly hired employees were:
February, 1982 1 Custodian
March, 1982 2 Aide & Temporary Clerk
April, 1982 1 Temporary Clerk
May, 1982 1 LPN
June, 1982 1 Dentist
July, 1982 4 2 MDs, Bookkeeper, Medical Technician
August, 1982 3 MD, Temporary Clerk, Laboratory Receptionist
September, 1982 4 2 MDs, Medical Technician, 1 RN
October, 1982 2 Custodian & RN
November, 1982 1 Temporary Clerk
December, 1982 4 Temporary Clerk, RN, Social Worker, Custodian
January, 1983 3 Social Worker, Receptionist, Clerk
Most, if not all, newly hired employees had been in the bargaining unit.
Toward End of February 1983
This year's negotiation, quickly completed in about two weeks, peaked the employees'
interests. Celaya thought the employees read the union newsletter mostly during negotiations.
Many, perhaps most, employees believed the newsletter gave an honest account of the
negotiations process and what would happen to their contract. Still, the grapevine proved to be
the quickest communication vehicle and although its accuracy demonenstrated less reliability,
some employees relied on the grapevine.
March 1983 - Mejia Leaves El Rio
March 14, 1983
Memo from James "Jim" Lynch, Interim Executive Director to All Staff - Appointments, Providers, Nursing, Reception, and Registration
Lynch used this meeting to discuss patients' complaints and listen to employees' problems. There were multiple problems that had been allowed to fester and they needed to be understood and then changed.
Many of the problems related directly to patient care, to scheduling difficulties and excessive noise. For example, the physicians had no control over scheduling and this added to the difficulties. The Appointment Department, whose supervisor's most endearing skill was her rabid anti-union attitude, did most of the scheduling. A follow-up meeting to deal with a long list of problems was scheduled for April 6.
In July, the new Executive Director would be coming to El Rio.
March 22 to 24, 1983
Conference on Collective Bargaining and Labor Law
This annual conference provided valuable resources for both labor and managements.
Several union activists attended workshops that would be useful at El Rio: Containing Health
Care Costs, Bargaining Impasses, Special Problems in the Public Sector and Developing
Communication Skills in Bargaining. Of special interest to Union people were the speeches
"Changing Trends in Bargaining" and "The NLRA & NLRB in Changing Times."
April 1983 - Novice Administrators' Reports
April 6, 1983
Memo from James Lynch, Interim Executive Director to Provider Staff & Management
This listing delineated the major problems and potential solutions.
There needed to be discussions about the potential solutions but by July the new
Executive Director took charge and set his own agenda.
April 13, 1983
Memo from Powers, Acting Marketing Director, to Larsen
The new administration began exploring problems relating to finances, the Accounting Department, and the late payments of claims. Larsen welcomed this turn of events even though she would be the center of some of the inquires. For Stringer, the inquires ultimately led to his dismissal.
"The number of medical service claims and the dollar amount at the end of 1982,
is totally unacceptable . . . the monthly budget statements reflecting the claims payable
amount were grossly understated . . . I want to be perfectly clear in my disappointment in
the way the accounts payable department performed during 1982. You are expected to
keep me informed of large backlogs, should they occur within this department. I want only
one monthly report -- number of claims received, number processed, number returned to
providers for completion."
April 18, 1983
Larsen's Response to Power's Memo
"In response to your memorandum dated April 13, 1983, I totally agree with you that the number of medical service claims and the dollar amount at the end of 1982 is unacceptable. (It would be interesting to ascertain the effect that AHCCCS had on that figure.) But as you are well aware, I was not permitted to function in a role which would allow me to gain knowledge of those problems.
I agree that in spite of my monthly reports enumerating the number of unprocessed bills, this was insufficient to convey the problem of accounting understatement. I must, however, point out that the reporting of dollars amounts on a monthly basis would not have been realistic in light of the problems I was encountering . . . During my two months on disability no attempt, to my knowledge, was made by the accounting manager to report the problem of understatement. As you are now aware, it was impossible to function properly given the perimeters established by my former supervisor, Tony Stringer.
As I previously stated, I do not agree with your assessment of my memorandum entitled 'Recommendations Leading to Policy and Procedure Changes' dated January 3, 1983. I would like to briefly clarify my position. The cash flow problem was such that each claim, presented on a monthly cycle, came numerous times, thereby multiplying the time required for repeating reviews of each claim. Additionally, the lengthened time between service and claim settlement resulted in a barrage of calls from patients, providers and collection agents. Perhaps you are unaware that the Monthly Financial Report showed that the bills processed during my illness were predominately hospital bills. I had only gained responsibility for hospital bills about ten days prior to my illness. I believe that an extensive review of the records would show that the number of unprocessed non-hospital claims grew dramatically during the time of my illness. As you recently saw, large numbers of bills, some dating back to 1981, sat unprocessed, in Tony Stringer's desk drawers. The fact that he was holding on to some unspecified amounts of bills was alluded to in my monthly reports. In contrast, I reported on a monthly basis the unprocessed bills within my possession and the time that they were received . . .
I certainly welcome the chance to communicate with you on a basis of mutual respect. Also, I find very welcome the introduction of professionalism with which you have approached the problems. It is my fervent hope that these positive changes will persist.
I will do my best to keep you informed, in the manner you requested, of the large
backlogs. I am cautiously optimistic, however, that your new plans for processing the
claims will, in the future, negate my need to make such reports. In any case, I wish to
reaffirm my fullest support in implementing those plans."
April 28, 1983
Medical Director's Report
Kris Olson began a review of fee schedules from other local clinics. She maintained that in many instances El Rio's fees were "markedly lower."
The emerging task for a Medical Director at El Rio involved dealing with the problems brought by the growing HMO. In this capacity, Olson had the very unpopular role of trying to limit medical expenditures outside the clinic. Most important in controlling those costs would be limiting hospitalizations.
The Medical Director reported an increase in clinic provider encounters. The discussion also included the underutilized of pediatrics services.
Assessments of problems continued so that information could be forwarded to the board.
"PRODUCTIVITY:
A. Overall of clinic encounters last year from January 1, 1982 through February 28, 1982
were --18,164. Same period this year is - 19,921. This is an increase of 10.3%.
B. Pediatrics has continued to be under-utilized. While the number of encounters to the pediatricians as a group has increased per pediatrician, the number of encounters have fallen:
January 1, 1982 - February 28, 1982 total 3,250
January 1, 1983 - February 28, 1983 total 3,675 an increase of 13%
ANNUALIZING:
1982 - per pediatrician - 4,333 encounters
1983 - per pediatrician - 3.673 encounters a decrease of 15%
This is mainly due to over hiring. An extra pediatrician was hired last summer for the
expected increase in pediatric patients due to AHCCCS. While we did increase the
pediatric census with AHCCCS, the number of encounters from this has not increased
proportionately. Since we do have to do an intensive pediatric screening program under
AHCCCS, one of the pediatricians has been assigned to assess why there has not been an
increase and secondly, to develop an outreach program."
Olsen prepared a major report to deal with a wide range of problems that had been neglected. Her recommendation would be made available in her next month's Medical Director's Report.
May 1983 - Union Changes & Medical Director's Report
May 10, 1983
AFSCME Minutes of the General Membership Meeting
El Rio was one division in AFSCME Local 449 along with four other divisions, Pima County, Pima College, Tucson Unified School District and City of Tucson.
Earlier, the International Office of AFSCME had set up an Arizona branch known as Council 97. AFSCME Council 97 acted as an umbrella organization for most of the Locals in Arizona. Local 449 had not been a part of Council 97 but now the question came up should Local 449 join the Council. At this meeting of the general membership of Local 449, which included El Rio employees, the membership decided not to affiliate with Council 97 until AFSCME International provided financial assistance to remove the burdensome IRS debt.
A resolution to the problem of owing the feds money had to wait a little longer.
Looking back to AFSCME Local 449's 1982 election, Larsen had been chosen to serve on the AFSCME board as the Local's Treasurer. Shortly after a whole new set of responsibilities descended upon her, Larsen had the serious motor vehicle accident. Shortly before the accident Larsen discovered that the Local had not paid taxes in several years. After numerous discussions and consultations with the IRS, the Local needed to decide how to deal with their financial woes. Then, in November, the accident occurred and strategies to deal with the problem were delayed.
Within a year, the international office of AFSCME paid the outstanding monies but the
Tucson director, Jon Showalter, lost his job and El Rio's union lost its independence. One
problem had been resolved but losing Showalter dealt a serious blow to many of the El Rio
employees and the union. Showalter's wise expertise and honesty would be deeply missed.
May 14, 1983
Annual Union Election Held
The membership overwhelmingly elected their new Chair, Alicia Tovar, the capable Chief Steward. The membership elected Sylvia Ortiz Vice-Chair by one vote. The accountant Ortiz had supported Larsen in the earlier conflicts with Stringer. The new Recording Secretary would be Irene Rodriguez, an entry level clerical worker. Rodriguez won by a wide margin. All three newly elected candidates ran in contested races.
May 19, 1983
Medical Director's Report
This report, which focused on the economic of medical care, began by looking at speciality consultants (often purchased medical services) and then discussing strategies to deal with hospitalizations, pharmacy and the appointment system. Years later, with the proliferation of HMOs, many of El Rio's approaches to cost cutting would become common. Unfortunately, in many HMOs, the money saved on purchased medical services went instead toward administrative costs and salaries. At El Rio, administrative costs did increase but not nearly as much as other HMOs.
In dealing with speciality consultants, the report said:
"In the interest of improving our services to our patients for subspecialty referrals, and at the same time improving on expenditures in one of the largest areas of our budget, we are examining and making changes in the following areas:
A. Reducing No-Shows for in-house specialty clinics. A system is now in
place to call and remind patients of appointments two days before their
appointment date; patients taken from an 'alternate list' will fill the vacant
appointment slots. This will hopefully decrease the need for outside referrals.
B. Improving Efficiency of Consultants' time in specialty clinics: Problems in
scheduling have been discussed with staff and the special lists and changes have
been implemented to improve availability of appointments for in-house specialty
clinics.
C. Addition of Specialty Clinics in-house will be considered as we examine the cost of outside referrals in each specialty and find areas in which there is high demand for consultants and it would be less expensive to negotiate an in-house contract. (This is an on-going program through which Dr. Olson has already made many changes).
Other recommendations discussed under speciality consultants dealt with discounts, a "Dual Checking System," computer printouts and medicare assignment.
In cases where specialists outside of El Rio would be used the report recommended negotiations "to achieve discounts for El Rio patients." This had been done in the earlier days under Maltos, but, by 1983, there were very few discounts left. Because El Rio now largely serviced an HMO population, many of the physicians who previously gave discounts would be resistant to such ideas.
In order to monitor the referrals, the report recommended establishing a "Dual Checking System of Referrals" and "Developing a Regular Monthly Computer Printout." This meant that El Rio only paid for purchased medical services if an El Rio physician gave prior authorized for the use of the service. To accomplish this ideal, a computer system needed to be established and monthly computer printouts generated. These printouts enabled the monitoring of all referrals so that no bills, theoretically, would be paid unless a documented referral could be found. But the computer system at El Rio left much to be desired. At the center of the system stood a huge main frame that only the head of the Data Processing Department fully understood. That department head exercised absolute control over an inflexible system. Staff had no desk top computers so the administration suffered a disadvantage. In contrast, the union, with access to one word processor, had a technological advantage over El Rio when it came to transcribing the notes from the negotiations.
El Rio believed that money could be saved by identifying those physicians who "accepted
Medicare assignment." To "accept assignment" meant that the physician, in exchange for getting
a check directly from Medicare, would only charge the patient or El Rio for Medicare's 20%
allowable charges. For practical purposes, most physicians in Tucson, at that time, "accepted
assignment."
The second major issue covered by this report dealt with hospitalizations. A laundry list of recommendation on how to reduce that cost included:
"A. Improve the Availability of our utilization review nurse to be involved in early discharge planning.
B. Improve the Use of our home health programs for physical therapy and nursing care.
C. Review all elective surgery for its appropriateness instituting a 'second opinion' consultation where the primary provider feels it might be necessary.
D. Formally Develop a protocol for pre-admission laboratory testing for all possible admissions to help reduce hospital laboratory costs and length of hospital stays.
E. Identify Providers who tend to hospitalize patients for long periods and help them find resources to facilitate earlier discharge.
F. Allow Patients to use their medications from El Rio when in the hospital, in order to reduce costs of medications in the hospital which can be 'marked up' as much as 300% in some hospitals.
G. Review Hospital Bills for other items for which we might find cost saving measures.
H. Develop computerized monthly printouts of hospital costs in order to keep in touch with trends in hospitalization expenditures.
I. Negotiate discounts for all our patients admitted to certain hospitals and find other cost
savings incentive programs, such as early payment programs.
The third issue dealt with pharmacy costs. Providers had been sent a memo listing costs of all major medications so that they may select the least expensive of several of the same kinds of drugs. In later years, it would be common for HMOs to restrict which medications physician could prescribe.
The final area involved the appointment system. Patients sometimes could not get through after as much as 60 rings on the overloaded phone system. The location of the appointment clerks further complicated the problems.
"Many areas of confusion and problems exist in scheduling because of unavailable communication between providers and appointment clerks."
Another report expressed the hoped that moving the appointment clerks back to the suites
would decrease the burden on telephones. Problems of identifying who took messages came
under the heading "THE GHOST WHO TOOK A MESSAGE." The basic idea the Medical
Director wanted involved each employee assuming responsibility by signing the messages they
received.
June, July 1983 - New Administrators
Changes in the Administrative Staff
Most of the employees believed there were more high paid administrators than needed. While probably true, those administrators and supervisors were not highly paid. Larsen viewed them as being paid reasonable amounts when compared to administrators in other businesses, but she also viewed them as ineffective administrators who lacked knowledge of the original goals. These subjective assessments were widely held among employees.
About this time the new Executive Director, Juris Poncius, came to El Rio and Tony Stringer lost his job. Bogy also left about this time. Shortly after Bogy left, John Hogan, the new Director of Finance, came to El Rio. Jorge Garcia along with his job title "Deputy Director" would leave El Rio within a few months.
Before Stringer left El Rio, a hearing had been held to explore the situation with medical purchased services and other problems within the Accounting Department. At the hearing, the new administrators became aware of the incompetence that had been allowed to persist. As the results of those hearings, Stringer lost his El Rio job. Few, if any employees, expressed regret at this loss.
In looking back over Garcia's past at El Rio, Celaya had a softer view of him than some. Celaya remembered a grievance involving two women who worked in medical records as transcribers. One of the women asked Celaya to represent her in a grievance. Jorge Garcia, the supervisor in the medical records, the two women with the grievance and Celaya were all there. When they resolved the problem, the integrity of the contract remained protected. Celaya's experience (very different from Larsen's) showed most of the grievances were handled quickly and rarely if ever got to the second level.
Elenez thought that the best person to replace Garcia was Jessie Reece, the Personnel Specialists. But Elenez lamented, "she never wanted the responsibility." Still, Elenez recalled that if you wanted information, she gave it to you. Elenez, like so many of the El Rio employees, thought that Reece cared about the other employees.
Celaya believed that the new CEO, along with the new Director of Finances, Hogan, had
favorites among the staff. While this might have been true, it would be rare for anyone, any
where, to be without favorites.
Memo Regarding "Attendance and Punctuality"
With all the problems that El Rio had, Poncius' earliest memos involved "Attendance and Punctuality." Like most other work sites, most employees were responsible and punctual. But, also like most work places, El Rio had a very few employees who were chronically late and absent. So El Rio did not need to spend lots of resources to deal with such a minor problem. Unlike most work places, El Rio still had very many employees who put in much more time than their jobs required and accepted emotionally charged challenges for which they did not seek additional compensation, all because they truly wanted to serve El Rio, the neighborhood and the early aspirations. The desire for El Rio to succeed remained strong among many employees, even with the changing goals. Poncius' stern warning to all employees seemed out of place to those many who put in that additional time and shouldered many burdens over and beyond what might normally be expected. This just did not stand as the most important issue.
Excerpts from Poncius' full page memo said:
"The purpose of this memo is to make sure everyone understands the policy on Attendance
and Punctuality and to emphasize that this policy must and will be uniformly enforced
throughout the Clinic. Supervisors who refuse to enforce this policy will have to account
to me."
October 1983 - Medical Executive Committee Report
October 28, 1983
Medical Executive Committee Meeting
The focus of the discussion involved the physician hours both in the clinic and with hospital coverage. The concept of "hospital coverage" referred to physicians' time when they monitored the care of their hospitalized patients.
First the problems were discussed:
"-- The contract stated a session was defined as up to four hours and not more than eight
sessions were permitted in a week."
This might give the false impression that physicians at El Rio only worked a maximum of 32 hours per week. That involved only the time they saw patients at El Rio. They actually worked considerably longer hours. Not included in that statement were the hours put in on required committee meetings, periodically being "on Call" which might involve being responsive to the phone calls of sick patients on a 24 or 48-hour stretch including holidays and weekends, visits to patients hospitalized, working on medical charts, attending to medical education required to keep up with changes in their profession, and other obligations that arose.
The physicians wrote their concerns:
"-- El Rio clearly had far sicker people than other health facilities in town.
-- The Executive Director did not seem to understand the amount of work required for hospital coverage of patients. Look at hospital rates and discuss with emergency room physicians at St. Mary's Hospital. For marketing purposes, El Rio could 'sell' its HMO plan easier if El Rio could claim that its physicians visited various hospitals. However, that was totally unrealistic from the physician's perspective since such time would dramatically take from patient care at the clinic.
Other health centers:
Pima Care - has 35,000 patients with 54 full time physicians who begin their clinic work at 9:30 a.m..
INA - has 24,000 patients with an unknown number of physicians. They
are considering changing their starting time to 9:00 a.m. They
average 1 to 2 patients in the hospital per provider. They are
the highest paid of the providers. The average clinic visit they
have per day is a maximum of 20.
El Rio physicians had much heavier loads than either Pima Care or INA
but they were compensated at lower rates of pay."
The physicians then discussed and listed "Suggested solutions":
"1. Educate the Executive Director about what we do - in hospital and in clinic.
2. Identify the 30-50 interrupting encounters each day in addition to
appointments.
3. Relate secretarial work done by providers.
4. Clarify requirements for staff privileges:
5. Look at what other HMO's do.
6. Look at overall productivity and compare with national average for
provider/patient ratios.
7. Increase the number of providers.
** 8. Consider returning to non-private practice health service corp. providers. .
9. Providers are willing to consider doing full time clinic work without
hospital work. Contract out for hospital coverage.
10. Outline income generated through hospital work.
11. Account for hours we put in involving inpatient/outpatient, direct and indirect patient care, including on call.
12. Look at violations of providers rights in Union contract.
13. Look at the problems administration is having:
efficient triage.
14. Review reasons for high turnover of physicians. This is part of dissatisfaction."
November 1983 - AFSCME Considers Health Care Issues
November 11, 1983
Letter from Ethel Larsen- AFSCME Council 97 Health Care Committee Chair to Members
At the state level, Larsen had been appointed the Chair of AFSCME Council 97's, Health Care Committee. The state considered moving all state employees from the more traditional indemnity health care coverage to the HMO model by expanding AHCCCS to cover state employees. AFSCME's Council 97 Executive Board and Director directed Larsen's committee to make recommendations regarding the role of AHCCCS as a health care benefit for state employees. Invitations were sent out to all AFSCME Locals for members who wished to testify on the issue. The hearings were scheduled for November 19 in Phoenix.
It had been the policy of AFSCME that state employees might have the option of joining AHCCCS but that AHCCCS coverage would not be mandatory for employees.
Larsen saw that many state employees did not want to join AHCCCS because they believed that AHCCCS had been established primarily for the indigent. While most enrollees were poor, AHCCCS provided excellent coverage. The two major problems for the indigent were periodically having to reestablish eligibility and the second involved staying within poverty levels to remain in the program. Neither of these problems affected employee groups. Still, state employees vigorously fought the program.
The hearings basically resulted in upholding the current AFSCME policy.
November 14, 1983
Union Newsletter.
The membership once again voted for their representatives at the up coming negotiations.
November 18, 1983
Interagency Memo from AFSCME Research Director to AFSCME International Research Director Re.: Health and Safety Fact Sheets
The Health & Safety Committee at El Rio had been very active and quite effective. They had surveyed the work site for potential hazards and were successful in amending much that had been hazardous. Additionally, under the guidance of Dr. Warren, they had pulled together "fact sheets" dealing with health and safety work site issues that the AFSCME Research Director now mentioned.
The health and safety fact sheets dealing with work site hazzards, developed at El Rio, were distributed to about 10,000 AFSCME members throughout Arizona. Unfortunately, the union never monitored the outcome of industrial injuries among public employees.
Performance of Silkwood
The Coalition of Labor Union Women brought a single performance of the play,
"Silkwood," to Tucson. This production, about the union experience of Karen Silkwood,
portrayed how her actions led to safer work site rules. Two El Rio employees, Larsen and
Warren, played major roles in bringing this stage production to Tucson. While many people came
to see the show, few El Rio employees attended.
December 1983 - New Union Field Representative
Early December 1983
Motor Vehicle Accident
There were several El Rio employees who regularly went to annual meetings of the American Public Health Association. This year, Larsen and Warren traveled together. Upon returning, Larsen's husband, Arno, met them at the airport. They started driving home when they were hit by a drunken driver.
Arno Larsen and Barbara Warren's injuries were not serious. But Ethel Larsen sustained severe injuries. It would be two months before Larsen returned to work.
The output of support and sympathy from the El Rio employees and patients deeply
touched Larsen. While Larsen laid in the intensive care unit only family members were allowed to
visit but one day, claiming they were Larsen's niece and nephew, Tovar and Figueroa breached
the barriers. This delighted Larsen. Many other employees and even El Rio patients sent their
expressions of support with gifts and cards. El Rio physicians visited when on their regular
rounds seeing other patients at the hospital. Larsen, normally a very private person, experienced a
very social time as her family, friends, co-workers and even El Rio patients became part of a
stream of visitors. In contrast to all the earlier awful events, the good wishes of so many
expressed through the showering with flowers, gifts and get well cards humbled Larsen.
Late 1983
Personal Notes
Before she got out of the hospital, Tovar visited and enthusiastically told Larsen about the
new AFSCME staff person, Ruben Robles. Robles would take Showalter's place and service the
needs of the El Rio union members. Robles, a middle-aged man, had a long history servicing
blue collar union members. Before coming to AFSCME he had worked with railroad workers.
He had no prior experience with health care workers, female workers, professionals nor the public
sector.
Union Newsletter
The newsletter reported that AFSCME had hired Ruben Robles as a new field
representative in Tucson. He had experience as an elected union officer and as a union staff
person with the Brotherhood of Railway Carmen. Robles had trained in collective bargaining
techniques, grievance handling and organizing techniques at the George Meany Center for Labor
Study. On paper, his credentials looked very good. But before long, many employees realized
that he brought with him some serious problems.
December 14, 1983
Union Elections
The membership elected employees to serve on the 1984 Negotiation Committee.
Throughout 1983
The year 1983, a relatively quiet year, allowed employee activists to catch up on projects that had been temporarily delayed. One such project was certification for nurse practitioners. Mary Lou Gonzales used this hiatus in union activity to pursue certification. So in 1983, Gonzales received her National Certification from the American Nurses Association. But the seeds for new turmoil, this time within the union, had been sown.