Chapter 7. Problems Within the Union - 1984

End of Winter Conflict Within Union Begins............................................ 396

Spring Conflict Grows.................................................................. 401

Summer Attendence & Punctuality................................................. 411

Autumn New Personnel Manager.................................................... 412

Start of Winter Financial Report Looks Bleak............................................ 415

Chapter 7. Problems Within the Union - 1984

Winter, Beginning 1984 - Conflict Within the Union

January 1984

Letter From Board Secretary to All El Rio Patients

The letter notified people about the next Annual Meeting and also informed people, who wished to serve on the Board of Directors, on how to get their names placed on the election ballot.

"The election, by democratic process, of vacant seats as well as seats up for reelection will also take place on March 30, 1984, Friday between the hours of 8:00 a.m. and 5:00 p.m. There are six (6) eligible seats on the Board of Directors, four (4) required to be within the catchment area and two (2) from outside this catchment area. Elections will take place at the Main Clinic of El Rio . . . , in the Main Auditorium. All enrollees 16 years of age or older are eligible to vote.

Enrollees, 16 years of age or older, seeking to be placed on the election ballot should submit a letter of intent to the Chairperson of the Election Committee, Isabel Garcia-Gallegos, care of El Rio Santa Cruz Neighborhood Health Center, Ron Rivera, Personnel Manager. This letter of intent must be submitted NO LATER than January 30, 1984, Monday. Election Committee will notify all potential candidates when election petitions can be obtained, as well as other election details and information . . . "

Outside Medical Purchased Service Report & Larsen's Activities

During Larsen's sick leave, most of the work on the bills for medical purchased services came to a halt. On her return to the clinic some two months later, Larsen found that more than a thousand bills, including hospital bills, had not been processed. Larsen's new work site returned to the main clinic, to an area in the front lobby. Her new spacious office held several clerical workers who were assigned to her. Even with the heavy work load and in a physically weakened condition, Larsen absolutely enjoyed the new peaceful atmosphere.

Union Preparations for Next Negotiations

Labor's revised contract needed to be turned in by a date in late January or early February. Although the Negotiation Committee had held meetings to determine the changes that needed to be made and even though the membership had opportunities to contribute to that process, the final contract the union staff had not begun to write the final draft. Larsen reacted with shock when she learned this two days prior to the deadline.

Larsen had not been very involved in the process. When she discovered that the union's proposal had not even begun to be typed, she contacted Tovar and the two went to the union office to type the proposed new contract. The union office, housed in one of the old Victorian homes in the downtown area, had several steps that Larsen found difficult to climb because of the earlier accident. To maneuver the steps, Larsen had to leave her crutches and crawled. This she did. Typing the revised contract turned out to be a race against time. Larsen grew increasingly agitated at the new unreliable AFSCME staff person, Ruben Robles.

February 12, 1984

Letter From a Physician to Olson, Medical Director

Although El Rio services a relatively poor community, most physicians at the clinic delivered their health care services with a high degree of concern and competence. But there were exceptions to this rule. For whatever reasons, El Rio hired an older physician who did not have privileges at any hospital servicing El Rio patients and as might be expected, his competence came into question.

One of the union physicians formally notified the Medical Director about "the poor diagnostic skills" of the older man. The union physician wrote a letter documenting the new older physician incompetence. This letter referenced three cases where the old guy's decisions might have resulted in serious harm to three different patients. The letter ended:

"These are three life threatening situations. Fortunately the patients are doing all right so far, although all three are now in the hospital. However, I am gravely concerned about the apparent lack of good diagnostic skills and good judgment. I find it very difficult to discuss these problems or anything with Dr. . . . , as he becomes threatening, defensive, and abusive whenever I try to talk to him about anything. Therefore, I am bringing this to your attention for hopefully immediate and appropriate action."

After examining the complaint and finding it legitimate, the offending physician voluntarily left El Rio without filing a grievance.

February 13, 1984

Union's Notice Regarding Negotiations

"Union Spokesperson Alicia Tovar" indicated six negotiations were scheduled from February 13 to February 29, 1984. The first session scheduled from this date had eight items listed:

"1. Employee Rights [Article III]

2. Labor/Management Communication [Article VII]

3. Purpose and Intent

4. Reorganization [Article XI]

5. Management Rights [Article II]

6. Recognition of the Union [Article I]

7. Compensatory Time [Article X]

8. Holidays [Article XIV]

9. Grievance Procedures [Articles XXIII]

10. Union Rights [Article IV]

11. Sick Leave [Article XV]"

Ground Rule 8, at the bottom of the notice and directed toward observers read:

"The number of observers present in the Negotiating Room during negotiating sessions shall not exceed the total number of members present on the Negotiating Teams."

This mantra continued to be repeated on all later notices during these negotiations.

Mid February

New AFSCME Staff Person & Negotiations

The negotiating committee elected Alicia Tovar as Chief Negotiator for the union but Robles, the new union staff person, appeared determined to play that role. In the past, when there were problems in the union's presentations, as there always would be, the rule had been to send a note to the Chief Negotiator or to ask for time out so that the team could discuss the issue. This practice had always been done before by the union team.

Robles showed dogged determination to change the union's presentation. He vigorously opposed Larsen's participation and this caused a mutual anger between them. After the first day of negotiations, Robles and Larsen openly expressed their mutual anger. Larsen resolved not to attend the negotiations as long as Robles acted as the Chief Negotiator. In effect, this meant that Larsen, for the first time, did not participate in the negotiations.

Robles either did not understand or did not care to pursue the interests of female professionals with one very important exception. Robles and Ortiz, became solid allies.

In the negotiations, the issues raised by the mid-level providers, mostly family nurse practitioners, were ignored. The mid-levels wanted their credentials to be recognized through monetary compensation. This, along with all their other proposals, was ignored. Robles either did not understand their issues or he did not care to advocate for these employees.

February 15, 1984

Union's Agenda for This Day's Negotiations

The negotiations were scheduled to go from 3:30 p.m. to 6:00 p.m. in the El Rio Auditorium.

"1. Completion of Session 1 agenda

2. Employee Discipline, Personnel Records [Article XXII]

3. Separability and Savings Clause [Article XXVIII]

4. No Strike [Article XXIX]

5. Duration [Article XXX]

6. Vacation Leave [Article XVI]"

February 17, 1984

Union's Agenda for This Day's Negotiations

This agenda aimed at finishing discussion on all the items that had been scheduled for Session 1 & 2 but had not yet been completed. Additional meetings would be scheduled and held generally as scheduled. The severe problems of the early days of unfair labor practices were past.

Spring, 1984 - Conflicts Within Union Grows

March 1984

The Arizona medicaid program, AHCCCS, which had begun the previous October ran into trouble. The political conservatives in the state had wanted the government to be, as much as possible, out of the program. They had devised the AHCCCS program, sought and received a waiver allowing them to receive federal medicaid monies without adhering to the rules, and set up the program so that a private firm, rather than state agency, could administer the program. The philosophy behind those decisions argued that private enterprises were more efficient than public entities. The award to handle the AHCCCS Administration had been given to McAuto Systems. By March of 1984, after only six months, it had become very evident that serious problems existed. Eventually, the state sued the contracted administrator and successfully took over the chore of administration.

March 12, 1984

Grievances Filed

Five physicians grieved a violation of their Labor/Management Contract because they believed that they were compelled to work beyond the limits specified in the contract. The board's Personnel and Grievance Committee decided that until more physicians were hired, the five physicians should receive additional compensation of "bonus compensatory time" of 6l.4 hours during each pay period beginning January 31, 1984. That continued until the staffing level reached the minimum acceptable level, of eight providers. This time could be used as vacation or annual leave or it could be converted to cash.

Other professionals also filed grievances. Throughout Celaya's time as a Shop Steward, there had been lots of grievances filed in pharmacy. But the grievances in pharmacy were quickly resolved. Few, if any, ever got beyond the first level. Celaya recalled that when the technicians saw how quickly and effectively grievances were resolved, they too joined the union. For a while the Pharmacy Department had 100% membership within the union.

The pharmacy technicians went back to classes, got certificates and then were called Pharmacy Assistants. Basically they learned in those classes how to better understand and read the complex pharmaceutical labels. El Rio did not want to increase their wages when they got their certificates. Although they were not immediately compensated, eventually they did receive a raise in recognition of their added skill.

Mid-March, 1984

Union Newsletter

The union newsletter reported that negotiations were in full swing with large sections of the contract already reviewed and agreed upon. For further information employees were asked to contact the members of the union negotiation team. Also notices of meetings to discuss the negotiations were posted in the employees' lounge.

The newsletter also reminded employees that on March 30 there would be another election for the El Rio Board of Directors. The only contest involved two candidates who ran for one seat. The union endorsed both candidates.

With the permission of management, the union set up voter registration tables at El Rio then registered both employees or patients. The union encouraged people to vote in the public elections.

Employees were encouraged to attend a Labor/Management Conference scheduled to be held in Tucson. Several workshops dealt with issues of special interest to health care workers. These included (1) Appropriate Bargaining Units in the Health Care Industry, (2) Health Care Cost Containment, (3) Local Group Responses to Health Care Cost Containment, and (4) Making Sound Labor Relations Pay Off in Health & Safety.

The Health Care Committee of AFSCME Council 97, no longer chaired by Larsen, planned a short series of seminars on "STRESS."

The Health Care Committee made available a packet up of material developed by the El Rio Health & Safety Committee and included Dr. Barbara Warren's CLUW column in the Clarion and AFSCME International's pamphlets.

March 30, 1984

Annual Meeting of Board of Directors Held at the El Pueblo Neighborhood Center

This congenial meeting, well attended by El Rio employees and their family, did not have the hostility of the earlier meetings.

About April 1984

Negotiations

The mid-levels wanted several provisions. They lobbied the members of the union team but were unsuccessful in getting significant support. They wanted contract language protecting the current level of their staff. They believed there should be moderate compensation for national certification and for accomplishments beyond a bachelor in science, just as other professionals enjoyed. This they did not get. Additionally, the mid-levels wanted the same degree of increases as all other El Rio employees were getting.

When the mid-level practitioners learned how inadequately they had been represented by the union, they felt betrayed. To deal with this, the mid-levels asked Ruben not to speak on their behalf and this further alienated Ruben from the mid-levels. Then the mid-levels met in a sidebar with management and met with some moderate success. They succeeded in protecting the number of mid-levels to be employed at the clinic. They were unsuccessful in improving their compensation for credentials. On the issues of compensation, they were particially successful as they did get one extra day of continuing education leave, some of the bonuses, and some raise but still below the other members of the bargaining unit.

May 1, 1984

Union Meeting at Noon

The newly concluded Labor/Management Agreement had a provision for the re-negotiations of sections of the contract. This provision would be used several times at the request of management and with the agreement of the union. The provisions dealing with renegotiations read:

"This agreement commences May 1, 1984, and shall terminate on the last day of May, 1987. Specific articles or sections of this contract may be renegotiated annually beginning June 1, 1985, providing the party desiring such renegotiations specifies the issues and submits proposals in writing to the other party at least sixty (60) days prior to June 1st of each year."

The problems of the mid-levels had been ignored by the union staff at the negotiations. Dr. Warren argued that no segment of the bargaining unit should be excluded from the negotiations. Tovar expressed her satisfaction with the action of the mid-levels and complimented them on their accomplishments and determination. These events marked the beginning of the erosion of Ruben's support among union members.

May 8, 1984

Conflict Within Union Expressed During Election

Initially, Ethel Larsen and Mary Lou Gonzales did not wish to hold an office but after the experiences at this year's negotiations they felt compelled to seek positions. Gonzales, who rarely talked negatively about anyone, described Robles as the new union staff person who had a big ego and a very small brain. The mid-level providers, as in the past, turned in their proposals to the Negotiation Committee before negotiations. But Robles did not bother communicating with the Negotiation Committee so he remained unaware of the information they had retrieved from many employees. The mid-level providers let Robles know that he had not represented them. They believed that they were hurt by him.

But when the elections for union officers came, the candidates Sylvia Ortiz, Josie Guerena and Alicia Tovar all supported Robles. Larsen and Gonzales ran because they were concerned about the damage that might be done if Robles were to take over the El Rio union.

In the only leaflet put out during the election for El Rio union officers, Larsen and Gonzales ran as a team and put out a joined notice describing themselves as follows:

"Mary Lou Gonzales, one of the original Family Nurse Practitioners in Arizona, has been at El Rio since August 1970. She has been actively involved in issues affecting her profession, patient care and the union. Recently, she received her National Certification from the American Nurse's Association. She was instrumental in bringing State Certification for nurse practitioners. She has been actively involved with the State Legislature on health care issues. At El Rio, Mary Lou was actively involved in organizing the union, and served on the negotiating committee for the first two years. She frequently attended the negotiations that were just completed."

"Ethel Larsen has been with El Rio for seven years and during that time consistently played a central role in the advocacy of patient and employee rights. Ethel served as the first chairperson of the El Rio Division and provided the needed leadership to bring employees from all segments of the clinic, along with the union staff, toward unity in the development of a new, vital bargaining unit. Currently, Ethel represents Local 449 at the Southern Arizona Central Labor Council. She is also president of the Pima County Coalition of Labor Union Women and she represents labor on the Tucson Program for Affordable Health Care."

Ortiz did not make available any information about herself. Her primary method of soliciting votes involved phoning union members. Robles phoned employees on Ortiz' behalf, an illegal act according to union policy.

In a very close election which had been conducted illegally, Ortiz won. Although AFSCME maintained a policy prohibiting union staff from participating in elections, Robles phoned employees seeking votes for Ortiz. Because Robles acted contrary policy, AFSCME eventually terminated him. Being unopposed, Gonzales became the Vice-Chair. As Tovar took administrative leave, Guerena, ran unopposed and gained the position of Chief Steward.

With the election over, Ortiz, unlike all predecessors, refused to communicate with most of her officers except Guerena. Gloria Gonzales tried to communicate with Ortiz and phoned her but never received a return call. Ortiz built a cold wall which separated her from most of the other union activists. About this time the relationship between Tovar and Ortiz cooled possibly because their style of leadership differed dramatically. Tovar believed in involving as many employees as possible in the process while Ortiz took a more autocratic approach. Some employees believed that Ortiz saw herself as being in a special elite role, above the others.

Although there had been a friendship between Larsen and Ortiz, this conflict which had arisen over the new AFSCME Field Representative, Ruben Robles, never caused Larsen as much pain as the earlier conflicts in the Accounting Department.

For Mary Lou Gonzales, however, the episodes surrounding Ruben were defining events that undermined much of El Rio's original philosophy. Gonzales saw Robles as at best indifferent to the mid-levels, but more likely indifferent to all El Rio professionals. The earlier efforts that had been so successful in breaching walls that divided employees were raised again. Gonzales' situation as an officer, by this time, became frightening. While she understood the implications of the events that were unfolding, she felt virtually alone. Tovar, a supporter of Robles at that time, eventually opposed him.

AFSCME rules prohibited union staff from becoming involved in the election process of rank and file unions. Robles had violated rules before the election and AFSCME fired him for interfering in the internal affairs of El Rio's bargaining unit. Ortiz, however, stayed loyal to Robles and for a while resigned her position as Chair. Both Ortiz and Guerena believed that the union had acted hypocritically in firing Robles without allowing him due process in a grievance hearing. They pressed their case in support of Robles and although AFSCME rehired him, they prohibited him from servicing the El Rio union. Shortly after that event, Robles left AFSCME. In November, after Ortiz dropped out of the union, Mary Lou Gonzales became the Chair. Ortiz later rejoined the union.

Years later when asked about the events surrounding Robles, Guerena claimed she was unaware of why AFSCME initially fired Robles, but she did remember that he had been denied due process. Guerena did not remember any rift between Robles and the nurse practitioners and she did not understand why AFSCME had fired Robles. Guerena, who thought of Robles as very knowledgeable in terms of the union, felt comfortable talking to him and getting advice from him. She believed that his strongest asset rested on his negotiating ability and she could not see him as having any weak qualities.

After the election, Mary Lou Gonzales, as Vice-Chair, hoped that they could mend fences so she set up a meeting between Reuben Robles and Sylvia Ortiz and the nurse practitioners, and physicians' assistants. This meeting did not produce any positive results.

Larsen, burdened with union obligations outside of El Rio and with continuing significant health problems, decided to stay out of this internal conflict at El Rio. The problems fell mostly on Mary Lou Gonzales, and while she had many employees who supported her, it was not as all encompassing as in the earlier days. In some ways Gonzales stood alone but still she tenaciously persisted. Larsen felt terrible that she could offer so little help to Gonzales.

Mary Lou Gonzales had a long term commitment to both patients and employees, so the stress of the union conflicts took a heavy toll on Gonzales' health. Gonzales found trying to keep unity within the union and do her work very challenging and at times it seemed impossible. She found it very difficult to deal with the blatant dishonesty whether on the board, among the administrators or within the union. Eventually, Gonzales could neither eat nor rest properly and so suffered serious health problems that eventually put her in the hospital.

Gloria Gonzales, the dental hygienist who had not been involved in the conflict, observed from a distance:

"...activists are not only fighting the management but also some of their own co-workers that are only out for their own self interests. These people are often rewarded with some elevated titles."

Gloria Gonzales believed that management played a role in the conflict when she observed:

"management's actions sometimes lead to fragmentation of the staff and so employees are less interested in going to bat for anyone else. It seems as though people are increasingly out for themselves."

Gloria Gonzales, in addition to being a Shop Steward, served on two committees, the Career Ladder Committee and the Health and Safety Committee.

About Mid May 1984

"Planner I" Hired

Another management person, with the title Planner I, was hired to negotiate medical accounts payable contracts with providers of medical services outside of El Rio. Essentially, she spent all her time trying to accomplish what Bill Maytorena had successfully done as part of his job years earlier. While Maytorena had secured arrangements to facilitate the patients' ability to get needed, but expensive specialized health care not available at El Rio, the Planner's goal aimed at minimizing El Rio's cost's for purchasing medical services for El Rio HMO patients. Unlike the earlier days when arrangements were made to facilitate access to care for poor patients, now the strategy aimed at satisfying the El Rio HMO patients.

May 24, 1984 to July 2, 1984

Larsen returned to the hospital for more surgery from damage caused during last years auto accident.

Summer, 1984 - Attendance and Punctuality

Notes about Extended Hours Clinic.

"The Extended Hours Clinic was introduced in June of 1984 in order to decrease the utilization of Emergency Room Services. The original concept called for one physician (moonlighting Family Practice Resident), a midlevel, an RN, and a nurse's aid. Additionally, X-ray, Laboratory and Pharmacy would be open. The hours of operations were to be 5-9:30 p.m. Monday thru Friday. Also, the Saturday clinic was to be extended from 12 noon until 4 p.m."

Notes About the Time Clock Committee

Larsen and Guerena represented the union on this joint committee. Guerena, whose job involved handling the payroll, initially wanted time clocks because she thought this might make her job easier and at the same time bring fairness to the process. The time clocks, when they were tried, were unsuccessful because of the complexity of the different employee functions at El Rio. Guerena changed her mind when she learned that supervisors and top management were not going to use the time clocks.

Larsen, who had reservations about the time clocks, decided to check the literature at the university library. She found very little information on the subject. Management people on the committee had mixed responses to time clocks. The committee was disbanded before reaching a conclusion. Although discussion of time clocks took place in 1984, El Rio did not use them for many years. When tried, the time clocks proved ineffective and so discontinued.

Autumn, 1984 - New Personnel Manager

Personal Notes

Jorge Garcia, probably the last of Baldenegro's loyal supporters, left El Rio. Baldenegro's influence, along with his presence, were no longer felt at El Rio.

El Rio hired a new Personnel Manager, Ron Rivera, a quiet, youthful appearing, pleasant young man. One of Rivera's earliest chores and perhaps one of the most difficult involved reviewing job descriptions. To help do this, he started by having employees fill out a "Job Questionnaire" followed by a series of meeting with both management and union people.

Conflict Within Union Continues

Sylvia Ortiz resigned October 31 because she believed that Tovar had undermined her position as Chair. Ortiz later briefly dropped out of the union. Mary Lou Gonzales, as the Vice-Chair, stepped up to assume her new duties as Chair. Gonzales found it almost impossible to work with her Chief Steward, Guerena. The Secretary Susan Moreno, however, worked well with Gonzales the whole time.

After Gonzales assumed the position of Chair, Guerena disputed her position because inadequate notification had gone out to the membership. Because of that problem, Luis Arellano, the Executive Director of AFSCME Council 97, came to El Rio to attempt to resolve the differences. At a special meeting to elect a Chair, Ortiz attempted to regain her position by rescinding her resignation. This was defeated because the membership had already accepted her resignation. This was deja vu. In a new election, Gonzales won the top position almost unanimously. But the problem still existed between Gonzales and Guerena. However, before too long, Guerena resigned as Chief Steward and Tovar stepped in again. Additionally, although Ortiz had briefly dropped her AFSCME membership, she still had a seat in Phoenix on AFSCME Council 97's Board of Directors, Arellano's bosses. But Ortiz focused in on saving Robles. She played an instrumental role in retrieving his job with AFSCME.

Changing Job Classifications

Changing job classifications proved very difficult for both the union and management. Most people make judgements about what they think they should receive, not on absolute criteria, but by relative criteria based on what "the other" employee is getting. To be in the center of such change is very difficult. The new personnel manager, Ron Rivera, along with the union Reclassification Committee, Chair and AFSCME staff person were caught in the middle.

Perhaps one of the better ways to approach this problem is to look at the market forces and how other employers paid for like jobs in Tucson. This did not happen. Instead, the squeaky wheel philosophy prevailed. Those who squawked the most, got the most.

Guerena recalled the many meetings to deal with the problems. What she found most difficult involved explaining that heavy work loads did not warrant more money. Only advanced skills warranted more compensation. Some union people complained that Guerena advocated raises unfairly, for herself and others who they thought were her friends. Guerena denied this. Although Guerena professed that she "might have gotten an upgrade" she added that almost everyone except housekeeping and medical records received upgrades. There were union employees who thought that Guerena argued against some employees getting upgraded but Guerena did not remember this happening.

The reclassifications were also very difficult for Mary Lou Gonzales. She remembered it as causing a rift among many employees when they believed that they were not fairly reclassified. Also, the mid-level, dental hygienists and staff nurses were again being shafted. While Gonzales also remembered the many meetings, what bothered her most occurred when employees got upgraded but continued to demand more. They saw co-workers doing similar work and being paid higher wages.

Celaya also recalled the job reclassifications as a very difficult time with everyone fighting to advance their position. For Celaya, this was especially true of employees in Lab, X-ray and Dental, the areas he serviced. Even the employees who were eligible but who had not joined the union, wanted their voices heard and their jobs favorably reclassified. They went to the union and sought representation for their interests. Celaya remembered that all employees wanted advocacy for pay increases.

At the meetings to discuss the reclassifications, Ortiz and Guerena would challenge decisions made by the union representative and the union chair. It appeared to Gonzales that these many of these challenges further undermined the membership and the union. This whole process of reclassification caused alienation between the employees and many people dropped their union membership at that time.

A few years later, when Guerena's position was taken out of the bargaining unit, no vocal or obvious objections from the membership existed.

Winter Ending 1984 - Financial Report Looks Bleak

Statements of Revenue and Expenses for Year Ending December 31, 1984 & El Rio's Statement of Revenue and Expenses for Year Ending December 31, 1984

The two financial reports had conflicting information. The auditor's report attested to a deficit on December 31, 1984 of $1,292,920 while the El Rio report showed an excess expense of revenues at only $178,592. For purchased medical services, the auditors indicated an expense of $8,719,596 while El Rio produced expenditures of $7,016,020. So, the major area of difference involved the purchased medical services, the area of Larsen's responsibilities. Larsen believed that the auditor's figures were the correct ones. El Rio's financial statement had been based on the dollar amount of bills paid while the auditors also reviewed the outstanding bills, those that had not yet been paid.

Although the auditors' financial statements were not so blunt, this proved to be an unsustainable liability. In addition to all previous problems, new problems arose because El Rio's bid for the AHCCCS contract fell below her potential costs. When bidding for AHCCCS contracts began in October 1983, no one really knew what appropriate bids should be. There had been no prior experience to judge this phenomena. El Rio gave the lowest bids for the sickest population and got burned. The results of those management decisions meant that the costs for purchased medical services could be expected to go up but so would El Rio's deficit also rise.

The year ended with little or no conflict between El Rio's administration and the union but with growing conflict within the union. But the most ominous problem involved the mushrooming financial debt.