National Nurses United

RNs battle Kaiser's shift away from hospital care CALIFORNIA ven before the Affordable Care Act passed into law, National Nurses United nurses have been warning that healthcare corporations will use the new legislation as an excuse to undercut the ability of RNs to provide quality care, to gouge consumers, and to ultimately restructure the medical care model in a way that maximizes profits for them, but leaves patients sicker and poorer than ever. Nowhere is this happening more obviously and more quickly than in the giant "nonprofit" healthcare system run by Kaiser Permanente, which helped craft and lobbied heavily for the ACA. Kaiser is unique in that it not only acts as the insurance company which sells policies to consumers, but also operates all the facilities that provide the healthcare services and employs the doctors, nurses, and other medical professionals who work there. Kaiser has posted profits of more than $9 billion since 2009, according to its audited financial statements and recent press releases. The 17,000 registered nurses and nurse practitioners of Kaiser Permanente in Northern California, represented by the California Nurses Association/NNU, are reporting that Kaiser over the last year has been making it harder for patients to be admitted for hospital care when sick or injured, and sending patients to their homes or discharging them early when they should still be in the hospital. These changes have E O C TO B E R 2 01 3 included everything from altering protocols for how certain diagnoses should be treated, to the elimination of certain units and services at a facility, to the wholesale gutting and imminent closure of certain hospitals. "All of us would like to stay out of the hospital, but decisions on hospital stays should be made for clinical reasons, what's in the best interest of individual patient need, not on how to generate ever more revenue and profits," said Deborah Burger, a longtime Kaiser RN and a member of the NNU Council of Presidents. As part of that shift away from hospital care into outpatient settings, Kaiser has been reducing RN staffing in its hospitals. Most recently, over vigorous objections by RNs, management illegally eliminated a policy against cancelling regularly scheduled RN shifts—a change that RNs say will cause short staffing in hospitals and make it harder for patients to receive quality care. Kaiser nurses are fighting back, mounting a campaign to expose and protest what Kaiser is doing at every turn. Over the past months, nurses have rallied at Kaiser's corporate offices, picketed and protested at a number of facilities, run a campaign urging members to hold Kaiser accountable for providing the healthcare services for which they've paid premiums, and hosted town hall community meetings to inform patients about how Kaiser continues to cut services. RNs are also circulating a "Patient Bill of Rights" that states that patients have the right to be cared for by registered nurses; that they should be promptly admitted to the W W W. N AT I O N A L N U R S E S U N I T E D . O R G hospital if they need nursing care; and that they have the right to be cared for until they are fully recovered and to receive the right level of care for the severity of their illness. At the Kaiser facility in Hayward, Calif., nurses are lobbying to save inpatient pediatrics beds. Kaiser built a new hospital nearby in San Leandro, but eliminated the peds unit. As of Nov. 17, parents with sick children will be forced to drive along heavy traffic corridors to Oakland in the north or Santa Clara in the south. On Oct. 24, Hayward nurses, elected officials, parents, and concerned community members held a press conference to condemn the imminent closure of the inpatient peds unit. "Many of our pediatric patients have complex chronic conditions such as asthma, seizures, and metabolic disorders," said Kristine Richter, an RN who has worked in the unit for more than 37 years. "Many come from working families who either rely on public transportation or who have heavy work demands. What we are asking for is pretty simple: A few beds dedicated to children, so when very sick kids come in, they can be taken down the hall, not forced to commute on crowded freeways." In Manteca, a Central Valley community, Kaiser patients are facing the slow but steady gutting of their entire facility. Recently, the entire third-floor medical-surgical ward has been closed. Cardiology is no longer doing basic stress tests on a treadmill. Radiology has stopped ultrasound services after 5 p.m. Ortho is no longer doing shoulder, hip, and knee replacement services. Maternity and peds closed years ago when Kaiser bought the facility from St. Dominic's. Because Kaiser Manteca is not providing these services, it is transferring hundreds of patients, many by ambulance, to its facilities in Modesto. This practice, report firefighters, paramedics, and emergency medical technicians, is jamming up the entire emergency response system because ambulances are often tied up transporting patients. "Families are being forced to travel very long distances to see their loved ones," said Clarice Spann-Reeve, a Kaiser Manteca RN who works in the transitional care unit. "This causes serious disruptions in our patients' continuum of care and unnecessary hardships on families. As nurses, we regard this as a crisis for all Manteca area residents." —Staff report N AT I O N A L N U R S E 9

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