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And nurse complaints have state and federal inspectors crawling all over Kaiser. Last August regulators found numerous deficiencies in service in Kaiser's Northern California region. In March, a patient died while being transported from Kaiser Foundation Hospital, Richmond Campus, to another hospital. She was the third patient to die in or awaiting transport since Kaiser stopped hospitalizing acute-care patients in Richmond as part of its hospital consolidation program.
Somehow, even consumer advocate Ralph Nader was persuaded to jump into the dispute; he's called for state regulators to prevent Kaiser from enrolling patients until the staffing and other problems are fixed.
Company officials have made a public apology for the staffing problems, which, they say, were created when more nurses and technicians than expected quit ahead of downsizing at three Kaiser hospitals in the East Bay.
Today, though, is strike day. The talk is about nurses, who are overflowing the sidewalk in front of Kaiser's main entrance. Official representatives of organized labor and political groups weigh in, pledging their support in passionate soundbites that carry for a two-block radius.
Security guards periodically move people aside to allow vans with darkened windows into the driveway. It's pretty clear the vans are bringing workers across the picket lines, some from other Kaiser facilities and some hired in from nurse registries.
Hospital officials cannot estimate the cost of this one-day labor action. All non-emergency procedures at Kaiser facilities have to be rescheduled, some patients are moved, doctors and supervisors must perform nursing duties. That's not to mention the contract nurses brought in at high hourly rates. In total, the number of hospital patients drops some 32 percent. Although Kaiser engages in a full-court media press, the publicity damage is enormous.
That cost, however, is one that Kaiser, with $12 billion in annual revenues, is apparently willing to bear. And Kaiser will have its responses to this union offensive. On the medical field of battle, the labor-management war is hardly one-sided.
The brochure, which advertises a May conference in Los Angeles, says it all: "Union Avoidance for the Health Care Employer." Produced by New York-based Executive Enterprises Inc., the conference allows health care managers to learn about fending off health care unions while earning continuing education credits that are required to maintain certain professional licenses.
During the two-day seminar, health care executives will learn "New Union Techniques in Health Care Industry Organizing," "Preserving the Supervisory Status of Nursing Personnel," and "Winning the NLRB Election," among other things.
Call it highly organized management responding to highly organized labor. Consulting to the health care industry is rapidly becoming one of the most lucrative businesses in the country, and advising health organizations about their labor problems makes up a big part of that consulting boom.
The current buzzword in health care is "restructuring," something medical corporations can't seem to do on their own. For as much as $3,000 a day, consultants come in and provide health care firms with everything from consumer advertising to down-and-dirty union busting.
It is all but impossible for outsiders to ferret out how much each corporation pays to which consultants for what; financial disclosures required by the government don't provide that type of specific information. But here's a clue: Kaiser paid $96 million to consultants in 1995 for services that included direction of a massive advertising campaign, legal work, and the restructuring of Kaiser's hospitals and staffing.
Meanwhile, the large unions involved in health care -- Service Employees International (SEIU), for one -- have entire staffs of people dedicated to research, organization, and strategy. The AFL-CIO, to which the SEIU belongs, has its own Organizing Institute, which helps train health care's rank and file in warfare against management.
So not only are employers and employees fighting each other; the employer's consultants are fighting the employees' representatives. And this is trench warfare.
Corporate boards of directors, Wall Street investment bankers, consultants, and executives each have their own imperatives that boil down to one reality: Investors will judge them by the share price of the health care firm they run or advise. And those investors want lean, mean, profit-making health machines. They want downsizing. They don't want a union contract that restricts a health care firm's ability to buy, sell, merge, close, restructure, or cut.
And so the executives continue to go to union-crushing class.
Today, on a sunny day in April, a group of nurses and other health care workers, shepherded by newfound union leaders, is circling in front of the Tenderloin's Ambassador Hotel, carrying signs that bear the names and photographs of hotel residents they've cared for over the years. A nurse holding a sign in one hand passes out pieces of fried chicken to interested passers-by from an open box on the hood of a car.
The Ambassador is home to a program created by workers for a health care group known as Visiting Nurses and Hospice of San Francisco, in conjunction with city welfare agencies. The program provides medical care for low-income AIDS patients and drug users in the Tenderloin.
And that link to the city makes the Ambassador a particularly good place for Visiting Nurses and Hospice (VNH) workers to call attention to their battle with California Pacific Medical Center, which owns VNH.
This plan of attack runs directly through the community, supported by the well-established network of political activism in San Francisco.
In November, the Service Employees International Union held a "community election" for the right to represent the workers. This process for forming a union local has not been widely used for several decades. Essentially, the union had sidestepped a union election process under the auspices of the National Labor Relations Board, because the appeals process associated with an NLRB election can drag on for years.
