California state Sen. Ed Hernandez (D-West Covina), chair of the Senate Committee on Health, said state legislators will look into allegations of mismanagement at University of California medical centers that have put patient safety in jeopardy.
A new report from the American Federation of State, County and Municipal Employees Local 3299 contends that the UC system's five medical centers are understaffed and patient care is suffering.
"I am always concerned when I read about problems in a health care facility in California," Hernandez said. "But to read about these issues at the University of California medical system is especially troubling because we expect more from a taxpayer-supported institution that is training our future health care workforce."
The report, "A Question of Priorities; Profits, Short Staffing and the Shortchanging of Patient Care at UC Medical Centers," paints a scenario of shifting priorities at UC hospitals after a 2011 policy change "decentralized UC budget practices and turned each medical center into an independent profit center."
The report says frontline providers in hospitals and medical centers are understaffed, sometimes leading to dangerous situations threatening patient safety. The report urges legislative oversight of the UC health system and audits of UC staffing, management and financial practices.
UC officials discount the report as a disgruntled labor union seeking to gain bargaining clout.
"These wildly misleading charges are simply a bargaining ploy, one that AFSCME has employed in the past," said Dianne Klein, spokesperson for the UC Office of the President.
"UC respects the collective bargaining process and rather than attempt to negotiate contracts in the media, we will do so at the bargaining table."
Klein suggested the root of the problem is the 22,000-employee union's refusal to negotiate employee pension contributions.
"That response is consistent with what we've gotten for years now -- which is a non-response," said Kathryn Lybarger, president of AFSCME Local 3299. "I've been at UC for more than 10 years, and I've been hearing it the whole time, but the problems have increased significantly over the past couple years. This report is about patient safety, nothing else," Lybarger said.
UCSF Gets High Marks, Criticism in Same Week
UC-San Francisco's School of Medicine is ranked fourth in the nation in research and primary care education in a new survey by U.S. News & World Report, according to a recent UCSF release. The survey will be included in the April issue of the magazine.
In the same week, the union report accused the teaching hospital of cutting corners in staffing.
Last fall, UCSF Medical Center announced plans to reduce its workforce by 4%, eliminating about 300 jobs. Last week, UCSF officials said about 1% of job eliminations would result in layoffs.
"Four days after our report came out they announced they were only going to cut 1% instead of 4%," said Todd Stenhouse, spokesperson for Local 3299. "Coincidence?"
UCSF's workforce reduction target is still 4%, according to a UCSF spokesperson, but university officials hope the majority of those job losses will come through attrition, redeployment and retirements,
"It is anticipated that fewer than 1% will be targeted for layoffs," said Karin Rush-Monroe, deputy director of public affairs at UCSF.
Based on California Department of Public Health data, inpatient discharge information from the state Office of Statewide Health Planning and Development and interviews with union workers, the report's highlights include:
- In November 2012, Ronald Regan UCLA Medical Center received an "F" for patient safety from the Leapfrog Group, which publishes an annual "Hospital Safety Score;"
- Since October 2008, the state Department of Public Health has made 11 formal findings of immediate jeopardy at two UC facilities: UC-Irvine Medical Center and UCSF Medical Center;
- UC-Irvine Medical Center has one of the highest rates of hospital-acquired pressure sores among elderly patients in California;
- The California Department of Public Health found 10 violations at UCSF related to hospital-acquired pressure sores; and
- UC-Irvine Medical Center has the worst rate of hospital-acquired urinary tract infections among female patients in Orange County and the 10th worst in California after adjusting for case mix.
'Sharp Rise in Management Salaries, Compensation'
The report cites a trend over the past few years marked by "a sharp rise in management salaries and compensation, excessive management costs and unprecedented borrowing to construct new buildings."
Since 2009, management at UC medical centers has grown by 38%, adding $100 million to the annual payroll cost of management, according to the report. Debt service payments have almost quadrupled since 2006, according to the report.
"This diversion of patient care dollars results in management's need to capture 'efficiencies' to bolster profit margins," the report says.
"While 'efficiencies' can be positive, they can also have serious negative consequences. Often taking the form of aggressive cost-cutting measures, some translate into chronic short staffing, over-scheduling of operating rooms, prioritizing 'VIP' patients over everyone else, shortchanging charity care and outsourcing essential services. These degrade the medical centers' core mission," the report says.
Among the report's contentions regarding management:
- Between 2008 and 2011, the total UC workforce grew by 2% and faculty members increased by 2%, but the number of managers and administrators grew by 9%;
- 28% of all new positions were for managers;
- Employees whose salaries were higher than $200,000 grew by 44%;
- Between 2009 and 2012, management positions grew by 38% percent and payroll costs for managers grew by 50%, adding an estimated $100 million to the annual cost of management, bringing total yearly salary costs for managers to an estimated $298 million;
- UCLA Medical Center doubled the number of administrators between 2009 and 2012, adding 430 full-time managers at a cost of $62 million; and
- UCSF Medical Center CEO Mark Laret received $300,000 in bonus pay in 2011, bringing his total compensation that year to almost $1.2 million.
Legislative Scrutiny May Be Around the Corner
Union officials said they're hearing concern and a willingness from legislators and state officials to look into the issue further, but no formal inquiries have been planned yet.
"This report raises a number of serious issues, including whether the reduction in staffing levels for rank-and-file workers at UC hospitals is negatively impacting patient care," Hernandez said.
"The UC system can expect the Legislature to look at these issues carefully in the coming months," he added.