番茄社区

Dozens of emergency department (ED) staff at a California medical center staged a walkout to protest what they say are untenable work conditions made worse by the Omicron surge.

Personnel at the Santa Clara Valley Medical Center (SCVMC) in San Jose walked out earlier this week, citing unsafe conditions, including longer hours -- in some cases without enough pay -- and inadequate staffing to cover the ongoing deluge of patients, the first reported.

Joy Alexiou, public information officer for the County of Santa Clara Health System and SCVMC spokesperson, told 番茄社区 via email that the walkout lasted less than hour, though two employees say it lasted an hour and a half.

According to Allan Kamara, RN, an SCVMC ED nurse, and an ED physician who spoke to 番茄社区 on the condition of anonymity, working conditions went downhill when US Acute Care Solutions (USACS), a physician staffing group, contracted with Santa Clara county in June.

The group, which staffs ED physicians, acquired Valley Emergency Physicians (now VEP Healthcare), which previously staffed the SCVMC ED. USACS is also .

Kamara, who does not work for USACS, is the president of the Registered Nurses Professional Association, a nurses' union. He said the walkout was not a union-led event, but was spearheaded by ED staff. Alexiou put the walkout number at 30; Kamara said that, at one point on Tuesday, he counted up to 42 people.

"The way the doctors are treated by USACS affects the very essence of our presence in this hospital, caring for the patient," Kamara told 番茄社区 in a phone interview Wednesday. "When you lack continuity of care for a patient in any way, anybody in healthcare will tell you, that's a recipe for disaster."

Kamara and the ED physician said the day before the walkout, the ED's interim medical director and other county leadership held a "town hall" via Zoom to hear out staff concerns, and that SCVMC CEO Paul Lorenz was in attendance.

"I don't know what decision he is going to make, but I'm pretty sure he will make a decision that's going to make the staff happy," Kamara said of Lorenz.

The staff wants Santa Clara county to end their contract with USACS, Kamara said. The physician said SCVMC's medical director of inpatient medicine seemed to understand that staff no longer wanted to work under USACS and that they would "try to look into the options, alternatives."

"It gave us a little bit of hope," the physician said. "But of course, nothing's going to happen overnight."

"We just don't want to deal with [USACS]," Kamara stated. "We just want the county to sever partnership with them and look for ... someone who can concentrate on our patient population."

A statement attributed to Lorenz via Alexiou read in part: "Part of what makes the SCVMC Emergency Department successful is the collegiality of staff, the support amongst the team and each other, which is why I am confident we can work together to address any concerns while continuing to provide excellent patient care."

Though the "town hall" held some promise, Kamara said USACS could still convince the county to keep the contract, which is why they went ahead with the walkout. The contract is set to expire on February 6, the physician said.

Alexiou called Tuesday's walkout a "rally." She said USACS employees' contract "was bought by another group, and they're not happy with the changes."

"It's not like a union strike type of thing," Alexiou stated. "It's really against their employer, which is not us [the county]."

Pay Cuts, Higher Workload

According to the Spotlight article, physicians who became USACS employees saw 15% salary cuts. The physician MedPage spoke with said that USACS-managed employees could choose between being a 1099 independent contractor with an hourly wage, responsible for paying for their own health insurance, or a W-2 employee with "not good" benefits, and be paid barely more than physician assistants.

The ED physician also said doctors often wouldn't take time off because they'd have to find coverage for their shifts or risk leaving their co-workers short staffed.

Matt Patlovany, MD, USACS chief clinical officer, told 番茄社区 via email that since the takeover, three part-time physicians and four advanced practice practitioners (APPs) had left. He also stated that among 43 USACS physicians, only four experienced pay cuts because they opted for health insurance and retirement benefits, which are factored into total pay.

He also said that nurse practitioners and physician assistants had received a pay increase.

The physician said this account neglected to include the six physicians who left before the USACS takeover rather than stay and work under them, and added that out of the 43 credentialed physicians, most were barely on the schedule. Only about 10 to 12 worked at the medical center full time, the source said.

Kamara called the USACS version of the personnel drain at SCVMC "outright wrong." He said the coverage gaps left by providers quitting has meant others have taken on more work, must spend longer hours in the ED, and avoid taking sick days. "People are frustrated and extremely stressed," he said.

Patlovany said all USACS employees have a right to sick time under California law, and financial support from a "quarantine relief fund" from the company when they are unable to work because of COVID-19 exposure or illness.

The physician said of the relief fund, "You mentioning that is the first I've heard of it."

Leader's Exit Shakes Morale

Kamara described the SCVMC ED staff as a tight-knit group ("like family") who serve a "unique patient population. ... Our patient population is the homeless; the indigent. Those are the people that we take care of every day," he stressed.

USACS removed ED head Jeff Chien, MD, earlier this month as he voiced concerns about USACS physicians taking pay cuts and leaving, both Kamara and the doctor told 番茄社区.

Kamara said Chien's removal shook the ED staff, and prompted them to write "an overwhelming letter of support" on Chien's behalf. "The only reason why he got in trouble was because he was advocating for his fellow physicians," he said. "You know these big corporations. Once you start going after their bottom line, you're gone."

Kamara described Chien as a great communicator and leader who supported the staff: "The way he communicates with patients, the way he talks to people -- it does not matter how down you are ... this guy will cheer you up. And imagine losing every aspect of support in the midst of a pandemic."

Chien did not respond to a request for comment from 番茄社区 in time for publication.

Patlovany confirmed that Chien had been replaced as ED head, but still works in the hospital ED. The physician said the interim medical director asked other ED doctors if they wanted to take his shifts.

According to Patlovany, staff complaints are exaggerated. He said the Spotlight article "grossly misrepresents several key facts about the way we at USACS treat our fellow APPs and physician owners."

"Frequent staffing changes to accommodate increases in volume are disruptive to our clinicians' lives, and we know the burden they face on each shift," he said. Patlovany confirmed that the hospital did add an extra shift to help with EMS arrivals and reduce the time ambulances would have to wait at the ED for patients to be admitted.

"I would love to see the email battles going back and forth before between our prior director and USACS on how hard it was to get that shift," the physician said.

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