HMO nurses in Calif. win oversight role Kaiser Permanente contract lets union place quality watchdogs


OAKLAND, Calif. -- Kaiser Permanente, the United States' largest health maintenance organization, agreed yesterday to let its Northern California nurses' union appoint "quality liaison" nurses to serve as watchdogs at each of the organization's hospitals in the region and to force prompt attention to abuses and oversights in the care of patients.

Because of the organization's size and influence, with nearly 9 million enrollees in 18 states, analysts and federal officials said the agreement was a striking breakthrough in both patient protection and labor-management relations in the health care industry.

The agreement, part of a four-year contract subject to union members' approval, follows more than a year of one- and two-day strikes that had contributed to Kaiser's loss of $270 million last year, the first loss in its 53-year history.

"We're going to try to set up an internal process to get problems dealt with before they become a public issue," said Rose Anne DeMoro, executive director of the California Nurses Association.

Lila Petersen, a Kaiser spokeswoman, said, "It puts us at a new level of collaboration."

Yesterday's agreement comes at a time of growing backlash to the managed care industry, largely centered on complaints that HMOs are delaying or denying care, which has prompted a wave of patient-protection legislation in state capitals and Congress.

Kaiser invented managed care to help employers provide cost-effective medicine for their workers, and its home base of Northern California became the crucible of innovation in care.

Richard Barnes, deputy director of the Federal Mediation and Conciliation Service, who helped expedite the negotiations, said the agreement ranked in importance with the Teamsters union settlement last year with United Parcel Service and the settlement this week of the long-running dispute between the United Auto Workers and Caterpillar.

"And these are life-and-death issues, which are as important to the U.S. as any economic issue," Barnes said. "Nurses will play a greater role in the design of patient care.

"Now that's done primarily by management. We think this language will be a model for other health care negotiations across the country."

The settlement applies for now only to the organization's 2.7 million enrollees in Northern California and the 7,500 members of the California Nurses Association it employs in the region.

The nurses had scheduled another strike for yesterday, an ominous prospect for Kaiser, which says its cost in shifting patients and personnel in each strike was $10 million.

Under the agreement, Kaiser will appoint 18 union-selected registered nurses to "quality liaison" positions, one for each of 15 hospitals and the others to work with other Kaiser services.

"They will monitor what's going on and advocate basic patient standards, staffing levels and other things that impact the quality of care," DeMoro said.

On economic issues, the union said it won important concessions.

The nurses, who earn an average of $29 an hour or close to $60,000 a year, will receive 3 percent annual increases over the four years of the new contract.

"It sounds like the CNA got exactly what they wanted," said Joanne Spetz, a health economist for the Public Policy Institute, a nonpartisan research organization in San Francisco.

But she said it was the issue of quality that the union emphasized most in its strikes, its Web page and its advertising.

Pub Date: 3/26/98

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