by Ramona Castellanos

A pregnant woman experiencing complications went into the ER at Community Regional Medical Center, and, after being rushed through an examination, was told that her baby was dead and that she needed to have a DNC (extraction of the dead fetus). After waiting almost 12 hours to have the procedure done, she decided to go to another hospital, where she was told that her baby was actually alive, and her complications normal. One can only wonder what would have happened if she stayed where she was and went through with the complicated and extremely painful procedure.

A Patient Care Assistant in the same ER struggling to look after several patients, was called to cover for a clerk in the front desk. Forced to leave her patients unattended, she covered for the clerk and, minutes later, a patient of hers in delicate condition started pressing the call button for help. He continued to do this, but there was nobody there to answer his calls. After some time he finally “coded” (slipped into critical condition), at which point alarms started going off and multiple staff had to rush to his rescue, leaving other patients unattended.

These are two of many disturbing stories shared by local community members and workers from Community Medical Centers (CMC) at a town hall meeting held on July 31st, where community members and leaders spoke directly with CMC employees. Almost 200 people filled the cafeteria at Yokomi Elementary School in Fresno, sharing one goal: to form a coalition that will work to make much needed improvements in patient care at CMC. After about an hour of testimony and small group discussions, community members and leaders committed to working side by side with CMC employees to address what they consider a patient care crisis at the system's hospitals and other facilities. Presenters included Helen Villa, an LVN in the ER at Community Regional Medical Center, Latisha Jones from Medical Records at the same facility, Richard Yanez from Fresno Metro Ministries, Alegria de la Cruz from California Rural Legal Assistance, Minister James Whitfield from the Cavalry Full Gospel Baptist Church, and Matthew Jendian from the Sociology Department at CSU Fresno. Also in the audience were members of other community based organizations, several local labor unions, local churches, and at large community residents. As Keith Kelley from the Fresno West Coalition pointed out during the opening presentations, much of Fresno's community, and especially low income families and the uninsured who depend on CMC for their wellbeing, have a right to quality healthcare.

As the Central Valley’s healthcare safety net, the CMC system includes downtown Fresno's Community Regional Medical Center (CRMC), Clovis Community Hospital, the Behavioral Center in Fresno, the Cedar Campus facility (formerly University Medical Center), and a variety of other clinics and facilities. This system is the main provider of health services in our region, including the only trauma level facility between San Francisco and Los Angeles (CRMC). Needless to say, because of the central and huge responsibility that CMC has to us as a community, there really ought to be enough well trained staff, clean rooms, sterilized equipment, and competent service in general. Unfortunately for Central Valley residents who rely on this system during life-and-death situations, CMC ranks consistently low in crucial areas. Health Grades, a healthcare ratings group, gave CMC's two hospitals “poor” ratings due to their high mortality rates in their most recent survey. According to the 2005-2006 assessment in the areas of heart surgery, maternity, and pneumonia done by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which accredits most of the country's hospitals, CMC hospitals are ranked consistently below average in terms of patient safety and surgical infection prevention. The same assessment found that Kaiser Fresno Medical Center, a unionized hospital, ranks consistently above average in the same areas.

Improving patient care is something CMC workers have already been working towards by organizing for a union contract that will allow them a say in areas like staffing ratios, staff training, and equipment supply. The year-and-a-half long organizing drive at CMC became public in August of 2007, and has been growing ever since. According to a survey recently conducted by the CMC union organizing committee, with the support of UHW West, workers cite inadequate patient service as a result of problems like insufficient staffing in critical departments like the ER, telemetry floors where patients are kept continuously on heart monitors, housekeeping, and sterile processing, which ensures doctors have clean tools to work with. One Patient Care Assistant at the main hospital in downtown Fresno knew all too well the impact of inadequate staffing on patients and employees. “I remember I had an elderly patient in a wheelchair who needed to be lifted to the bed, but there was no help around and all the gurneys were being used, so, after keeping him waiting for a long time, I just had to pick him up by myself and just do the best I could. I felt like that wasn’t fair for either of us.” According to the survey, this type of situation frequently results in workers being seriously injured, which in turn leads to further short staffing. For Cesar, an uninsured city college student who recently got dental treatment at CMC’s Cedar Campus facility, the concept of sharing the same interest as CMC’s frontline employees is a no-brainer. “If I go to the hospital, it’s because I’m in serious pain, and I want the people taking care of me to have time to do their job right, to be good at what they do, and to have the equipment they need to do it. Who wants to put their health or even their life in the hands of people who are overworked, underpaid, and unhappy where they are!”

Workers at the town hall also went deeper into the issue by connecting inadequate pay and benefits for employees to the interests of patients. A housekeeper in one of the small group discussions, who mentioned having worked in the CMC system for over 20 years, said that starting pay for her department is $9-10/hour, while the same position at Kaiser starts at over $16/hour. She added that people working at Community consider it a place to get by until they can go to Kaiser or another, better paying job. The result is a high turnover rate, which makes it impossible to maintain a stable and well-trained workforce. “I can't imagine working for a hospital where patients and staff are so unhappy and they’re not given the chance to change things,” said Robin, a Kaiser employee, to a tableful of CMC workers and community members.

At the closing of the meeting, workers, patients and local leaders agreed to form a coalition which will push for a change in priorities at CMC, and for putting quality patient care at the center of the system’s agenda. The timing of this effort could not be better, since CMC has recently recovered from its previous financial challenges and is currently reporting millions in profits. As cited by CMC’s quarterly statements, the system reported a $24 million profit for 2008 so far. It will be hard for CMC’s management to argue financial hardship as a reason not to address these community and worker concerns.

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Ramona Castellanos is a freelance journalist and activist living in Fresno.