Below is a summary of topics covered during the last few weeks of bargaining. As always, there is a limit to how many issues we can address in each session. Please contact your labor representative if you have questions about an issue not yet covered.
Fixing the PEPRA Pension Cap
As of today, more than 20% of UAPD members are “new hires” under PEPRA and subject to the cap on pensionable salary. That percentage will grow every year as more new hires come into the system. When these doctors retire, their pension will be based on a maximum of $117,020 (adjusted for inflation each year), rather than their actual salary. By our calculations, that constitutes a 45% loss of pension income for “PEPRA” members as compared to “Classic” members who are not subject to the pension cap.
UAPD has met with legislators to urge them to introduce legislation remove the cap, but so far none have shown willingness to take the lead on the issue. Therefore, UAPD has been looking for an alternative method to address the problem. On June 23rd, UAPD proposed that the State take the employer contribution on salary above the cap that, pre-PEPRA, would have gone to CalPERS, and put that money into defined contribution pension plans for PEPRA employees. For more details, click here to read the text of UAPD’s presentation to the State. UAPD strongly believes successful recruitment and retention requires a good pension, and that means doing something like this to offset the losses that came from the PEPRA pension cap.
Alternative Work Schedules
On June 9th, a staff psychiatrist from DSH-Patton presented material to serve as an introduction to UAPD’s proposal on alternative work schedules, hours of work, and timekeeping. He discussed shifting the focus from “filling time” to creative problem solving, efficiency, and reaching clinical milestones. In addition, the UAPD team took issue with the state audit that purported to show that some DSH physicians were not working enough hours, arguing that the conclusions were invalid because the data collection was highly flawed. The audit also clearly made use of time-keeping devices, in violation of the UAPD contract. UAPD gave multiple examples of timekeeping violations that doctors in several departments have endured.
UAPD passed a proposal on Flexible Work Hours that would increase the likelihood that an alternative work schedule request will be approved, and require management to meet and confer with UAPD before rescinding an individual doctor’s schedule arrangement. Taking away an alternative work schedule has a very negative impact on existing employees, and making those shifts unavailable impedes recruitment of new doctors.
Telemedicine and Telepsychiatry
UAPD asked the state to present on all of its telehealth (telemedicine and telepsychiatry) programs to allow the union to craft appropriate proposals. These presentations have been taking place over the last two weeks.
On June 15th, DSH presented on its two-year old program to provide telepsychiatry services, first to Coalinga State Hospital then to other facilities. DSH claimed that patients actually express a preference for meeting with their doctors on a screen, but did not have good information on effectiveness of treatment. They admitted that equipment failure has been a significant problem, and now they have mobile backup units. UAPD had questions about issues including seclusion and restraint for patients whose primary psychiatrist is not located on-site.
For telepsychiatry within CDCR, bargaining unit doctors are located in hubs at San Quentin, in Elk Grove and in Rancho Cucamonga. They provide psychiatric care to prisoners across the state, including at Pelican Bay and RJ Donovan. In one unit, High Desert, all psychiatric care is provided by remote doctors. The presenters said that when a position in CDCR is filled by telepsychiatrist, it is still posted at the facility being served.
Lastly, a representative from the Receiver’s Office presented on the use of telemedicine (Physician/Surgeons) in CDCR. The department’s primary use of telemedicine is to bring specialty care to remote locations and to reduce the cost of transporting prison patients to offsite facilities for specialty care. Within CDCR there were 25,000 patient visits via telemedicine last year.
After the infrastructure was developed, the Receiver’s office started to explore providing primary care via telemedicine. They were motivated by what they described as dire physician shortages at Pleasant Valley State Prison around 2011. While a number of institutions use at least one telemedicine primary care provider, the Receiver admits that such a system is less successful than having a doctor on-site. They consider primary care telemedicine to be a supplement during doctor shortages, and would disagree with any plan to make it a central feature of prison health care. In response to UAPD’s question, the Receiver’s representative said that vacant doctor positions would not be converted to permanent telemedicine positions or positions for mid-level practitioners.
In all presentations, UAPD asserted the importance of including the union in decision making about telemedicine/psychiatry, both in determining when and where it is used and how it is implemented. Telehealth has an effect both on the UAPD doctors who practice it and on the doctors who work in-person at the facilities where it is in practice. UAPD will present new contract language to address concerns raised by both types of doctors, including the issues of call, workload, and liability. UAPD also argued that the staffing shortages that the state is now solving through telemedicine/psychiatry would be better resolved by improving doctor pay and benefits.
Contracting Out
UAPD President Dr. Stuart Bussey made a proposal on private contractors, which he called the
“hidden branch of government” because of the high costs and the lack of oversight. Dr. Bussey proposed new language to require the State to provide UAPD with better information about pending contracts that involve the work currently done by our members, including the actual amount spent on such contracts. Dr. Bussey also proposed giving a firm deadline to the joint labor-management committee on contracting, so that the committee would have until the end of 2017 to come up with a plan to limit contracts related to the UAPD unit.
On Call and MOD/POD
Last week UAPD made a proposal on Article 7.8 regarding Medical Officer of the day (MOD). UAPD hopes to reduce the 3-day advance notice needed for switching an MOD shift, and to increase the amount of MOD time off an employee can accumulate. The proposal also calls for holiday credit for MOD work on holidays, and compensating those who provide MOD coverage during lunch breaks.
In a future meeting UAPD will make its proposal regarding On Call. This week and last, several doctors presented problems encountered at their facilities. A doctor from Yountville Veterans Home explained that doctors at her facility do not volunteer for call because of the inadequate compensation and the difficulties they face getting good information remotely. Another doctor spoke to the pilot program that requires CDCR doctors carry a laptop while on call. Nurses in the pilot will no longer take phone orders and sometimes won’t report out the issue, leaving the doctor to review the whole chart and do the orders him or herself. UAPD believes that the State is inappropriately expanding the amount of work that call entails – making it a “mandated mobile office shift” without appropriate pay.
In some CDCR facilities, license reclassification allowed the state to convert MOD/POD shifts to on-call coverage after hours. This is a problem, because the patients at the affected facilities are still very acute. At the Correctional Healthcare Facility in Stockton, on-call physicians have gotten up to 69 calls in a single 16 hour call shift, for which they get only 1.15 hours of Compensatory Time Off (CTO). Doctors are quitting over the issue, because they are overworked and worried about liability. The Stockton physician who presented the issue said his hours at Stockton are worse than during his residency.
Union Security
Both sides reached a tentative agreement on language that UAPD proposed to make the union less vulnerable to attacks from external anti-union organizations.
Continuing Medical/Dental Education
UAPD proposed language to raise the CME payment to the employee, to increase the amount of time off for CME activities, and to make it easier to carry over unused time. Additional language was proposed to ensure that doctors are the ones who choose their own CME activities.
Health Benefits
UAPD has proposed increasing the amount of the employer contribution towards health, vision, and dental plans, and also the amount paid to people who opt out of those plans because they receive their coverage elsewhere. The State proposed eliminating the two-year waiting period before family coverage can go into effect.
Office Space
To comply with HIPAA, doctors need a private enclosed space to do their work, including those telecommuting from remote work locations. UAPD made a proposal to require the State to provide that.
