Kaiser Hospital Managers Bend to Humbler Tasks

Men with letters after their names are carting out trash. The assistant chief of pediatrics has discovered the joys of medical records filing. The supervisor of health-plan systems is putting her master’s degree in computer science to work, superintending the employees’ sandwich bar.

A facilities architect wheels patients on gurneys to and from CAT scans. A vice president spends his days filing X-ray slips-- a step up from a past Kaiser Permanente strike when he passed his time cleaning up a room in which women had been giving birth.

“We’ve learned to pull charts, do EKGs, give the enemas, God forbid,” said Dr. Thomas Godfrey, assistant chairman of the urgent-care department at Kaiser’s Los Angeles Medical Center. “We’ll do whatever needs to be done.”

Life lurched forward at Kaiser Permanente this week, despite the absence of thousands of technicians, maintenance workers and licensed vocational nurses who went on strike Monday against seven hospitals and more than 40 clinics in Los Angeles, Orange and Ventura counties.

Desk-bound Kaiser managers throughout Southern California found themselves suddenly reborn as “housekeepers” and “diet aides.” Physicians relearned a few of the unglorious tasks they thought they had left behind in medical school.

As for patient care, Kaiser officials insist it has not suffered. Patient service, they concede, may not be up to par--a point that the strikers also make. Procedures are being postponed, patients are being transferred, some phone calls go unanswered. But people who need care are getting it, officials say.

“I know the quality of service may not be as good,” said Dr. Fred Lapsys, assistant to the area medical director for Kaiser. “People may have to wait longer on the phone. But we are definitely dedicated to maintaining the quality of care .”

At Kaiser Permanente Los Angeles Medical Center on Sunset Boulevard, the largest facility affected by the strike, administrators cut the patient “census” from 425 to 300, transferred patients to other hospitals and indefinitely postponed elective surgeries.

The hospital administration also urged physicians to limit their requests for lab tests and X-rays so as not to overload laboratories now staffed by substituting supervisors. As a result, the number of tests ordered has dropped significantly since Sunday.

In the adjacent medical office buildings, where as many as 70% of the nurses are on strike, physicians have found themselves forced to answer their own phones, summon patients, fetch charts and clean up their examining rooms.

Some patients have opted not to show up for scheduled appointments. Some came anyway this week and were pleased to find the usual wait diminished by the lesser patient load. Others, particularly those needing tests, found the usual delays doubled and even tripled.

Susan Morales, a Los Angeles teacher, arrived at the medical center Monday evening with her brother, who had fainted. According to Morales, they were met by a handwritten sign warning of a 2 1/2-hour wait and a clerk who encouraged them to return the next day.

They waited anyway, and after two hours saw a doctor, Morales said. They were told to return Tuesday for a brain scan. When they did, they spent more than four hours at the hospital getting the scan and a blood test and waiting to see a physician.

Other patients, however, reported no unusual delays. Some said they had been unable to get through by telephone to confirm appointments. But having arrived, they said they had no trouble seeing their doctors. Some said the waiting rooms seemed unusually empty.

At least one striker insisted the inconvenience was significant.

“They’re not getting the charts and they’re not seeing all the patients. No way!” said Rolanda McIntosh, an appointment clerk. “I know for a fact, as an appointment clerk, the telephones are not being answered.”

Several physicians observed that while the strike came as something of a surprise, and some of the staff were not prepared, it is in many ways less crippling than strikes involving more nurses that have affected Kaiser in the past.

“It’s a combination of a disaster and a fiesta atmosphere,” mused Dr. Evan Steinberg, the medical center’s assistant chief of pediatrics. He was peering out a window at picketers below, who were whooping at passing cars and crossing the street against the traffic lights.

“Right now, there’s a certain spirit and, frankly, the novelty of things,” mused Godfrey, the urgent-care physician. “It’s not bothering anybody. But if it goes on weeks and weeks and weeks, everybody’s going to get disheartened.”

Lili Sohrab, who holds advanced degrees in computer science and public health, normally supervises a dozen computer programmers and analysts and is responsible for maintaining and developing systems for Kaiser’s 2.3 million members in Southern California.

But these days, Sohrab arrives at the hospital at 6 a.m. to serve breakfast in the employee cafeteria. She staffs the sandwich bar at lunch: “I can make chicken or tuna or ham or turkey or roast beef, or any combination, with mustard, on any type of bread you want.”

“The job that I (usually) do, I have my neck on the line in decisions that I make,” said Sohrab, who in one lunch hour cooked 144 pan pizzas. “Here, you see the rewards immediately if you do a good sandwich.”

Representatives of Kaiser and the Service Employees Union Local 399 met separately with a federal mediator Wednesday afternoon. The union, representing nearly 10,000 Kaiser employees, is seeking increased wages but has declined to reveal the amount.

Kaiser is offering a three-year, $44-million contract that would guarantee 5% raises in the first year and 3% raises in each of the next two years.