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SAN DIEGO -- Mariana Hernandez, who has been a certified nursing assistant for 11 years, walked off her job at Kaiser Permanente Zion Medical Center in San Diego at 6 a.m. sharp Wednesday morning, along with some 250 other workers donning their blue strike t-shirts and taking their strike shifts.

After making sure all the patients' rooms were clean and ready, she said, "I told my manager I was leaving. They don't pay what we deserve. We have to work double shifts, and staffing issues are making a big impact on patient care."

Also walking off the job was Eddie Nevarez, a tech assistant in CT radiology for 24 years. "They need to pay us more. Inflation!"

And David Hawa, a striking pharmacist at Kaiser's Springfield Medical Center in Virginia, lamented "longer lines in the [pharmacy] wait area, longer lines in phone queues, with people requesting faster care. They are stretching the frontline pharmacists very thin," causing staff burnout.

The striking workers are members of the Coalition of Kaiser Permanente Labor Unions, including Service Employees International Union United Healthcare Workers. They represent lab scientists, lab technicians, optometrists, pharmacists, home health therapists, coders and claims examiners, telephone operators, phlebotomists, respiratory therapists, food and nutrition workers, and appointment schedulers.

The California and Virginia workers were among some 75,000 nationwide who labor leaders said would not report for work during a 3-day labor action that was said to be the largest in history, affecting Kaiser hospitals and medical offices in six states and the District of Columbia. The majority -- 68,000 -- are employed by Kaiser facilities in California.

Sarah Levesque, secretary-treasurer for the OPEIU (Office and Professional Employees International Union) Local 2, which represents the Virginia and District of Columbia workers, said the staffing shortages translate to up to 3-month waits for patients to get an appointment with an optometrist. "They can't hire [because] they are under market [in the salaries they're offering] and because they're so short-staffed, they're having people rotate weekend shifts," she said. The sign-on bonus they're offering, she said, is not enough.

Some of the striking workers said that because they are also patients, they've seen how the shortage affects patient care first-hand. Rosa Felix, a clerical worker for 28 years, said staff shortages have resulted in unreasonable wait times for patients to get the care they need. "It was a 6-hour wait in the emergency department with my son," she said. "They don't have enough nurses or support staff."

And several noted Kaiser's billion-dollar profit margins, in the second quarter of 2023. Chris Hoover, an environmental services worker in San Diego, said that despite that, Kaiser was trying to reduce pensions and other benefits. "They're just cheap and greedy," he said.

Speaking for Kaiser Permanente's corporate offices, media representative Wayne Davis wrote as of 4:56 a.m. Wednesday Pacific time, representatives of the Service Employees International Union and management were "still at the bargaining table, having worked through the night in an effort to reach an agreement."

He said there had been "a lot of progress, with agreements reached on several specific proposals late Tuesday, and that the organization "remains committed to reaching a new agreement that continues to provide our employees with market-leading wages, excellent benefits, generous retirement income plans, and valuable professional development opportunities."

Davis said the hospital system is encouraging members to use its mail-order pharmacy and may expand its network to include non-Kaiser Permanente hospitals in the community if some patients need to be redirected or transferred, although Kaiser physicians will follow their patients' care.

On Tuesday, he said in a statement that all hospitals and emergency departments will remain open and that vacancies are being filled by trained contract workers "to backfill employees who choose to strike."

The statement said urgent needs of patients are "the top priority," but that non-emergency and elective services may be rescheduled in some locations "out of an abundance of caution."

He said Kaiser has been able to hire more than 50,000 frontline employees in the last 2 years: 29,000 people in 2022, and another 22,000 so far this year. That includes more than 9,800 people hired into jobs represented by the coalition. He said Kaiser expects to reach a 10,000 new-hire goal by the end of October, if not sooner, and won't stop there.

"We are committed to addressing every area of staffing that is still challenging," Davis said. "Additionally, our attrition rate of 7% is roughly a third of the industry average and continues to fall. These achievements underscore the value of a Kaiser Permanente job and reinforce our position as a leading healthcare employer."

Ultrasound technician Michael Ramey, who's been with Kaiser in San Diego for 27 years, volunteered to be a strike captain because of what the labor organizations say is a "major staffing crisis throughout the organization. We are grossly understaffed, and the quality of care has been impacted for our patients because people are leaving their jobs.

"I've never seen anything like it before," he said.

For his patients, not having enough people to take care of patients translates to delays from the time a doctor orders an ultrasound to how quickly patients get their scans, and "the results take longer than they should, and for the patient to get those results." And if there's a finding on the scan requiring the patient to get treatment, there are more delays.

Ultrasound technicians have patient quotas for their shifts, and if they're overworked, they tend to rush through patients "just getting numbers," Ramey said. "You're not taking care of people."

"The patients are frustrated and they're anxious," he said. "We hear patients' concerns and their fears."

Ramey added that with Medicare beneficiaries facing re-enrollment decisions starting in 10 days, the fact that Kaiser's facilities have a serious staffing crisis "should definitely factor in ... and you're talking about an influx of more patients, then they're not going to be getting the quality of care they thought they should and are paying for. For responsible people who do research, that should factor into their decision-making."

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