Sandra Leal-Lopez, LMFT, is a steward and former Bargaining Team member at Kaiser’s Panorama City clinic in Southern California. When Kaiser moved to cut Patient Management Time, known in Northern California as Indirect Patient Care Time, Sandra and her colleagues fought back. In this interview, edited for length and clarity, Sandra talks about the importance of standing up to Kaiser and what she believes can be won in upcoming contract negotiations.
When did you start with Kaiser?
I started in September of 2015 shortly after we settled our first contract.
How would you describe working for Kaiser?
Working at Kaiser has been a big challenge for me, especially with the amount of patients that we see and the lack of control we have in managing our caseloads.
How have you managed to stay at Kaiser given the challenges?
I started as a return therapist, but I was burning out, so after two and a half years, I switched to crisis management, so I’m no longer a case-carrying therapist.
Where you work at Panorama City, Kaiser cut patient management time from five hours to as few as two hours for return therapists and from a full hour to only 30 minutes for your department. What was your response?
Most of my colleagues in crisis management decided to stop taking our 30-minute lunch and have a shorter work day. Instead of working from 8 to 4:30, we started working from 8:30 to 4:30. Kaiser couldn’t prevent us from doing that because we’re exempt employees.
Why give up your lunch for a shorter work day?
It was an act of defiance. When we had a full hour, we could connect 30 minutes to our half-hour lunch break and then take the other 30 minutes to finish up paperwork. That hour-long break around lunch gave us enough time to catch our breath, take a walk and also do welfare checks. When they took that away from us, I didn’t see the point in having a lunch break if I had to go back after 30 minutes.
How did management respond?
They didn’t like it, but they couldn’t stop us. They had to change schedules and accommodate coverage. Everyone on my team are huge union supporters and advocates. We’re team players, and patient care is our top priority. But we also advocate for our own personal needs.
Can you explain further?
It’s important for us to take a stand together and let management know that what they’re doing isn’t right. One of the things Kaiser doesn’t understand is that when you’re in this profession you give out a lot of your emotional energy. You need a breather. You need to decompress. And you need space to move on from difficult patient to difficult patient. That’s what Patient Management Time is for a lot of therapists: not only calling back patients and charting, but taking a breather and being able to focus — and be fully present for the next patient.
As a steward, you represent everyone at your clinic, including generalists. How has the cut to patient management time impacted them?
We don’t have the time anymore to check in on each other. Recently, I saw one of our colleagues running to the restroom. They said, “I can’t even talk. I don’t have time to go to the restroom. My other patient is here already.”
Ever since this implementation occurred, there’s been an increase of people calling out. I attribute it to people being burnt out and tired.
How has the cut to Patient Management Time impacted patients?
Clinicians are leaving constantly. We’ve never had so much turnover. There was a staff meeting a few months ago when five people said they were leaving and four of them were taking virtual positions in Northern California where they still have the pension and more Patient Management Time.
A lot of the clinicians who have left are Spanish speakers. Access for Spanish-language therapy is now much farther out. We are losing therapists who provide that critical service because of the horrible working conditions that are in place.
You served on our last Bargaining Committee. How did that contribute to your advocacy against the cut to Patient Management Time?
It made me not trust Kaiser. I was really upset when I heard about the region forcing this implementation. Cutting Patient Management Time was specifically brought up by management in bargaining. And we rejected it. Because they wanted to move forward with finalizing a contract, they agreed to keep it the same. For them to turn around and implement something that we strongly fought against and didn’t agree to, strongly makes me think they were not bargaining in good faith.
What do you take from your experience having helped bargain the most recent contract?
It was good learning for me on how things work and how it’s important to be united as a union. The power our union has is being democratic. We have a strong voice and our power comes from being willing to use our voice and take action. It’s hard for me to understand colleagues being fearful of using their voice. When I meet new coworkers, I always try to stress that the benefit of being in a union is that member-led is that you get to use your voice. But if you don’t, it weakens us.
How are you feeling about upcoming bargaining?
We’re going in with more bargaining power than we ever had. A fight with Kaiser is never easy, but we’ve done a lot of work especially with the Department of Managed Health Care investigation in documenting what Kaiser is doing wrong and making it harder for management to hold a hard line against us. Our concerns were validated by the DMHC investigation, so if we are strong and unified, I don’t think Kaiser can get away with demanding a contract that doesn’t address the fact that we don’t have enough therapists to meet the needs of patients.
What do you take from the 2022 strike in Northern California?
They have a better contract because they were willing to fight for it. If someone asks ‘why don’t we have what they have,’ we have to remind them, (Northern California) threatened an open-ended strike (in 2015) and kept their pension. They went on an open-ended strike and increased their Patient Management Time. We haven’t done that in the past, but we need to be ready to do it now.
What are you hoping to win in the upcoming contract?
I would love to get our pension back. I think that would help tremendously on retention. More Patient Management Time would also impact patient care. If we’re happy at our jobs and feel supported, we’ll stay and patients won’t have to go through a bunch of different therapists in a year because of the lack of retention.
