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Faced with the possible loss of their all-important accreditation, the Alta Bates Summit Medical Center in Berkeley is confronting the possibility of a one-day walkout early next month by virtually all of its employees. 

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) presented the hospital with a stinging critique of the hospital after a team of investigators examined the hospital earlier this month. 

The JCAHO findings come at a bad time for the hospital, which faces an impending strike by members of Local 250 of the Service Employees International Union, which represents most hospital and medical center employees except registered nurses (RNs) and physicians. 

SEIU employees in Sutter’s other 11 Northern California hospitals have either voted or are scheduled to hold votes for a one-day walkout early next month. 

Members of the California Nurses Association, which represents registered nurses, voted Wednesday and Thursday on a walkout in support of SEIU’s job action at five Sutter hospitals including Alta Bates in Berkeley and Summit Medical Center in Oakland. Results are expected today (Friday.) 

“We’re very concerned about Sutter’s continual foot-dragging on safety standards and their lack of compliance with the minimum staffing levels set by the state,” said CNA spokesperson Charles Idelson. 

Alta Bates spokesperson Carolyn Kemp denied the allegations. “How could we possibly not be in compliance with state staffing standards? We’ve met or exceeded whatever staffing ratios the state requires.” 

The walkout would involve 2,700 RNs at Sutter hospitals in Berkeley, Oakland, San Francisco, San Leandro and Vallejo in addition to the 4000 SEIU members. 

SEIU members are seeking two key concessions from Sutter. First is a voice in setting staffing levels, and second is the establishment of a training fund so workers can upgrade their skills and advance in their jobs.  

“Every other hospital chain in Northern California has accepted these standards, including Kaiser and Catholic Healthcare West,” said a union spokesperson. 

“The employees do have a voice in staffing,” said Kemp. “They participate in the committee that sets staffing levels, and there’s a provision for arbitration by a third party in case of disputes.” 

Kemp said the only dispute about training funds involved who would control them. 

“Maintaining a pool of people with the skills to work in the modern healthcare environment is very important to us,” she said. “We currently have in place a tuition reimbursement fund of up to $1,200 per employee, but the SEIU wants us to put our money in their pot, which could go anywhere they choose. We want out money to go to our own people in our own community.” 

In response to a strike, Alta Bates “would take whatever steps are necessary to maintain continuity of quality care for our patients,” Kemp said. 

“We may have to bring in replacement staff for as many as five days, though any staff member who works the first day can work as many days as they like,” she said. 

The initial accreditation report won’t be ready for another 10 to 14 days, and when it’s issued the hospital will have 10 to 14 days to reply. 

“We’ll be able to provide additional information we know will be very helpful,” Kemp said. “Everyone should hang their hat on the final report. We’re not going to lose our accreditation.”  

JCAHO is a private, industry-funded organization whose seal of approval is a prerequisite for receiving Medicare and MediCal funding, a major source of capital for most of the nations hospitals and HMOs. 

Kemp said none of the issues involve patient care. 

However, a Nov. 8 memorandum to hospital staff from Alta Bates President and CEO Warren Kirk warned that “The surveyors indicated that, unless we can successfully clarify and refute some recommendations, we could be at risk to receive a preliminary denial of accreditation.” 

The memo acknowledged failures in the patient care documentation process.  

The public has no access to JCAHO reports other than the final document, which offers no specifics other than numerical scores. Final reports are issued after organizations have reviewed the initial reports and implemented or challenged the findings and remedies in the initial report. 

Earlier drafts, which cite in detail the specific problems encountered by the inspection team, are never made public and—because the agency is private—they are immune from either the federal Freedom of Information Act or the California Public Records Act. 

The final report notes only the broad areas where failures were found and contains revised scores based on the institution’s ability to correct problems found. 

“It’s virtually impossible to flunk,” said CNA spokesperson Charles Idelson. 

The union official said Alta Bates had kicked four of their members out of the meeting to review the preliminary report. All four were quality care liaison RNs, he said. 

“What are Alta Bates and Summit hiding?” Idelson asked. “Though the hospital says there weren’t any patient care violations, we believe there were, and the public deserves to know what was in that report.” 

Problems with patient documentation were discovered three years ago when an Oct. 26, 2001 JCAHO review issued the lowest possible passing score, a “5,” for availability of patient-specific information. The rating were raised to the highest “1” score on May 8, 2002, following a compliance review. 

A July 22, 2003, survey of the Alta Bates laboratory resulted in an The hospital received another “5” for accreditation participation requirements, which was raised to a “1” on Dec. 16 of the same year. The same survey resulted in a “3” rating (”acceptable compliance, least deficient”) for general quality control systems, raised to a “1” on March 8 of this year. 

The full JCAHO commission will take up the initial report and the hospital’s responses after the hospital responds, which Kemp says will be in time for the scheduled Jan. 27 session.