Contra Costa Herald

News Of By and For The People of Contra Costa County, California

Contra Costa Regional Medical Center earns “A” for safety from national evaluator

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Contra Costa Regional Medical Center (CCRMC) has earned an A grade for hospital safety from the Leapfrog Group, a national nonprofit evaluator of healthcare services.

The Leapfrog Hospital Safety Grade evaluates nearly 3,000 general acute-care hospitals across the U.S. for occurrence of preventable safety problems such as surgery-related infections or complications, observed safety incidents, and the presence of staff training and procedures to prevent errors in care.

The latest grades, released Wednesday, show that CCRMC, which is part of Contra Costa Health (CCH), provides its patients with some of the safest, highest-quality healthcare in the nation.

“Our county’s commitment to health and equity for all underscores our belief that our county’s most vulnerable and lowest-income residents deserve the highest quality medical care,” said John Gioia, chair of the Contra Costa County Board of Supervisors. “We are proud that Contra Costa’s full-service community hospital has been recognized for the excellence and quality of its care.”

Leapfrog assesses several dimensions of patient safety including medication safety, complex surgeries for pediatric and adult patients, maternity care, intensive care unit staffing, patient safety practices, managing serious errors and outpatient procedures.

“It really comes down to our staff. It’s an honor to work with so many dedicated, talented health professionals, all of them focused on delivering the best possible care for our patients,” CCH Chief Executive Officer Anna Roth said. “Their daily efforts are reflected in this grade.”

CCRMC is a full-service, 164-bed county hospital that offers patient-centered healthcare services in a modern hospital, including a 24-hour emergency department, and 10 satellite health centers providing high-quality care throughout the county.

CCRMC has been recognized in recent years for many efforts to improve health in Contra Costa County, including the California Association of Public Hospitals, Cal Hospital Compare and the Lown Institute. In 2020, Leapfrog and Newsweek rated CCRMC among the nation’s top hospitals for maternity care.

“We are proud and grateful to be recognized by Leapfrog for patient safety, because safety is our top concern,” said Dr. Samir B Shah, Chief Executive Officer of CCRMC. “Developing, teaching and following best practices improves outcomes, prevents mistakes and improves our patient’s experience. Our clinical system emphasizes a culture of safety where every staff member knows the importance of their contribution in risk reduction at CCRMC. It’s part of our mission, to care for and improve the health of all Contra Costa residents.”

Read the Spring 2023 Leapfrog Hospital Safety Grade for CCRMC here. 

 

Soil sampling conducted around Martinez refinery to assess health risks from “Spent Catalyst” release

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Proposed samples and refinery locations map. Source: CC Health

Martinez Refining Company area map. Source: Bay Area Air Quality Management District.

A toxicologist hired by the County this week began collecting samples of soil that may have been exposed to metal-laden “spent catalyst” released by the Martinez Refining Company (MRC) into the surrounding community last Thanksgiving. (See related articles here, here and here)

Soil samples are being taken from more than a dozen sites, primarily areas neighboring the refinery in Martinez and Benicia. Collected samples will be sent to a lab to analyze for concentrations of metals associated with the catalyst that may pose risks to human health through skin contact, inhalation or from consuming produce grown in the contaminated soil. Lab results of the soil samples are expected in late May or early June.

“We know the community is eager to find out what’s in the soil in their yards and whether they should be concerned for their health,” said Supervisor Federal Glover, whose district includes the refinery, which is owned by PBF Energy Inc. “The soil testing will help provide residents with answers to those questions.”

The sampling plan was based in part on a plume model map created by the Bay Area Air Quality Management District that showed where the spent-catalyst dust likely traveled. The plan was reviewed and approved by the MRC Oversight Committee, which includes seven community residents, at its April 27 meeting.

The soil sampling and risk assessment are being done for the County by TRC, a Concord-based environmental consulting firm. The risk assessment will also compare levels of metals found in the sampled soil against background levels taken from published academic and regulatory sources.

Catalyst dust fallout from MRC on a car. Source: BAAQMD

On November 24-25, 2022, MRC accidentally released up to 24 tons of metal-laden spent catalyst dust into the surrounding community. MRC failed to notify the County about the incident, which the County learned about two days later from social media, as required by local policy. Initial wipe samples of the spent-catalyst dust taken from surfaces in neighborhoods around the refinery in the days after the accident showed elevated levels of certain metals, such as aluminum, barium, chromium, nickel, vanadium, and zinc.

The most acute health risk occurred at the time of the incident when people could have breathed in the dust and caused respiratory distress. Questions have persisted about possible long-term health impacts, particularly from food grown in potentially contaminated soil exposed to the spent catalyst.

In March, with spring and gardening season arriving, the County’s health officer issued an advisory cautioning residents not to eat food grown in potentially contaminated soil until environmental testing could be completed.

“Residents affected by this release deserve to know if there is any health risk. Contra Costa Health is working as quickly as possible to ensure that accurate information reaches the public about this issue,” said Board of Supervisors Chair John Gioia, who also serves on the Bay Area Air Quality Management District Board of Directors.

For more information on the risk assessment and independent investigation of the November 2022 incident, visit cchealth.org/hazmat/mrc.

 

Three Kaiser Permanente Medical Centers in Contra Costa receive top patient safety rating

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The Leapfrog Group’s biannual safety report gives an “A” to Richmond, Walnut Creek and Antioch locations for limiting patient injuries, reducing medical errors, and preventing infections

By Antonia Ehlers, PR & Media Relations, Kaiser Permanente Northern California

The Leapfrog Group recognized both the Kaiser Permanente Richmond, Walnut Creek and Antioch Medical Centers with a top score of “A” in its biannual Hospital Safety Grades report. After reviewing hospital clinical performance, The Leapfrog Group assigned letter grades to nearly 3,000 hospitals throughout the United States. The Kaiser Medical Centers in Walnut Creek and on Sand Creek Road in Antioch received the same top rating for Fall 2022. Kaiser’s Richmond Medical Center improved from its B rating last fall. (See related article)

Hospitals received grades based on approximately two dozen measures that analyze patient injuries, medical and medication errors, and infections. The Leapfrog Hospital Safety Grades are updated twice annually, in the fall and spring.

This spring, 17 Kaiser Permanente hospitals in Northern California received “A” scores including: Antioch, Richmond, Walnut Creek, Fremont, Fresno, Manteca, Modesto, Oakland, Roseville, San Francisco, San Leandro, San Rafael, Santa Clara, Santa Rosa, South San Francisco, Vacaville and Vallejo. Additionally, Kaiser Permanente hospitals in Redwood City, Sacramento and San Jose received “B” scores.

More than 80% of Kaiser Permanente Northern California (17 of 21) hospitals received an “A” grade. In California overall, only 34% of the state’s hospitals earned the top grade.

“Patient safety is at the heart of everything we do,” said Chris Boyd, senior vice president and area manager of Kaiser Permanente’s Diablo Service Area. “We are honored to be recognized as a leader in patient safety, and we are incredibly proud of our health care professionals who make a difference every day.”

The Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits, released its Hospital Safety Grades after examining publicly available data on patient injuries, medical and medication errors and infections at U.S. hospitals. The report includes data collected by national health care organizations, including the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services. Scores are calculated based on more than two dozen publicly available measures, and hospitals are then assigned A, B, C, D or F grades for their safety records. The grades are released as a free resource to help patients and their families make informed health care decisions.

“Recognitions like this speak to our commitment to safety,” said Sharon Mowat, MD, physician in chief of the Antioch Medical Center. “Our goal is to provide excellent, compassionate patient care of the highest quality and safety to every patient, every day.”

Kaiser Permanente is one of America’s leading integrated health care providers and serves more than 12.6 million members. Nationally, 29 of 39 Kaiser Permanente hospitals, nearly 75% percent, received a Leapfrog Safety “A” grade. In contrast, less than 30% of the nation’s hospitals received an “A” rating.

For more information and a complete list of the hospital safety grades, visit Leapfrog.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 12.6 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. For more information, go to about.kp.org.

 

National Prescription Drug TAKE BACK Day is Saturday, April 22

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Photo: CCCSheriff

On Saturday, April 22, 2023, from 10 AM to 2 PM, the Contra Costa County Office of the Sheriff and the Drug Enforcement Administration (DEA) will give the public another opportunity to prevent pill abuse and theft by ridding their homes of potentially dangerous expired or unused prescription drugs.

“The Take Back event is a great opportunity to dispose of unwanted medication in our homes,” said Contra Costa Sheriff David Livingston. “These drugs could fall into the wrong hands or harm family members. Take Back helps prevent drug addiction and overdose deaths.”

Needles and sharps cannot be accepted; only pills, patches, and liquids sealed in their original container will be accepted. Vape pens or other e-cigarette devices from individual consumers are accepted only after the batteries are removed from the devices.

The service is free and anonymous, no questions asked. Bring your pills for disposal at the following sites:

DROP OFF LOCATIONS

-Sheriff’s Office Muir Station, 1980 Muir Road, Martinez

-Sheriff’s Office Bay Station, 5555 Giant Highway, Richmond

Sheriff’s Office Valley Station, 150 Alamo Plaza, #C, Alamo

-Delta Station/Discovery Bay Annex 1555 Riverlake Rd., Discovery Bay

-Danville Police Department, 510 La Gonda Way, Danville

-Lafayette Police Department, 3471 Mt. Diablo Blvd., Lafayette

-Orinda Police Department, 22 Orinda Way, Orinda

For more information about the disposal of prescription drugs, locations, or the Take Back event, visit: https://www.dea.gov/takebackday.

 

Cancer Support Community and BASS Medical Group form collaboration to increase support to cancer patients, families

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In picture from BASS: CEO Inez Wondeh, MPA, MBA; Jesse Kaestner, BS, RT(T); K. Kenneth Chao, M.D.; Dr. Soheila Azghadi, BASS Medical Group; From CSC: Board President, Donald Duggan; Board VP, Patricia Falconer, MBA; Danielle Bertoni (and BASS), Rob Tufel, MSW, MPH; Margaret Stauffer, LMFT. Source: CSC

Cancer Support Community San Francisco Bay Area (CSC) and BASS Cancer Center, a division of BASS Medical Group, have partnered to develop an automated patient screening process to identify and refer patients at an increased risk of depression, anxiety, and stress to free mental health services provided by Cancer Support Community.

This new referral process is now integrated into BASS Cancer Center’s electronic medical record system. Patients will automatically be provided information for CSC’s services when they indicate an increased risk of mental and emotional stress related to their cancer diagnosis.

“As many as three out of every four cancer survivors experience symptoms of psychological distress which can negatively impact clinical outcomes and quality of life,” says Rob Tufel, MSW, MPH, Chief Executive Officer of Cancer Support Community. “Unfortunately, fewer than 10% of patients are referred for support by their medical team. The lack of support is even more pronounced among cancer patients from communities of color and those who have lower incomes as well as older adults.”

CSC Board Member, Patricia Falconer, MBA, notes that “40% of Cancer patients experience financial hardship as a result of their diagnosis. This unique collaboration between CSC and community-based cancer providers is a model of how to increase patients’ access to vital support including financial assistance and navigation.”

This new screening tool was developed by the National Comprehensive Cancer Network––an alliance of 32 leading cancer centers devoted to patient care research, and education––and is designed to look for evidence of psychological, social, spiritual, and physical indicators that may interfere with one’s ability to cope effectively with cancer, its physical symptoms, and its treatment.

“As the number of cancer patients continue to increase, it is vital that we offer not only high-quality medical care but also comprehensive support,” explains Inez Wondeh, MPA, MBA, Chief Executive Officer of BASS Medical Group, “It was really important to us to develop a streamlined process to better address our patient’s needs and partnering with Cancer Support Community, who already provides excellent psychosocial services for patients and families at no cost, was a natural fit. This will make an incredible impact for our patients.”

CSC has locations in Walnut Creek and Antioch. To learn more visit cancersupport.net.

Healthcare workers to protest understaffing at Walnut Creek, Antioch Kaiser hospitals   

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By Renée Saldaña, SEIU-United Healthcare Workers West (SEIU-UHW)

Starting the week of April 10, healthcare workers at medical facilities across California, including Walnut Creek and Antioch, will hold events to speak out against the dangers of short staffing and the effects on patients and caregivers.

On Tuesday, a protest will be held at Kaiser Permanente in Walnut Creek from 11 am to 1 pm and on Wednesday, another protest will be held at Kaiser Permanent on Sand Creek Road in Antioch, also from 11 am to 1 pm.

“After years of understaffing and dealing with the pandemic, we are stretched thin and burnt out. Healthcare workers are leaving the field, and those of us who have stayed are doing the work of two or three people. We can’t give our patients the care they deserve without enough staff,” said Datosha Williams, a service representative at Kaiser Permanente. “We are calling on Kaiser to do what it takes to hire more caregivers so that we can deliver the best care possible for our patients.”

After three years of the COVID pandemic and chronic understaffing, healthcare workers are calling on management to provide safe staffing levels and additional support. Caregivers say that short-staffed hospitals can lead to long wait times, mistaken diagnoses, and neglect, making it harder to give patients quality care.

Even before the pandemic, California faced a massive shortage of allied healthcare workers to care for its aging population — as many as 65,000 workers annually, according to conservative estimates. The stress and the toil of fighting the pandemic has led many to leave the industry, creating a full-blown healthcare staffing and patient care crisis.

A survey of over 30,000 SEIU-UHW members, Crisis in Care, highlighted the short-staffing crisis in California, with 83% of responding healthcare workers saying their facility is understaffed. At the same time, healthcare corporations are reporting record profits.

Contra Costa Health Order to require staff in skilled nursing facilities to continue wearing masks

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After April 3 state order expires

Staff in local skilled nursing facilities (SNFs) will be required to continue wearing masks under a new Contra Costa County health order.

The order, which requires masks to be well-fitted and cover the nose and mouth, will also apply to paramedics, emergency medical technicians, contractors and vendors when they enter these facilities in Contra Costa. The masking order will not apply to SNF patients or visitors seeing their loved ones.

The County’s health order will go into effect on Monday, April 3, immediately after the state’s COVID masking order for healthcare settings expires.

“Requiring staff at SNFs to wear well-fitting masks will help protect their vulnerable elderly patients from being infected with COVID,” said Dr. Ori Tzvieli, the County’s health officer, who is issuing the order. “We know from our experience during the pandemic that the people SNFs serve – seniors with serious underlying health problems – are the ones who are most susceptible to severe outcomes from a COVID infection.”

Since the pandemic began in 2020, 57% of the deaths from COVID in Contra Costa have been among people ages 75 and older.  

There are 30 SNFs in Contra Costa. Skilled nursing facilities provide a higher level of medical care than other long-term care facilities. The order will not apply to assisted living facilities, residential-care facilities or board-and-care homes, although masking is still highly recommended in those settings.  

Hospitals and outpatient healthcare clinics in Contra Costa County will not be subject to the new County order, although local health systems can choose to enforce their own masking policies. Dr. Tzvieli said hospitals have robust infection-control policies and personnel and can determine if and when masking is required.

California’s pandemic-related health emergency ended on Feb. 28. While the state is lifting its masking requirements for healthcare settings on April 3, local health officials can still issue their own masking orders.

Under the County health order, a well-fitted mask is defined as covering the nose and mouth and it’s strongly recommended that SNF personnel use higher-quality masks, such as an N95 or KN95/94, to provide the maximum protection.

County health staff were asked why the order is still necessary when there has been less than a 1% infection rate in the county in the past 60 days and according to a physician at John Muir Medical Center Concord, the latest COVID strain is treated like a bad cold and they no longer hospitalize for it.

UPDATE: According to Contra Costa Health spokesman Will Harper, “The new local order is narrowly focused on skilled nursing facilities and not any other settings. We are focusing on SNFs in this order because they are where we have seen some of the worst impacts of COVID in Contra Costa County, and we are being cautious with removing one of the last major layers of protection in this setting. As we said in the press release, requiring staff in skilled nursing facilities to wear masks will help protect the vulnerable elderly patients they serve.

From March 2020 to August 2022, deaths of residents of skilled nursing facilities accounted for approximately 27% of all deaths from COVID in the County and, looking more broadly, since the start of the pandemic, 57% of the deaths from COVID in Contra Costa have been among people ages 75 and older.”

Allen D. Payton contributed to this report.

 

Contra Costa County physicians union reaches contract agreement with management

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The Physicians’ and Dentists’ Organization of Contra Costa (PDOCC), a labor union representing more than 240 doctors in Contra Costa County’s public health system, announced a contract agreement with county management. 

The agreement was supported by 90 percent of voting PDOCC members and approved by the County Board Supervisors on Tuesday, May 21. It avoids a historic strike which would have impacted operations throughout the county health system. 

The contract enhances the time doctors have to manage their panels of patients and also makes the compensation package more competitive in the Bay Area market. 

The contract addresses many issues PDOCC members raised in their negotiations. During the negotiations county doctors and dentists pointed to high patient caseloads, insufficient time for administrative tasks, long waits for primary care appointments and specialty referrals, chronic short staffing and high turnover – all of which combine to negatively impact patient care and health impacts. 

“Our new contract advances our goal of improving the ability of Contra Costa County to recruit and retain top medical and dental talent to best serve our communities,” said Dr. David MacDonald, PDOCC President. “We will continue advocating for the patient care issues we called attention to in our negotiations, but we are optimistic about our progress and path forward.” 

 

Kaiser Permanente named among world’s most ethical companies for 5th year in a row

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Recognition honors organizations that demonstrate business integrity through best-in-class ethics, compliance, and governance practices

By Antonia Ehlers, PR and Media Relations, Kaiser Permanente Northern California

Kaiser Permanente is again one of the World’s Most Ethical Companies, according to Ethisphere Institute, an independent group that monitors business ethics.

Companies that receive the World’s Most Ethical Company designation work to improve their communities. They also foster and grow empowered employees while modeling a workplace where ethics and a strong sense of purpose lead the way.

“Kaiser Permanente is committed to improving access to care, having a diverse workforce reflective of our communities, and addressing the inequities, structural racism, and injustices that marginalize our most vulnerable populations,” said Diane Ott, vice president, ethics and compliance for Kaiser Permanente’s Northern California region. “This recognition highlights our on-going efforts to improve the health and well-being of our members, patients, and the communities we serve.”

Some of those efforts in Northern California include:

  • Prioritizing communities that have endured decades of underinvestment. Kaiser Permanente is investing in programs that will close the racial wealth gap by creating economic opportunity for underrepresented communities and supporting programs that focus on addressing racism and trauma.  
  • In 2022, Kaiser Permanente awarded $1.6 million in grants to 20 Northern California agencies for child and family vaccination outreach in areas with lower vaccination rates and to ensure the equitable distribution of the vaccine across communities of color. It is part of a larger $12 million investment in vaccine equity the organization has made to date.
  • We’ve invested in diverse small businesses and programs that provide quality jobs and prepare young people for college and careers. We also increased our purchase of goods and services from businesses owned by women, people of color, and other underrepresented groups.
  • Kaiser Permanente is partnering with homeless service providers, affordable housing organizations, researchers, homeless advocates, and city and county officials, working together to build a more robust and coordinated homeless response system to improve the health of our communities. ​​
  • We have invested $30 million through the Kaiser Permanente Mental Health Scholars Academy, to expand the pipeline for new, culturally diverse mental health clinicians across California. This includes offering eligible Kaiser Permanente employees the opportunity to pursue masters and doctorate degrees in mental health fields through our own and affiliated degree programs, with a focus on increasing diversity and representation in the mental health workforce. This will help impact communities where demand for services exceeds the availability of highly qualified mental health professionals.

Best-in-class practices

Kaiser Permanente is one of 135 honorees in 19 countries being recognized. In addition, Kaiser Permanente is one of only 2 organizations recognized in the Integrated Healthcare System category for 2023.

Honorees are scored based on an evaluation of their ethics and compliance program, culture of ethics, corporate citizenship and responsibility, governance, and leadership and reputation.

“Ethics matters. Organizations that commit to business integrity through robust programs and practices not only elevate standards and expectations for all, but also have better long-term performance,” said Ethisphere CEO, Erica Salmon Byrne. “We continue to be inspired by the World’s Most Ethical Companies honorees and their dedication to making real impact for their stakeholders and displaying exemplary values-based leadership. Congratulations to Kaiser Permanente for earning a place in the World’s Most Ethical Companies community.”

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 12.6 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. For more information, go to about.kp.org.

Healthcare workers protest short-staffing at John Muir Concord Medical Center

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Healthcare workers protest at John Muir Concord Medical Center on Wednesday, March 15, 2023. Photos by SEIU

“The union’s accusations of patients not receiving meals, dangerous working conditions and lack of investment in our employees, are completely false.” – John Muir Health PIO Ben Drew

By Allen D. Payton

Healthcare workers are gathered at John Muir Health, Concord Medical Center today, Wednesday, March 15, beginning at 11 a.m. until 1 p.m., to protest unsafe staffing levels and their employer’s lack of investment in their workforce. Members of SEIU-United Healthcare Workers West are wearing their uniforms picketing, carrying signs and speaking about what they claim is the hospital’s failure to invest in its patients and caregivers.

According to a press release from the union, “John Muir Health, Concord Medical Center employees say conditions are dangerous for caregivers and patients as management ignores concerns about understaffing and working conditions. Workers are worried about patient and staff safety and say they’ve been pushed to the limit by their employer. They are calling on their employer to listen to and work with healthcare workers to address the staffing crisis through ongoing contract negotiations.”

“We care a lot for our patients, but management isn’t giving us the support we need. Staffing shortages are hitting all departments at our hospital,” said Brian Mynatt, a dietetic technician at John Muir Health, Concord Medical Center. “One of the best ways a patient can recover from an illness is through food and nutrition. But, when we don’t have the staff to get patients the meals they need, it puts their health at risk.”

However, spokesman for the healthcare provider, Ben Drew refutes the claims. In a response statement issued, yesterday he wrote, “The union’s accusations of patients not receiving meals, dangerous working conditions and lack of investment in our employees, are completely false.”

Located at 2540 East Street, John Muir Health, Concord Medical Center’s refusal to invest in its workforce comes in the midst of a healthcare staffing crisis across the state. California faces a massive shortage of allied healthcare workers — job classes that include medical assistants, respiratory therapists, emergency room workers, licensed vocational nurses, lab assistants, housekeepers, and many other frontline staff. 

SEIU-United Healthcare Workers West (SEIU-UHW) is a healthcare justice union of more than 100,000 healthcare workers, patients, and healthcare activists united to ensure affordable, accessible, high-quality care for all Californians, provided by valued and respected healthcare workers. Learn more at www.seiu-uhw.org.

John Muir Health issues statement responding to SEIU-UHW informational picketing at Concord Medical Center

John Muir Health issued the following response to the protest: “SEIU-UHW and John Muir Health just began bargaining for a successor contract for the Concord Medical Center. The current agreement expires in mid-April and we’ve held one bargaining session to date.

The union’s accusations of patients not receiving meals, dangerous working conditions and lack of investment in our employees, are completely false. Notably, not a word was said at yesterday’s bargaining session about patients not receiving meals. At all times, the health and safety of our patients, staff and providers is our top priority.

Like all health systems, JMH has been facing staffing challenges. We have worked hard to address those challenges by hiring 1,125 new employees in 2022, and that hiring process continues.

We have a long history of constructive relationships with the unions that currently represent employees at our Concord Medical Center, including SEIU-UHW. We hope to continue this practice going forward and reach a fair agreement on a new contract. We will continue to bargain in good faith.”

Allen D. Payton contributed to this report.