The executive team fought unionization ferociously--  we were fomenting discord and destroying the clinic, and how could we do this to the community?

When I went to work at La Clinica de la Raza in Oakland, California, it was my dream job, the reason I went into medicine.  It was founded by activists in the Berkeley School of Public Health to address needs of the Spanish-speaking community, and had a strong Community Health Education (Casa CHE) component.  They used an approach inspired by Paolo Freire, and worked with community members to diagnose the root causes of health disparities—mainly “social determinants of health” such as safe streets, access to medical care and fresh foods, and mental health stresses arising from immigration, language, and poverty. In keeping with this holistic approach, there were also dental, eye, mental health, social services, nutrition and medical care services, where I fit in.

By the time I started in 1980, the clinic was still less than ten years old, but already had around a hundred staff.  There was a culture of dedication to the mission, and a flattened hierarchy.  Every Wednesday we would have meetings in the waiting area to discuss business matters, with occasional clinic-wide meetings.  Funding for community health centers is notoriously precarious, cobbled together with grants and contracts. It may have been at the first clinic-wide meeting I attended, where people actually voted to reduce their hours and forgo salary to keep the clinic afloat.

But more trouble was brewing.  The original founders had moved on, and were followed by several executive directors who didn’t endorse this collective approach.  Unilateral changes began, to the outrage of the staff, who felt disempowered and disrespected.  People groused, shared rumors, lobbied the Board, and even protested to the founders (which did not go well).  This culminated one day when we were informed that the personnel manual, which had been drawn up by staff some years earlier, had been replaced with a new one, with no input, and which no one was allowed to see—which was clearly ridiculous.  We were not a collective and did not have a say.  The clinic was a corporation, and we were employees.

This was a particularly painful conclusion for the Casa CHE staff.  But if we were only employees, we needed to protect ourselves from what was not a benign leadership, and the answer was, reluctantly, to unionize. Since the clinic had been born in the penumbra of the United Farm Workers Union movement, one might think this would have been a more popular option than it turned out to be.  It was hard for the staff to accept that we would have to institutionalize an adversarial relationship, especially since many of the most progressive and dedicated staff had taken on administrative responsibilities, and would now become “management”. Meanwhile, the executive team fought unionization ferociously–  we were fomenting discord and destroying the clinic, and how could we do this to the community?

The staff persisted making good trouble however. We interviewed several local unions, and settled on SEIU 535, with the health professionals opting to join everyone else in a single bargaining unit.  That was just the beginning—we still needed a contract!  I was on the negotiating committee, and we spent hours poring over every word and letter in our proposal, and debating every counter-proposal in detail.  After nearly a year of slogging through, we finally recommended a contract that had, for the first time, a salary scale with step increases, a progressive discipline and grievance procedure that could involve outside adjudicators, a clear description of leaves and benefits, and a provision for a union-management committee. It passed.

The union also taught me meeting skills, plus the power of the pen and the newsletter.  After a few years, when there was a vacancy, I applied for the Medical Director position to see if working as a flak catcher on the “dark side” could better support the work of the staff. After flailing about for an alternative, and with great reluctance, management offered me the job.  It was to start in a few months, after the current round of negotiations was over.  Of course, the negotiations stalled, and I was still responsible for representing the union until the new position began.  I felt I had no choice when I was asked to hold a bullhorn in the clinic parking lot, and rally the staff against voting for the contract, on the day before I was to start as management.  And when I walked into the management team meeting the next morning at 9 am, it was dead silent.

Going forward wasn’t easy, and governance of non-profits is not simple.  As always, communication and relationships are critical.  But the union gave us rules to live by, and when financial concerns arose, the staff was protected by the terms of the contract. It didn’t destroy the clinic.  It stabilized the staffing, and the clinic continued to grow over the years to become one of the largest community employers in the region.