Alameda County’s public health system is a nightmare for workers and patients. COVID-19 will make it worse.

By Nick French

Highland Hospital in Oakland does not have enough virus-killing disinfecting wipes to go around, so management has asked housekeepers to wipe down beds with reusable cloth washcloths. There aren’t enough face masks, either, so in many departments workers are instructed to use a single face mask per 12 hour shift. Workers have to bring soap from home because the hospital is short on that, too. The hospital also suffers from a lack of ventilators, hand sanitizer, gowns, booties, and HEPA filters, and severe understaffing.

You might think that these conditions are the predictable result of the COVID-19 pandemic, which has been straining hospital capacity all over the world. You’d be wrong. These are everyday, pre-pandemic conditions at Highland Hospital, one of Alameda County’s public hospitals. These hospitals are not-for-profit and publicly funded, and they primarily service working-class patients of color. Highland and the other county hospitals have experienced years of extreme underfunding and mismanagement. This has led to dangerous conditions for workers and patients alike.

With Bay Area coronavirus cases spiking, already overstretched public hospitals like Highland will be pushed past the breaking point. Thousands or even tens of thousands of unnecessary deaths could result, as staff and supply shortages make it impossible to contain the infection and people with treatable conditions go without adequate care. The only way to prevent catastrophe is with massive emergency funding from the county and the state — along with taking the quasi-privatized public health system back under public control.

Crisis in the Alameda Health System

Highland Hospital is one of five hospitals in the Alameda Health System, which also includes four primary care clinics. The Alameda Health System (AHS; formerly Alameda County Medical Center) is the public health system for the county, although it is no longer directly run by the county. As of 1998, AHS is formally independent of the county. It is run by a board of trustees appointed by the Alameda County Board of Supervisors.

According to the 1996 California State Assembly bill which removed AHS from county control, making the health system independent was supposed to “improve the efficiency, effectiveness, and economy of the community health services provided at the medical center.”

Things have not worked out that way: making AHS an independent entity has led to massive dysfunction. AHS is ineligible to receive money from the county’s general fund, and because its buildings and lands are still owned by the county, it does not have the collateral needed to secure private bank loans. This means AHS must ask the county for loans to cover shortfalls.

And ask it has. AHS has been in debt to Alameda County for nearly two decades and as of 2018 still owed over $64 million. A 2015 report by the Alameda County Civil Grand Jury found that much of the health system’s dire financial situation could be attributed to mismanagement by AHS executives and trustees.

This debt has led AHS management to consistently underfund its hospitals and clinics, endangering workers and patients at the same time. Highland nurse John Pearson (who has been publicizing the hospital’s hazardous conditions on Twitter under the handle @OaklandNurse) said, “It’s what you’d expect from a county hospital system with austerity funding and rampant mismanagement: massive budget cuts to direct patient care to fund a software upgrade, contracting out, short staffing, lack of basic equipment, dirty facilities, lack of training and breaks, and issues with safety and bad bosses.”

Pearson also reported emergency room wait times this week of up to 13 hours, flies in the operating room, failure to provide staff to observe suicidal and homicidal patients, patients sleeping and eating on the floor at John George (the county psychiatric hospital), and bodily fluids on beds, curtains, walls, and ceilings. Treating patients under these conditions, he says, encourages injury and infection caused in-hospital — and avoidable deaths.

COVID-19 spells disaster

Highland and other AHS hospitals are utterly unprepared to deal with the unfolding COVID-19 outbreak. Epidemiologists at the Center for Disease Control predict that between 160 million and 214 million people in the U.S. could be infected if strong measures are not taken to slow infection, and between 200,000 to 1.7 million people could die. Between 2.4 million and 21 million people could require hospitalization as a result of the virus.

What does this mean for the nation’s hospitals? Absolute chaos. There are only about 925,000 hospital beds in the entire country, so even in the best-case scenarios the virus will overwhelm hospital capacity. That’s not just a problem for those infected with COVID-19. It means that many people with other illnesses and injuries will suffer serious complications or die because they can’t get treatment.

Italy shows us what this might look like. Due to severe shortage of medical supplies and staff, Italian doctors are choosing to treat those patients with the best shot at recovery, leaving older and less healthy patients to die because they don’t have the equipment to treat everyone. What’s especially scary is that the U.S. seems even worse-equipped than Italy to deal with the virus: where Italy has 3.2 hospital beds per 1000 people, the U.S. has only 2.8.

COVID-19 will create a crisis even for fully funded, properly run hospitals. For places like Highland — where, Pearson reports, management has instructed health workers to reuse single-use masks and is telling housekeepers that “infection control doesn’t matter” — the pandemic will be even more disastrous.

Let’s take our public health system back

The only thing that can prevent a worst-case scenario in AHS is immediate and massive provision of emergency funds to ensure that the county’s hospitals are adequately staffed and equipped to deal with COVID-19. It may be necessary for California Gov. Gavin Newsom to use his executive authority to make this funding available right away.

But we shouldn’t just bail out AHS. The system’s history of mismanagement and fiscal crisis since it was made independent shows that the current model isn’t working. We should bring the county’s health system back under public control, as the union representing AHS healthcare workers (Service Employees International Union Local 1021) wants. Restoring public ownership would save money by cutting out a needless layer of bureaucracy, and it would eliminate the legal barriers that have led to dangerous underfunding of county hospitals and clinics.

Bringing AHS back under public control would also make the leadership of the system democratically accountable to voters, by placing direct responsibility for the system in the hands of the elected county supervisors (rather than an unelected board of trustees). In addition, putting AHS back in county hands would mean that its employees are protected by Civil Service rules. These regulations help protect employees from unfair treatment by management, and help prevent discrimination and nepotism in hiring and promotion practices. At a time when patients need protected, well-qualified caretakers more than ever, measures like these are essential to public health.

COVID-19 is revealing the cracks in our society. Nowhere are these more apparent than in the sorry state of our county’s public health system. We have a choice: we can let this pandemic ravage us, or we can use this moment to transform our system to meet human needs, through the expansion of public ownership and democracy in essential services.