“Trail of death”: Staffing crisis sparks largest health care strike in U.S. history

The day before close to 85,000 Kaiser Permanente workers in several states hit the bricks in the largest healthcare strike in American history, the Washington Post reported the results of an explosive year-long investigation that revealed the country’s life expectancy was cratering in large measure thanks to premature deaths due to chronic illness.

“Sickness and death are scarring entire communities in much of the country,” the newspaper reported. “The geographical footprint of early death is vast: In a quarter of the nation’s counties, mostly in the South and Midwest, working-aged people are dying at a higher rate than 40 years ago,” the Post found. “The trail of death is so prevalent that a person could go from Virginia to Louisiana, and then up to Kansas, by traveling entirely within counties where death rates are higher than they were when Jimmy Carter was president.”

The WAPO lede was to the point.

“The United States is failing at a fundamental mission — keeping people alive,” the newspaper declared. 

“After decades of progress, life expectancy — long regarded as a singular benchmark of a nation’s success — peaked in 2014 at 78.9 years, then drifted downward even before the coronavirus pandemic,” the newspaper reported. “Among wealthy nations, the United States in recent decades went from the middle of the pack to being an outlier. And it continues to fall further and further behind.”

For several years before the pandemic, the U.S. healthcare for-profit healthcare system was repeatedly rated as the most expensive with the poorest health outcomes of the dozens of its peer OECD countries. In 2018, CNN reported the United States would “take the biggest drop in ranking of all high-income countries, falling from 43rd in 2016 to 64th by 2040, with an average life expectancy of 79.8. The US will be overtaken by China, which rises 29 places to 39th in the table.

Today’s three-day walkout from Oct. 4 to Oct. 7 by the Coalition of Kaiser Permanente Unions is being staged by eight unions including members of SEIU and OPIEU in California, Colorado, Maryland, Oregon, Virginia, Washington, and Washington D.C.

Staffing, along with higher wages are key demands.


Healthcare unions have been sounding the alarm about what they call the acuity crisis years before the COVID pandemic which has so far killed more than 1.1 million Americans and permanently affected millions more. This nurses’ clarion call has been largely ignored by most elected officials, who all too often are reliant on the millions of dollars in campaign donations from the medical industrial complex that includes nominally non-profit conglomerates that pay their CEOs Wall Street-scale salaries.

And while the ongoing UAW and SAG-AFTRA strikes have commanded national media attention, the growing labor unrest in the healthcare sector is raising significant unaddressed public health concerns that affect the well-being of the entire nation’s population.

As a direct result of this unaddressed national acuity crisis, healthcare unions have had to move up the incorporation of staffing-nurse patient ratios into their top contract demands, on, or above wages and benefits. A healthcare staffing crisis that existed before the pandemic has only worsened, as more and more nurses are opting to leave the bedside after COVID required they put themselves and their families at risk of infection.

The government’s inattention to the deepening national wellness and healthcare staffing crisis has had consequences. Yet, the constant stream of pharmaceutical and healthcare advertising promotes the notion of the exceptionalism of American medicine, which as the Washington Post reports, is actually failing spectacularly at extending the average American’s life.

While the U.S. is just 4 percent of the world’s population it was 12 percent of the global death toll, medical experts explain in part, because such a large portion of the country was chronically ill and lacked access to healthcare before the pandemic.

According to the Guardian newspaper and Kaiser Health News, 3,600 nurses died in the first wave of COVID, 700 of them in New York and New Jersey, with two-thirds of them people of color. Many thousands more are believed to have lingering health issues in addition to dealing with PTSD from having to attend to a mass death event that could mean several deaths a day.


“Our patients are much more likely to be sicker than they were when I started bedside nursing thirty years ago — they don’t come in for one thing — it’s a complex of underlying co-morbidities like diabetes and heart disease,” said Judy Danella, RN, president of the United Steelworkers Nurses Local 4-200, which has, since Aug.4, been striking for safer staffing at the Robert Wood Johnson University Hospital in New Brunswick, NJ. 

The  RWJBarnabas system is a not-for-profit healthcare giant with a dozen acute care hospitals and a partnership with Rutgers University. The system has 38,000 employees and $6.6 billion in revenue. It relies on hundreds of millions of dollars in tax-exempt state-issued bonds for capital construction. The system’s recently-retired CEO and President Barry Ostrowsky earned $16 million in the second year of the pandemic, making him the highest-paid hospital executive in the New York area, according to Crain’s New York .

The hospital system’s latest IRS 990 filing includes links to dozens of “related organizations taxable as partnerships” that are identified with non-descript and anonymous-sounding names like Medmerge LLC or Jersey ASC Ventures LLC. There’s a C-corporation Major Investigations Inc., which is listed as “security”.

Under Schedule F in its IRS filings which catalogues its financial “activities outside the United States,” it describes “program services” listed in Central America and the Caribbean that’s a “financial vehicle” worth $41,174,204.   

For its public relations strategy, management is relying on MWW [MikeWorldWide], the powerhouse firm founded by Michael Kempner, described by  Politico as a “major Democratic fundraiser who bundled millions of dollars for Barack Obama’s campaigns.”  

According to Kempner’s LinkedIn profile, he is “active in progressive politics, having played roles in the presidential campaigns of Barack Obama, Hillary Clinton and most recently, Joe Biden.”


USW Local 4-200 has had just two meetings with a federal mediator with a third scheduled for this Friday. Last month, RJWBarnabas cut the healthcare coverage for the union’s 1,700 members and embarked on a major public relations campaign to discredit the union. The union rank and file responded, however, by reaffirming their strike vote at the request of the federal mediator.

In a sign of RWJBarnabas’s virtual lock on New Jersey’s power structure, it recently hired George Helmy, Gov. Phil Murphy’s longtime chief of staff, who had been speaking with the union leadership a few days into the strike and prior to the announcement of his new position several weeks later.

“I can think of no more respected policy leader in our region than George Helmy, and we are incredibly pleased to have him join our team,” said Mark E. Manigan, president, and CEO for RWJBarnabas Health “His depth of knowledge on a wide variety of issues facing our state is unparalleled, and we recognize that his contributions to advancing our mission of service to our patients and community will be significant.

One of New Jersey’s 40 state senators declined to comment on the nurses’ plight, noting he had an adult child who worked at RWJBarnabas. Last month, a judge restricted the union’s picketing at the New Brunswick facility, which is also the construction site of a billion-dollar expansion of a cancer center that bears the name of Jack Morris, a Democratic donor and philanthropist, who also chairs the RWJ University Hospital board of directors.

RWJBarnabas multi-million-dollar ad buys go a long way in a local news media market scrambling for revenue.

Back in 2021, SEIU 1199 won a union vote at another RWJBarnabas hospital, Clara Maass Hospital, in Belleville, NJ. Despite a recent agreement on higher wages, the represented members still are without their first contract. In a statement to Work-Bites, the union put their local struggle in the broader national context.

“Serious strains on our healthcare system existed well before the COVID-19 pandemic, including major staffing shortages, a growing mental health crisis, the opioid epidemic, and the need for more long-term care services in an aging society, COVID-19 intensified all of these related issues,” SEIU 1199 asserted. “Frontline healthcare workers know what’s at stake for the health of millions of Americans if hospital systems do not invest in raising standards for staffing and care, which is why they are raising their voices in New Jersey and across the country.”

The renewed push for staffing requirements and higher pay comes as a national survey predicted New Jersey would be shy 11,400 nurses by 2030, ranking it in the top ten state with a severe shortfall. Also, in that crisis mix Connecticut (27,926), New York (18,784), and Pennsylvania (16,430).

According to the American Hospital Association, 100,000 nurses left their profession over the last two years “due to stress, burnout and retirements, and another 610,388 reported their intent to leave by 2027,” according to a study released by the National Council of Nursing.


Like RWJ Barnabas, only larger and multi-state, Kaiser Permanente is a multi-billion-dollar non-profit that paid its CEO $16 million annually.

“We’ve been raising the alarm about patient safety, but Kaiser isn’t hearing us. Kaiser executives keep refusing to listen to frontline healthcare workers on the issues that impact the care of our patients, and they’re violating the law by failing to bargain in good faith,” said Katrina Schaetz, OB-GYN clinical assistant, in a union statement. “We are standing up for more staff and better patient care. If Kaiser doesn’t stop committing unfair labor practices, healthcare workers are prepared to go on strike.”

“Our team is available 24/7 to continue bargaining with the coalition until we reach a fair and equitable agreement,” Kaiser Permanente said in a statement. “We remain optimistic that there is still time to find agreement before any of the work stoppages called by the unions begin at 6 a.m. on Wednesday.”

The nation’s largest non-profit hospital chain defended its current pay scale asserting that it led “total compensation is every market where we operate, and out proposals in bargaining would ensure we keep that position.”

“Kaiser used to hold itself out as the best place to get care and the best place to work, but it is now failing at both. Kaiser can and must do better,” said Linda Bridges, president, OPEIU Local 2. “We are demanding Kaiser bargain in good faith, stop violating the law, and address the healthcare staffing crisis. That is why today we have joined tens of thousands of our fellow Kaiser healthcare workers in voting to authorize a strike over unfair labor practices.”

“Even as some frontline healthcare heroes live in their cars and patients wait longer for care, Kaiser released new financials this month indicating they made $3 billion in profit in just the first six months of this year,” according to a press release from OPEIU Local 2. “Despite being a non-profit organization — which means it pays no income taxes on its earnings and extremely limited property taxes — Kaiser has reported more than $24 billion in profit over the last five years.”

In addition to Kaiser’s CEO, 49 executives at Kaiser get more than $1 million annually. “Kaiser Permanente has investments of $113 billion in the U.S. and abroad, including in fossil fuels, casinos, for-profit prisons, alcohol companies, military weapons, and more,” according to OPEIU Local 2.

Back in the spring, HPAE, New Jersey’s largest nurses’ union, with the strong support of the NJ AFL-CIO, held a major rally launching a statewide campaign to get Trenton to enact nurse-to-patient staffing ratios as was done in California in 2004. In the years since, peer-reviewed studies documented that California saw greatly improved patient outcomes, workplace safety, as well as nurse retention.

Debbie White, RN, is the president of HPAE which represents 14,000 nurses and healthcare professionals. In a response to a Work-Bites query, White wrote the national Kaiser Permanente three-day strike “highlights the critical need for staffing legislation in every state. All healthcare workers across the country have felt the impact of deliberate understaffing and, as a result, they are severely stressed and burned out. Even before the pandemic, hospital administrators were cutting staff to maximize profits. Now, we have a crisis in healthcare.”

“The national strike at Kaiser Permanente — prompted by growing concerns over staffing and safety as well as bad-faith bargaining — echoes the struggle of New Jersey nurses who are demanding improvements in jobs and care at hospitals affiliated with RWJBarnabas Health,” wrote SEIU 1199 in a response to a Work-Bites query. “Emerging from the greatest public health crisis in generations, healthcare workers are raising the alarm that hospital conglomerates must be accountable to the communities they serve and respect the voices of professional caregivers.”

The union statement continued, “It is outrageous that at Clara Maass Medical Center, for example, management has consistently rejected nurses’ call to have input in health, safety, and staffing committees. How can a hospital seek to improve standards of care if it refuses to hear the concerns of the very people who provide it?”

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