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2014: The Year of 50 year anniversaries!! – Both St. John’s & War on Poverty Turn 50

January 15, 2014

By Jim Mangia, President & CEO, St. John’s Well Child and Family Centers

IMG_5180-22014 is the 50th anniversary for two critical aspects of life in South Los Angeles.  It’s the 50th anniversary of America’s “War on Poverty” and the 50th anniversary of St. John’s Well Child and Family Centers.  St. John’s, founded by the LA Pediatric Society and St. John’s Episcopal Church in 1964, has become a major community based institution, not only as a critical part of the war on poverty in the United States, but the global struggle for health and human rights.  Serving more than 150,000 patient visits a year – more than any other health institution in South Los Angeles – and engaged in a host of service, intervention and prevention programming that goes way beyond the traditional scope of a federally qualified health center, St. John’s embodies the efficient and effective use of private and public resources to attack a seemingly intractable problem (like poor health outcomes, or poverty) head on and with great success.

Political rhetoric aside, the War on Poverty has saved millions of lives and provided food, shelter and hope to tens of millions of children and families who would have been malnourished, or homeless, or without early childhood education or health services if the initiatives had not been developed.  Many of these programs – among them the community health center program – are rated among the most effective and efficient by the federal Office of Management and Budget.  We must never stop engaging all aspects of our community – and both private and public dollars – toward the goal of eliminating poverty in America.

While I was only two when the war on poverty was first announced, I grew up during the time when these programs helped us and many of our neighbors in the working class area of Brooklyn where I was raised.  We lived in “government-subsidized” housing until I was eight, allowing us, in partnership with my grandparents, to save enough money to buy a small house.  And we accessed health care at newly formed community health centers – which were a critical component of the war on poverty.  President Johnson, and every subsequent presidential administration since, recognized the critical importance of primary care access for poor and working class families.

The link between ill health and poverty is well documented and study after study has shown that access to public health insurance and regular source of medical care for families living in poverty – improves life expectancy, health outcomes and (interestingly enough) improves income attainment.  St. John’s has, for 50 years, provided those services and the access necessary to significantly improve health outcomes for hundreds of thousands of patients.

But as the CEO I see firsthand the limitations of the impact we can have because of the lack of resources available.  I would argue that is the major problem with the war on poverty.  From its inception – investment in the effective programming has declined in relative dollars.  The problem with the War on Poverty is not that the programs didn’t work – it’s that they didn’t receive the resources necessary to go deeper and reach more people.  The problem is under-investment.  The cycles of budget cutting even in the midst of the Great Recession is testament to the ongoing failure of government to effectively fund and evaluate anti-poverty programs.

As someone who has been involved in the fight to eradicate poverty since I was a child – and certainly for the totality of my professional career – I believe we need a Marshall Plan to eradicate poverty.  Much like we focused energy, know-how and resources to successfully rebuild the economies and indeed the nations we had defeated in World War II (which are now, two of the strongest economies in the world) – we must marshal a similar effort and a comparable investment to expand the war on poverty into a full-fledged, unrelenting, comprehensive effort.  Only then will we see the poverty rate fall (even in an economic downturn) and will we realize – as we should as the greatest nation on earth – the full eradication of poverty in our lifetime.


The Government Shutdown: Bad for Our Nation’s Health

October 8, 2013

By Jim Mangia

enrollmentIt is truly shocking to me as an American that the leadership of the House of Representatives engineered the shutdown of the United States government.  What is even more disturbing is that they did so in an effort to repeal the Affordable Care Act (Obamacare) – something that had nothing to do with the approval of a federal budget.  Engaging in this level of political brinkmanship is not only jeopardizing the health of our democracy, it is jeopardizing the health of the American people.  The shutdown has resulted in the suspension of funding for many health programs across the country.

Obamacare is the most significant piece of social legislation that has been passed by Congress in 50 years.  Never has a piece of legislation been so attacked – even after passing both Houses of Congress, signed by the President and upheld by the Supreme Court.  And yet the Affordable Care Act would provide health insurance coverage to tens of millions of Americans.  If anyone had any doubts about the need for Obamacare, one need only look at the fact that millions of Americans signed up for insurance on the Obamacare “exchanges” in the first days of the roll out that began last week. Americans clearly want access to healthcare coverage and no attempt by Congress to tie the defunding of Obamacare to the federal budget (and thereby shutting the federal government) can erase that fact.

For St. John’s Well Child and Family Center and community health centers like ours throughout California, the most significant aspect of the Affordable Care Act is the expansion of Medicaid, which will provide public health insurance to an additional 1.4 million low-income Californians come January 2014.  This is critical given the historic lack of access of low-income Americans to healthcare services.  Study after study shows that access to regular medical care increases life expectancy and quality of life.

While St. John’s as a community health center, supporting health for more than 200,000 patients a year, has little direct influence on the dysfunction in Washington D.C. – we feel strongly that the way we can impact is to make Obamacare a success for our patients and our organization.  That has been our unrelenting focus for the last 12 months and we are thrilled to share with you our successes in making Obamacare a reality – on the ground – for tens of thousands of patients throughout Los Angeles.

What does it mean to make Obamacare a success?  For St. John’s it means to engage in a re-engineering of our clinic processes and tasks to establish prevention, innovation and expansion as core functions of our health centers.  The beauty of Obamacare, in our opinion, is that it begins to finally realign and refocus incentives and investments to provide preventive services and patient-centered care.  It creates a major space for innovation and out-of-the-box activities to reorder healthcare priorities and practice.  We have the resources and commitment to make our patients healthier.

The Affordable Care Act invested heavily in primary care expansion – St. John’s alone received several expansion grants totaling more than $15 million that allowed us to open four school-based health centers, renovate and expand our Compton health center and to create a state-of-the-art central campus in the heart of South Los Angeles while tripling our clinic service space.

So while Congress fiddles and jeopardizes the health of our nation, St. John’s and community health centers throughout America (as well as millions of Americans who signed up on the health insurance “exchanges”) are making our voices heard by implementing Obamacare on the ground.


Digging In to Create a Healthier South LA

August 15, 2013

kids-gardeningOn August 10, I paused next to one of the giant mounds of dirt dumped early in the morning just steps from St. John’s Well Child and Family Center’s flagship health center on 58th Street in the heart of South Los Angeles and surveyed the scene.

The entire block was abuzz with more than 100 residents, St. John’s patients and staff and volunteers from Enrich LA and the LA Community Garden Council picking up trash, cutting, sawing and nailing garden boxes together, moving them into place on the parkways down the entire block and shoveling dirt into them. Volunteers crisscrossed the street with wheelbarrows and watering cans, dodging kids who lined up to plant tomatoes and peppers, rosemary and aloe, petunias and more.

It was the first dig-in we initiated to create edible gardens on city-owned parkways—and it won’t be the last. It’s the newest tool we’re using to impact disease in the communities our network of health centers serve because impacting disease before it becomes acute or preventing it altogether is what medicine should be all about.

Residents in St. John’s South Los Angeles service area struggle with grave public health and socioeconomic challenges. A majority live in poverty, 70 percent of adults are overweight or obese, only 11 percent of adults eat the daily recommended amount of fruit and vegetables, and less than one third of children and adults get the respective amount of recommended weekly exercise. The South Los Angeles landscape is also plagued by an over abundance of fast food outlets, corner liquor stores, and empty lots – leaving residents with little to no healthy food options in a city that is renowned for its farmers’ markets and fresh produce.

aloeCreating a block-long garden for health along 58th Street is part of a larger St. John’s vision to promote community interaction, increase access to healthy food & nutrition information, and help community members take active roles in managing diseases like diabetes, obesity, and hypertension. The garden will serve as a living tool to connect community members to healthy foods that can be grown in their front yards or parkways or larger community garden spaces. It will serve as a learning center for our diabetes patients, who already this week watered and walked up and down the block of new gardens for exercise, pointing out the tiny plants that will soon hold vitamin-rich tomatoes.

Helping patients dig in gardens isn’t the only innovative approach we take to health at St. John’s. We also identify and treat children sickened by slum housing conditions (and help get their housing fixed), we provide nutrition counseling and healthy cooking classes, we connect kids and families to green spaces and physical activities, we roll our mobile unit out to meet workers where they are to root out workplace injuries and illness.

We’re going to keep doing all of this work, but keep in mind there is no government agency and few private foundations that pay for prevention programs like ours.  We struggle and scrape together the funds to get them started and maintain them with partner organizations.  But imagine if the American healthcare system was fully engaged in supporting activities that prevented disease on the front end, rather than treating it after it developed on the back end.  Think about how much happier, healthier and productive Americans would be.

diggingSo in our big neighborhood of South Los Angeles, St. John’s is trying to turn the traditional medical system on its head.  We lead by example and collect the data we can to show how effective these prevention programs are.  But how can you show the impact of farms on your street?  How can you show a disease was prevented when a person never gets the disease in the first place?

We’ll see, and maybe one day we’ll figure out how to measure it.  But in the meantime, we’ll keep those Zumba classes rocking, those urban farms tilling, and those nutritional classes humming. Because we believe in more than healthcare services.  We believe in health!

Click here to view photos from the event

The Promise of School Based Health

April 16, 2013

By Jim Mangia, President & CEO, St. John’s Well Child and Family Centers

Jim-Mangia-blogAlready this year, St. John’s Well Child and Family Center has opened two school-based health centers, will open another in May and won approval for yet another, with additional facilities to come. These health centers are more than just buildings attached to schools—they are at the heart of the future of healthcare for children and families in South Los Angeles.

While at the grand opening celebration for our new Washington Prep Wellness Center with Supervisor Mark Ridley-Thomas, the Los Angeles Unified School District (LAUSD) and the L.A.’s Trust for Children’s Health this month, a parent of one of the students there introduced herself to me.  She told me that her daughter had asthma and often missed school because of acute asthma attacks.  There were months when their family would be in the emergency room two, three, four times.  She was so grateful that her daughter’s chronic condition could now be managed on campus by a team of physicians and nurses.  She looked at me with hope and expectation.  “Now my daughter will go to college,” she said.

That conversation expressed all the promise and determination of school-based health centers: increased access and improved health outcomes coupled with enhanced educational achievement.  Students without access to quality healthcare must overcome huge obstacles to learning. With each school-based health center opening, we’re tearing those barriers down. It was especially fitting that the doors of Washington Prep opened on April 4, the anniversary of the assassination of Rev. Martin Luther King, Jr. He said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

It made me so proud to realize a dream St. John’s embarked on over a decade ago, when we opened our first school-based health center at Lincoln High School in partnership with LAUSD in 2001.  Since then, we have opened five more in South Los Angeles and Compton, with two more scheduled—a brand new one to replace an older one at Manual Arts, a new one at Compton High School and even more on the drawing board.

The conventional wisdom is that school-based health centers are too small to allow economies of scale and enough “profit” to warrant the investment.  With more than 10,000 public schools in the State of California, there are just over 200 school-based health centers across the state.  And while I agree that sustainability is an important issue to address, we must look at opening school-based health centers as an issue of health and human rights for our communities.  School-based health centers improve the health of the students, their families and the community at large.

Through our work with patients in our school-based health centers, we have our finger on the pulse of student and community health trends and have been able to develop programming to intervene and focus on prevention efforts.  For example, through a joint effort between L.A.’s Promise, which manages Manual Arts High School in partnership with LAUSD, and our California Endowment-funded school health center there, we provide school physicals to every ninth grade student on campus.  We found that more than 40 percent of the student body was obese or at-risk of becoming obese.  With our old health center—and soon with the brand new one opening in May—we are developing education and health programming to directly intervene on the obesity epidemic at Manual Arts High: direct and focused health interventions and primary prevention activities in real time.

This is the promise of school-based health.  As the centers of communities, schools are uniquely positioned to impact the neighborhoods in which they sit and address the “shocking and inhumane” disparities in health care our children and their families face in South Los Angeles and other underserved communities throughout  America.   Much has changed since the Rev. Dr. Martin Luther King, Jr. expressed those words, and unfortunately, much still remains the same.

But what we have learned is that through partnerships between federally qualified health centers like St. John’s, school teachers and administration and the school district—we can and are improving student and community health and impacting inequality.  There is a severe underinvestment in this model for health despite all the evidence urging otherwise.  To honor and celebrate the life and work of Dr. Martin Luther King, Jr., let’s work to increase investment in school-based health centers as an important cornerstone of continuing to realize the dream.

Obamacare for All

March 18, 2013

Jim-Mangia-blogAmerica’s immigrants have a human right to health

 By Jim Mangia, MPH, President & CEO, St. John’s Well Child and Family Centers

I’m a child of immigrants.  My grandfather emigrated from the slums of Naples to escape Fascism.  He gained his American citizenship by fighting in the first World War.  He worked as a doorman, opening doors for the elite on the upper east side of Manhattan during the week and shined shoes on the weekends to support six children – two of whom died young in the dilapidated tenements of the lower east side.  Despite the hardship, he was proud to be an American citizen and he was forever grateful for the opportunities this country afforded him and his family.  He spoke little English and was proud of his heritage.  Our house was always filled with strangers he had met, more down on their luck than he, who my family would feed and clothe – even though we barely had enough for us.

What he drilled into us every day was the importance of education.  My generation was the first to attend college.  My parents and grandparents did nothing but struggle to make sure we had the opportunities they never did.

Now, almost two generations later, I have the privilege of leading a large network of nonprofit health centers in downtown and South Los Angeles, which provide healthcare to more than 160,000 patient visits each year.  My cousins are doctors, and lawyers and businessmen, with houses in the suburbs and children in the best universities of our country – all as a result of my immigrant grandparents’ backbreaking sacrifices.  The patients who come through our health center doors get care regardless of their ability to pay or their health insurance status.  So many of them are new immigrants, not yet citizens. Fathers from Jalisco, Mexico. Mothers and children from El Salvador. Young men from Guatemala.  Like my grandfather before them, they’re in the United States working to make a better life for themselves and their families and fleeing repression.  They are proud and hardworking and they sacrifice for their children to have the life they never could.

I know who America’s immigrants are.  I sit with them in our health center lobbies every day.  In our waiting rooms I talk to patients like Gustavo, who washes cars for 10 hours a day, on his feet in the baking Los Angeles sun, surrounded by toxic chemical fumes, getting by on barely $10 an hour (if he’s lucky enough to receive enough tips from the car owners).  I see the children of these immigrants whose moldy, roach-infested apartments are making them sick, requiring constant breathing treatments for asthma, or watching our pediatricians pull cockroaches from their children’s infected ears.  Like my grandfather before them, these more recent immigrants are building this country.   They are proud of their heritage and they are grateful to America for the opportunities we provide.  And I believe with every ounce of my being that these patients and indeed everyone in this country have a fundamental right to health.  In fact, isn’t that the very least we can do in exchange for the hard work and dedication immigrants show and have always shown for the American dream?

We have an opportunity as a nation to address the health status and access to care which our immigrant populations are currently denied as politicians in Washington begin the debate over immigration reform including how long it should take for a “pathway for citizenship” for the nation’s 11 million undocumented residents.

My grandfather lived to be an old man because he had health benefits through the Veterans Administration.  My grandmother, ravaged by diabetes, died when I was six.  She didn’t have access to the same benefits, nor could they afford health insurance.  And she died before President Lyndon Johnson began the war on poverty which provided funding to the community health center movement from which the health centers I lead grew.

America’s greatness was built by immigrants, whom we welcomed and rewarded with the honor of citizenship.  Let’s give our immigrant populations the healthcare they deserve so they can fully participate in continuing to build this country – the tradition and promise that was and still is America.  Let’s support them in living their dream.  Without direct access to healthcare services, immigrants often put off accessing care, or they use expensive hospital emergency rooms when they get sick, rather than regularly accessing primary care services at private physician offices and community health centers because they lack health insurance.  This is a huge cost to our society that could be eliminated if newly legalized residents could have access to Medicaid and be allowed to purchase insurance on the state insurance exchanges created by the Affordable Care Act.  But ensuring access to healthcare is more than a cost issue – it is a moral issue.

Immigration reform must include a guarantee of the right to health to every immigrant residing in this country.  Immigrants must be afforded the same right to healthcare that Obamacare provides to all American citizens.  The rallying cry for this effort: “Obamacare for all.” Let’s make sure that our immigrant populations can be healthy and productive members of our society.  Let’s make sure that on day one of the passage of immigration reform, America’s new legal residents will have healthcare access for them and their children.  That’s an America my grandfather would be proud of.

Will President Obama Defend Healthcare Reform?

July 26, 2011


healthcare reform

St. John's Well Child and Family Center

Will President Obama Defend Healthcare Reform?
By Jim Mangia and Dave Regan
Estela Chavez is like many mothers in California. Her two kids want new bikes and the latest Xbox
video game. But what they need is healthcare.
She works more than 60 hours a week at two different jobs, but even so there is barely enough
money for bare necessities. For healthcare for her two children she depends on a statewide
program that covers preventive care for children.
“My son has autism and without healthcare assistance he has no access to a doctor,” Estela said
recently. “I could never afford the medication and behavioral health care he needs to function
without this program.”
While President Obama and Congress are jockeying over the federal budget in Washington, D.C.
people like Estela and her family hang in the balance.
President Obama is talking about closing corporate loopholes, taxing private jets and requiring
the upper echelon of society to pay its fair share, but he is also proposing significant cuts to
programs like Medicaid that if enacted would eliminate basic healthcare for kids. Estela’s
children depend on Medi-Cal, the California Medicaid program for children.
Funding for our nation’s healthcare safety net is most in danger in the recent round of hyperbolic
debate. Republicans are wielding a sledgehammer – demanding to gut the program and move on.
President Obama can stand up for healthcare funding for millions of children and people with
disabilities while protecting the success of his own historic healthcare law passed last year by
looking at states like California that have responsible and efficient programs that have reduced
costs while adding coverage to those in need.
The Affordable Care Act has already extended coverage to dependents up to age 26 and
prevented health insurance companies from denying care to children with pre-existing
conditions. In 2014 the law will dramatically expand coverage for most Americans. For lowincome
people who have no health insurance now, the law calls for more than 16 million to
become eligible for Medicaid.
The program serves 50 million people, the vast majority children and the rest people with
disabilities. Cut the program at the knees now and future benefits will never come to pass and the
effects now will also be catastrophic.
We already see more people delaying care until only a costly dramatic or emergency room
intervention can save them. We see more and more Californians out of work or without good
jobs with benefits. Cut more out of the safety net and we will see nonprofit community clinics,
long the only bastion for low cost preventive care, closing their doors in record numbers.
Hospitals, community health centers and doctors serving low-income Americans would be
disproportionately affected.
Additionally, California will suffer. If Medicaid is slashed, our state stands to lose as many as
28,440 more jobs, and up to $3.7 billion in related revenue according to a new report by the
nonprofit health-advocacy group Families USA.
California just enacted enormous and extraordinarily painful spending cuts to almost every
program, university, hospital, clinic and courthouse in our state and we cannot weather another
round of slashing.
It’s no mystery how important the safety net is for children and families like Estela’s.
We’ve become accustomed to the slow unraveling of the healthcare safety net, rising
unemployment and revenue losses. President Obama can stop these phenomena. California has
done a lot to control the cost of Medicaid and that should be recognized before implementing a
blunt instrument.
Do not betray Estela Chavez and millions more like her. President Obama can take leadership to
protect seniors, people with disabilities and children now.
Jim Mangia is president & CEO of St. John’s Well Child and Family Centers, a network of
federally qualified health centers in South Los Angeles which serve more than 140,000 patient
visits each year.
Dave Regan is president United Healthcare Workers West, which represents 150,000 hospital,
nursing home and in-home care workers in California.

Lead Poisoning: Perhaps the Main Source Behind Chicago’s Youth Violence – Lessons for Los Angeles

June 20, 2011

Lessons For Los Angeles
By Jacqueline Jacobs Caster and Jim Mangia

 Last week, the 5th and final youth was convicted of first degree murder of Derrion Albert, a 16 year old beaten by a student mob near a Chicago high school in 2009.

 During the last several years, there has been an epidemic of deadly violence amongChicago’s schoolchildren.  The crisis recently prompted National Public Radio to dedicate a 7 part series to the topic. Its report included the astonishing fact that nearly 700 children in the city were hit by gunfire last year – an average of almost two a day, with 66 fatalities – and that the number is up over the prior year despite an overall decline ofChicagohomicides to a 45 year low.

 A recent analysis of over 500 children touched by this violence indicated that those most at risk tend to be youth lacking a stable home environment, enrolled in special-ed, skipping school an average of 42 days annually and having behavioral flare-ups at 8 times the rate of a typical student.  The proposed solution was to provide paid after-school jobs and adult attention to those at-risk in order to deprive them of the opportunity to stray. The NPR report also spotlighted other useful strategies such as pairing youth with mentors and initiating programs that create a “culture of calm”.

 While we are not disputing the value of these approaches, there may be another underlying problem – huge unnoticed red flags being vigorously waved:  far higher than average rates at which 1) these children are enrolled in special education and 2) exhibit behavioral flare-ups – both possible indicators of lead poisoning.

 The primary culprit of lead poisoning is substandard housing conditions. Though federal, state and local governments were aware that exposure to lead was directly damaging to children as early as the 1930s, legal bans on lead paint were not passed until 1978.  Most ofChicago’s inner-city children live in pre-World War II housing with limited money available for housing maintenance – a situation that also exists in low-income neighborhoods ofLos Angeles. 

 Multiple studies in leading medical journals reveal that blood lead levels in children as low as 3 micrograms per deciliter can cause serious developmental disabilities and dramatically lowered IQs – perhaps causing the higher than normal rates of special-ed enrollment in this Chicago neighborhood.  Additionally, numerous studies, some dating as far back as 1979, show a strong link between anti-social and impulsive violent behavior in those with childhood lead poisoning. 

 In 1998, Dr. Herbert Needleman compared a group ofPennsylvaniachildren in the juvenile justice system against those with no criminal behavior.  He found that the convicted children had bone lead levels 10 to 11 times higher than their non-offending counterparts.  In the first longitudinal study of the issue, Professor Deborah Denno weighed more than 3,000 factors to see what correlated with incarceration and criminality.   She discovered that an elevated lead level in blood was the single highest predictor of school behavioral problems and the third highest predictor of juvenile crime.

 Currently, the Centers for Disease Control classifies 10 micromoles of lead per deciliter of blood as a dangerous blood lead level – more than three times the level that causes decreased brain function in children.  As a result, most government health agencies will not intervene until a child is severely poisoned, often with levels as high as 30 and has severe irreversible brain damage.  The CDC needs to change its standards.

 InCalifornia, even with the recent passage of SB 460 that empowers government agencies involved to enforce lead safe practices in housing and construction, state and local government has been slow to protect our children.  In response, St. John’s Well Child and Family Center (and a coalition of nonprofit organizations including Strategic Actions for a Just Economy and Esperanza Community Housing Corporation), supported by a $1 million grant from The Everychild Foundation, has created the innovative pilot demonstration project, Healthy Homes Healthy Kids, to dramatically reduce lead exposure in 4,000 children here in South Los Angeles.  The program provides staff to help safely mitigate lead hazards in dwelling spaces of children and, if needed, facilitate legal advocacy.

 The public must demand that government take its lead from such foundation-supported, community-based strategies, and that the CDC revise its acceptable standard for blood lead levels.  Otherwise, our urban communities are likely to see the continued tragedy resulting from youth violence as well as the concomitant problems a concentrated population of brain-damaged individuals will bring to their communities as they age.


 Jacqueline Jacobs Caster is the Founder and President of The Everychild Foundation, a grant-making organization comprised of over 200 local women which has filled critical unmet needs of over 400,000 Los Angeles area children since its founding in 1999.

 Jim Mangia is President & CEO of St. John’s Well Child and Family Centers, a network of federally qualified health centers in south Los Angeles providing medical, dental and mental health services to more than 120,000 patient visits each year.  He is also the founder of the South Los Angeles Health & Human Rights Conference.



A Tale Of Two Cities

February 23, 2011

By Jim Mangia and Bob Schoonover

 Miguel Chaves works at a health care clinic in Compton.

 While tens of thousands of working Americans are in the streets in Madison, Wisconsin battling to keep basic rights as Gov. Scott Walker attempts to usurp collective bargaining and rollback benefits and wages for fire fighters, police officers, teachers, health care workers and others, Chaves has been working with his boss to make his job and the care he provides better.

 Here in Los Angeles, employees like Chaves through their union and in partnership with one of the largest nonprofit community health centers are a critical ingredient for positive change.

 Is this America’s post-modern “tale of two cities?”

 The new partnership between St. John’s Well Child and Family Center and SEIU Local 721, the union that represents clinic workers and thousands of other Southern California workers, will dramatically improve the quality of patient care, enhance worker morale and ensure the stability and growth of the organization.  Our two groups are hammering out the antidote to unchecked corporate influence that is lessening the quality of life for working Americans and their families. We are creating the partnership and the focus that America needs to improve the experience of workers and the quality of goods and services we produce and provide. It’s our future. 

 St. John’s Well Child and Family Center is a network of a dozen federally qualified health centers located in the poorest neighborhoods of South Los Angeles. We provide medical, dental and mental health serves to more than 125,000 patient visits each year.  SEIU, one of the largest unions in the country, is committed to uniting community health care workers, to improving the lives of working people and increasing access to quality patient care.

To St. John’s, an organization steeped in providing the highest quality medical care to L.A. poorest children and families, it seemed right to create a formal partnership with clinic employees. To SEIU and its membership, it seemed necessary to use our collective strength to promote quality health care and a stronger voice for workers.

 At first there were concerns on both sides. Would we be able to create a positive relationship rather than an adversarial one like we are seeing in Wisconsin? Would a union contract create animosity in the workplace? Would management really listen to its employees?

Clinic leadership and the Board of Directors of St. John’s decided to work with the union and proceed “shoulder-to-shoulder” in an innovative unionization process.  SEIU worked in the open and in the end an overwhelming majority of employees joined the union. Frontline healthcare workers, who are those most engaged in providing the direct patient care to tens of thousands of families in need, saw the benefit to our patients of an empowered and enhanced workforce.

For example, Miguel Chaves, who is a case worker at the clinic, now has a clear path to work with management to ensure that the clinic is prepared for the changes new health care reform laws will bring. Chaves, for one, is eager to take advantage of his new contract’s provisions for education and training.   “Training and new skills will help us make sure we’re ready for health care reform before it happens, instead of trying to adapt later on,” he said.

Patient “right-to-health” committees serve to build a unique alliance where the patients can inform healthcare workers of what their needs and desires are as well.  In this model there is one city, not two, united to improve health outcomes.

While Gov. Walker is leading the charge to expand corporate tax breaks and giveaways almost equal to the concessions he is seeking to extract from public employees and Americans for Prosperity, a front group for the billionaire Koch brothers, is working behind the scenes to fund and to foment the destruction of worker rights in Wisconsin; in LA our unique partnership at a South Los Angeles clinic is a model for fairness and social harmony across America. 

While some around the country seek to divide Americans once again by class and work, St. John’s stands proud as a union shop.  With joint employee/management quality of care committees a key part of the union contract we know healthcare services will improve for our county’s most vulnerable residents. 


Jim Mangia is President & CEO of St. John’s Well Child and Family Center.

Bob Schoonover is the president of SEIU Local 721, which represents 80,000 workers in Southern California.

As a Doctor, How do I prescribe Repeal?

January 19, 2011

Richi Manchanda – As a primary care doctor for working families, I am interested in anything that can tangibly address my patients’ health problems. But how do I prescribe Repeal? read more

Proper diagnosis and treatment makes all the difference

April 14, 2010

A man in his late-twenties arrived at one of St. John’s Well Child and Family Center’s clinics complaining of major weight loss, intense thirst and fatigue. The staff was shocked to find that his blood glucose level was 622, far above the threshold considered diabetic (which is anything over 125); his hemoglobin A1C level was 17 (the normal level is 6), which is a general measure of glycemic control over a three-month period. This was the highest such level that the clinician had ever seen. The patient was immediately placed on medications, and came frequently to the clinic for hydration and insulin treatment. He also received intensive nutrition and lifestyle education, and as a result radically changed his entire diet. After three months of this clinical and nutrition regimen, his hemoglobin A1C level was reduced to 6.5, an enormous improvement in glycemic control. St. John’s interventions and the patient’s own determination kept him out of the hospital. His blood sugars are now stable. He is on oral diabetes medication and now needs to come to the clinic just once every three months for a check-up.

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