More than 80 registered nurses, supported by dozens of physicians, struck the Group Health Association, the area's largest health maintenance group, yesterday.
The strike, which followed a breakdown in contract negotiations, was the second in four years to hit GHA, which has an estimated 112,000 members in Washington and its suburbs and usually handles about 2,000 cases a day.
Spokesmen for GHA said that all doctor appointments yesterday were canceled at the five medical centers that the association runs throughout the area. All emergency and hospitalized patients were treated by physicians, the spokesmen said.
Service in some of the centers' 24-hour minor-injury units was badly backed up, however, according to patients interviewed yesterday. Several of those in the waiting room said they had waited as long as two hours or more--about twice the usual wait--to be seen.
One woman, complaining of chest pains, left the system's main medical center at 2121 Pennsylvania Ave. NW, after waiting more than six hours, she said, to see a doctor. Several doctors who said they worked at GHA stood by the nurses' picket line in the front of the building, refusing to cross the line.
Don Mitchell, president of the doctors' union, the Capital Alliance of Physicians, said that, at last count, only six of the union's 100 members crossed the picket lines yesterday.
Bettie Payne, communications director for GHA, disputed Mitchell's count. She said many more doctors reported to work yesterday, but would not be more specific.
She acknowledged that about half the doctors at the system's Annandale center in Northern Virginia did not show up for work. The center's medical staff was supplemented with its administrators who are also physicians.
In 1978, doctors at GHA went on an 11-day strike, the first in the nation against a group maintenance organization. The strike closed three of GHA's clinics in Prince George's, Montgomery and Fairfax counties, and limited service in the downtown clinic to emergency care.
The issues then were malpractice insurance, outside practice and working hours. This time, the nurses, joined by five physical therapists say the issues involve staffing and salaries.
Mary Quinones, a physical therapist and a spokesman for the nurses' union, said much of the group maintenance medical philosophy hinges on medical staff being able to meet with patients and explain to them techniques of preventive care, describing prescriptions and teaching self-help.
"That takes time," she said, "something we don't have much of around here. The biggest issue is staffing. We don't have enough staff to give the kind of care our patients deserve."
Quinones said it is not uncommon for nurses and therapists to spend their lunch and break times--without compensation--meeting with patients. She blamed the administration for not hiring enough regular registered nurses.
She and other nurses said they disapproved of the administration's policy to hire temporary nurses, in what she termed stopgap fashion, to cover staff deficiencies. The nurses want the agency to hire more nurses, but Quinones would not say how many.
GHA executive director Edward J. Hinman said the staffing issue is "nearly resolved," adding that he doesn't believe it ever was a key issue at all. He said the root of the nurses' dissatification is money.
Hinman said the ratio between the systems' registered nurses and their patients has steadily improved since 1979. For example, he said, there were 110,883 GHA members three years ago, resulting in a nurse-patient ratio of five registered nurses to every 30,000 group members. By the first of the year, the ratio was seven registered nurses to every 30,000 GHA members.
At the same time, Hinman said, nurse salaries paid by the association have not kept up with those paid by other medical institutions.
Hinman said GHA offered the nurses a 29 percent salary increase through two years of their three-year contract. Quinones disputed that figure, saying it was "closer to 20 percent."
The average starting salary the association pays registered nurses is $14,627. Salaries range from that figure to about $19,000, Payne said.
Hinman said the nurses' union rejected the offer. Early last night, representatives of both sides were meeting with federal mediators in an effort to resolve the salary and staffing differences. GHA officials said facilities would operate today.