The California Nurses Association can place its record of campaign wins against any of the other big-time players on the left. But watching its lobbyists work the Capitol halls, I'm left to wonder which side they're on.
At a time when unions are on the decline, the California Nurses Association has had undeniable successes, doubling its size in a 10-year period to 86,000 members and doubling assets to $70 million in the past five years, its latest report to the U.S. Department of Labor shows.
The growth came as the union made its name in politics by mau-mauing Gov. Arnold Schwarzenegger, after he sided with hospitals and tried to roll back a law signed by Gov. Gray Davis that guaranteed nurse staffing levels. In the 2010 campaign, the union aimed its guerrilla theater tactics at "Queen" Meg Whitman, viewing her as a Schwarzenegger clone.
Operating behind the scenes, the union orchestrated the emergence of Nicky Diaz Santillan, Whitman's spurned illegal immigrant housekeeper. Diaz sent the Whitman campaign for a loop five weeks before the election by holding a weepy press conference in the Los Angeles offices of her celebrity attorney, Gloria Allred, recalling how billionaire Whitman fired her.
Three weeks after Jerry Brown trounced Whitman, the San Francisco Chronicle disclosed the union's role in the Diaz matter. Unknown at that time, the union had paid Diaz's immigration attorney $25,000 a week before the election, its Labor Department report shows.
For all its success, however, the union has been taking positions that leave allies in the Capitol scratching their heads. The union insists it defends the interests of patients in its lobbying efforts, not solely the interests of its union members.
"Our prime directive as a board of directors is making sure that any legislation protects the patients," said Deborah Burger, president of California Nurses Association and a nurse at Kaiser-Santa Rosa.
But some of its stands run counter to public health. There is, for example, legislation that would permit registered nurses to dispense birth control pills in community clinics. Earlier this year, there was legislation that sought to expand a program by which nurse practitioners and nurse-midwives provide nonsurgical abortions.
The California Nurses Association contends that the measures could leave poor women with lesser care than people of means. Health care advocates viewed those claims as bogus, and believe the issue comes down to union representation.
Planned Parenthood is the main proponent of both bills. As it happens, Planned Parenthood clinics are not union shops.
Assemblywoman Holly Mitchell, D-Los Angeles, the author of the birth control legislation, is hardly antagonistic toward labor and has spent a career focused on issues related to poor women and children.
In the 1990s, Mitchell was a health policy analyst for the California Senate and later a lobbyist for the Western Center on Law and Poverty, one of the few voices in the Capitol for the underclass. More recently, she was chief executive of Crystal Stairs, a nonprofit that provides child care for 25,000 poor kids in Los Angeles.
"It is a basic woman's reproductive health issue," Mitchell said of her bill, Assembly Bill 2348, which awaits a Senate vote. "I am deeply disappointed that the opposition comes from a female-dominated health care profession, at a time when we are experiencing attacks in public policy settings on women's health choices."
The beneficiaries of her bill would be poor women. Most live in rural areas or inner cities where doctors rarely venture, are between 18 and 29, and have no health insurance.
The bill would allow registered nurses who work in licensed community clinics to dispense the contraceptives, so long they have training and operate under physicians' orders. Other unions representing nurses support the bill.
"It is our mission to increase access to birth control," said Kathy Kneer, the longtime head of Planned Parenthood in California. "We have something we know is safe. The issue is, how do we remove barriers to obtaining birth control?"
There are other examples of the nurses union taking odd stands. The union is fighting county public health officers over legislation that seeks to encourage nurses who work with patients to get flu shots.
Last year, the union fought a bill permitting volunteer public school employees to administer a particular drug to epileptic children who are in the midst of life-threatening seizures. Union lobbyists argued unsuccessfully that nurses should administer the drug, though few schools can afford nurses.
Being an outlier is familiar territory for the California Nurses Association. Most unions sided with President Barack Obama and advocated for the Affordable Care Act in 2009. The nurses union held out for more, Medicare for all, despite the lack of political support for the concept.
All unions struggle for market share. Some see political and social action as the way forward. The California Nurses Association is pushing what it calls the Main Street Campaign, urging Congress to impose a tax on Wall Street transactions.
"We take on fights that are part of the greater public interest," said Chuck Idelson, the union's communication director.
A Wall Street tax will win congressional approval when Congress agrees to universal government-run health care.
With overall union membership shrinking by 10 percent a year, labor's clock is winding down unless labor does something to change public attitudes, Dave Regan, head of the 150,000-member United Healthcare Workers in California, told me the other day.
He is striving to remake his union into one that defends its members and also "is about something affirmative." Working with the Brown administration, hospitals and others, the union has embarked on its Let's Get Healthy California campaign, an effort to fight diabetes and other costly chronic conditions among union members and the public.
The California Nurses Association dismisses labor-management partnerships, as it goes off on its own. Its tactics have worked, some of the time. But a nurses' union that opposes allowing nurses to give birth control pills to poor women should ask itself how long that run of good fortune will last.