Muni operators have always had a tough job. But when coronavirus hit, the long hours, thankless customers and physical demands made the already-difficult work even more taxing.
Those bus drivers, car cleaners, engineers and others at the San Francisco Municipal Transportation Agency have now come to be known as some of The City’s most essential workers.
But at a time when their wellbeing is most at risk, a program known to prevent chronic conditions that exacerbate COVID-19 such as diabetes, obesity and hypertension has been cut.
The BackFirst Wellness Program started in 2001 as a pilot program to treat back injuries in the Presidio and Cable Car Transit Divisions. It’s since grown over the course of 20 years to provide direct health interventions for over 5,000 SFMTA operators across the field as well as at 1 South Van Ness.
Michael Leary, a physical therapist by training and founder of BackFirst, converted an old school bus into a mobile health clinic and assembled a team of wellness professionals to travel daily to at least one of the seven transit divisions. There, they conducted chronic disease health risk screenings, regular blood pressure checks and orthopedic assessments to reduce job-specific injuries.
They’d also drop off big salads or grain bowls for lunch and show people how to lift weights, do bench presses or press their own bodyweight for exercise.
“We were often the very first touchstones of wellness. Many of them had never had access to that kind of information,” Leary said.
Over the last seven years, BackFirst had provided roughly 17,500 blood pressure checks, 3,850 health risk assessments, 19,000 nutritional consults, 20,350 orthopedic assessments and 31,000 exercise training sessions, according to data from the providers.
SFMTA approved BackFirst for its fifth contract in early March, a nearly $1 million per year five-year commitment that would add to its arsenal a full-time mental health professional to provide treatment for anxiety, stress, depression and other ailments faced by workers.
Weeks later, Leary was notified of the program’s total termination by email from Dan Roach, the worker’s compensation manager in the SFMTA Human Resources Department.
Employees got the news in an agency-wide memo two weeks later.
“I know that the wellness services provided through the contract is very important to many and losing it is extremely disappointing for all of us,” SFMTA Director of Human Resources Kimberly Ackerman wrote.
Health care equity
SFMTA operators often struggle to meet ends meet. Many are people of color, and their communities experience higher rates of chronic health conditions such as diabetes or hypertension. And their jobs are physically demanding, putting great strain on their wellbeing.
Leary recalls realizing that many of the people he was seeing would commute from Sacramento or Manteca just to work an eight-hour shift, and that many didn’t have the time to cook a nutritious meal or squeeze in exercise once they got home.
“That was an eye-opener for me,” he said.
Loree Woods-Bowman, 58, has worked at the Woods Division, a Muni bus facility, for six years.
She says she benefited from the program’s healthy cooking demonstrations, instruction about exercises that could be done on short breaks and chair massages to relieve pain from sitting all day.
Woods-Bowman, who describes her body as sometimes “screaming out,” hasn’t received comparable care or stress relief since the program was eliminated.
“In this time we need as much health care as we can get. It should be way down the list of things to cut,” she said.
Comprehensive and preventative health care is a luxury for many people, but especially the majority of people who work as Muni operators. They drive hours each way to get to work, and to visit their allotted annual primary care physician they have to take sick leave.
Cutting BackFirst also cuts these people off from life-giving and, at times, lifesaving care.
“I can’t afford to take the day off. People don’t realize how much it helps to have them at the division, even if you only see them for 15 minutes,” Woods-Bowman said of the mobile clinic.
An SFMTA spokesperson said the agency has worked to connect employees with alternative wellness services so they don’t lose access to valuable care.
The agency has also repeatedly voiced its commitment to equity when determining where strapped resources will be directed in this moment of budget austerity.
Leary says BackFirst is foundational to that very mission as it seeks to correct the health inequities that face operators, many of whom otherwise lack adequate access to care.
“There are no obstacles to prevent equal access for all workers to the health care information and guidance they need,” he wrote in an email. “BackFirst plays an important role in addressing health conditions before they become dire.”
Once the economic impact of the coronavirus came into view, Leary proposed a watered-down version of the contract approved in March that would have distilled services to the core and offered a cost reduction of 65 percent, or roughly $340,000 annually, according to an email he sent the SFMTA director and staff.
Service would focus on high-impact care for frontline workers and especially workers of color, he said, with a focus on preventing comorbidity factors known to exacerbate COVID-19 cases.
“This way, BackFirst could do our part and provide only essential wellness services to workers who need them most,” Leary wrote. “Instead, BackFirst was suddenly canceled completely.”
The SFMTA Board still voted to terminate the entire contract as part of its revised budget passed in June.
In her memo to staff, Ackerman acknowledged this alternative put forth by Leary — though she said it would have cost $500,000 — but said “it still represented a substantial cost to the SFMTA that we could not in good faith proceed forward with.”
Scores of employees who say they’ve benefitted from BackFirst testified over email and during virtual SFMTA Board of Directors public meetings in May and June, asking it not be a casualty of budget cuts.
Paul Lee, who works in the System Safety Division, wrote into the Board of Directors that he received “essential services” from BackFirst care providers, including helping him to walk normally again.
Francis Pang, from the Greens Division Muni Metro Railyard, sent a petition to leadership in May with almost 100 signatures detailing the impacts the program had provided employees in his unit: lifestyle changes, paths to better blood pressure, reduced stress and physical activity, for example.
“The BackFirst team are committed to the idea that strengthening each employee strengthens the SFMTA as a whole,” the attached letter said “For our health and safety, we demand that SFMTA continue to fund the BackFirst Wellness Program.”
Medical professionals, many of whom were part of the team of experts that regularly hosted seminars and workshops for workers, wrote into the SFMTA Board with their full-throated support for its reinstatement.
“The BackFirst services, which are provided in a convenient and supportive setting, are ever more important now, in that they are designed to enhance health and reduce pre-existing conditions that could place our transportation workers at increased risk to COVID-19,” Margaret Chesney, professor of medicine at University of California, San Francisco wrote in her letter.
‘Pays for itself’
If the argument that BackFirst provides essential health care to frontline workers isn’t compelling, Leary says to consider the financial impact its absence could have on SFMTA.
He argues the program pays for itself by preventing work-related injuries and consequently reducing the number of workers compensation claims and lowering health care costs to the agency.
By his calculations, BackFirst would have to prevent two worker’s compensation claims per month to cover the original program cost approved in the most recent request for proposal process, and just one claim per month to pay off the modified version proposed after coronavirus destroyed the agency’s budget.
For its part, SFMTA says it recognizes the high value of the program, but ultimately the economics don’t come down in favor of the price tag when severely limited resources must be directed to the task of keeping everyone employed and guaranteeing service for San Franciscans.
The first priority is to respond to the safety of employees and customers, an agency spokesperson said, closely followed by efforts to avoid staff layoffs.
Supporters of BackFirst go as far as to say the SFMTA will lose workers because they will become ineligible or unable to work due to untreated health conditions.
One professor from the UCSF School of Medicine said “decades of science” show “cutting effective wellness programs from the MTA workers will lead directly to more sick days, more health care expenditures, more burnout and poorer decision making.”
Leary places some of the responsibility on the shoulders of relatively new agency leadership, including Tumlin, Ackerman and CFO Leo Levenson, who haven’t had the opportunity to experience the impact of the BackFirst program or spend much time at the Divisions.
“They’re at 1 South Van Ness, and not in the Divisions,” he said. “They are two different worlds. Sadly, it’s the same company, but it’s not the same company.”
Leary speculated that if the pandemic had struck a year earlier, that C-suite executives would’ve determined “it’s not just popular, but it’s also an economically strong program.”
SFMTA insists it’s not leaving workers without the care provided by BackFirst, and emphasizes it was a decision officials struggled to make.
The agency is working to expand its online tools and resources for Road to Fitness, the program once under BackFirst that provides free workshops, coaching and health indicator tracking.
Much of the information is said to be behind an employee-only portal, which the Examiner couldn’t access, but an SFMTA spokesperson said it includes healthy recipes, ideas for how to get movement and blog posts covering topics such as how to respond to community unrest and how to parent during the pandemic.
Group exercise classes have also been made available virtually through the Zuckerburg San Francisco General Wellness Center.
“We recognize you can’t replace face-to-face contact, but what we’re trying to do now is focus on educating employees so they can better improve their own health using online resources,” an SFMTA spokesperson said.
Leary says an online replacement isn’t viable.
It’s devoid of the years-long trust engendered between patients and providers, it can’t provide truly personalized guidance and it fails at basic follow-up to ensure improvement’s being seen, an assessment backed resoundingly by the doctors who worked with the program and wrote to the SFMTA Board.
He worries vulnerable workers will lose valuable confidants in the BackFirst providers as well as risk falling off track without a person they’re seeing weekly, if not more often, keeping track of progress.
“It’s not just the medical service they provide, but how they provide it. They give you anything you need to reach them, even their phone number, and they’ll help in any kind of way,” Woods-Bowman said. “It was a great thing to have, and a sad thing to lose.”