More than 75,000 Kaiser Permanente health care workers – including about 19,000 in the Bay Area – began a three-day strike at dawn this morning, a job action that could cause delays for patients in getting medical appointments, lab results and prescriptions.

After contract talks failed overnight, the walkout started with a small number of employees in Virginia and the District of Columbia, where they set up picket lines outside Kaiser’s facilities.

A majority of the Kaiser employees on strike are in California, where the company is based, and the workers were stationed outside hospitals and clinics on Wednesday. Some other work stoppages also began at Kaiser locations in Colorado, Oregon and Washington.

Doctors and many nurses were not involved in the strike, but Kaiser officials warned that some non-urgent procedures might be postponed, some clinic hours might be reduced and that waits on phone calls for assistance could be lengthy.

Participating union members include support staff and other workers, including X-ray and lab technicians, sanitation workers who disinfect rooms between patients and pharmacy workers who help dispense medications. These workers attend surgeries, run imaging equipment and assist in outpatient clinics.

Kaiser, a large nonprofit health system, provides care under its health plans for 13 million people in eight states. Union leaders say this could be the largest strike by health care workers in recent U.S. history.

Workers in Georgia and Hawaii will remain on the job, according to a Kaiser official, and walkouts are expected to be limited in Washington state. In Virginia and the District of Columbia, only pharmacists and optometrists are striking and are expected to return to work after a day. Maryland workers are not striking.

“Tens of thousands of frontline Kaiser health care workers across the country are ready for an unfair labor practice strike at 6 a.m. today,” the Coalition of Kaiser Permanente Unions, the collection of a dozen unions representing the workers, said in an earlier statement. “Patients and workers need dramatic action now to solve the Kaiser short staffing crisis and to ensure our patients’ safety.”

Kaiser said it had “robust contingency plans in place to ensure members continue to receive safe, high-quality care should a strike occur,” emphasizing that all hospitals and emergency departments would remain open.

Talks appeared to be continuing, after the previous contract expired on Saturday. Earlier on Wednesday, Kaiser issued a statement that the two sides “are still at the bargaining table, having worked through the night in an effort to reach an agreement.”

“There has been a lot of progress," it continued, “with agreements reached on several specific proposals late Tuesday.”

The strains of an acute staffing shortage led to tensions between the unions and Kaiser executives in the run-up to the contract’s expiration. Workers said the lack of adequate staffing at Kaiser facilities created unsafe conditions for patients. The unions argued that Kaiser needed to offer better wages to attract workers and hire enough people to make up for the exodus of staff during the pandemic.

In proposals considered for a new four-year contract, the union had sought a $25 hourly minimum wage and increases of 7 percent in the first two years and 6.25 percent in the two years after, according to a recent proposal.

Kaiser had countered with minimum hourly wages of between $21 and $23 next year, increasing by a dollar a year. Raises would vary among locations.

“It’s so disappointing to see them falling down here,” said Caroline Lucas, the executive director of the Coalition of Kaiser Permanente Unions, which represents about half of Kaiser’s unionized work force.

While the pandemic caused an immediate crisis in which workers were stretched too thin, Lucas said employees had been concerned about short staffing even before Covid hit. “For years, there has been a crisis on the horizon,” she said.

Michelle Gaskill-Hames, regional president for Kaiser Permanente in Southern California and Hawaii, had said earlier that Kaiser was dealing with the same staffing problems as other health systems across the country. The group has fared better than many of its competitors, she said, in limiting turnover and hiring replacement staff. “We have really ramped up on aggressive retention and recruitment strategies,” she said.

The frustrations of health care workers, who feel they are being forced to care for too many patients for too little pay, have been boiling over across the country. Many of the workers who remain feel burned out and are struggling to handle a higher volume of patients. The concern over inadequate staffing resulted in a nurses’ strike in New York City in January, and there were more than a dozen similar strikes this year in California, Illinois, Michigan and elsewhere.

The tight labor market has emboldened many unionized workers, leading to the recently averted strike at United Parcel Service and current picket lines among autoworkers. “Unions are flexing their muscles in a bunch of industries,” said Ruth Milkman, a professor of sociology and labor studies at the City University of New York.

The pervasive short staffing in health care gives workers significant leverage to demand better working conditions and higher pay, she said.

Many nurses are represented by other unions, including the California Nurses Association, which agreed to a new contract in Northern California last December.

The high levels of burnout have exacerbated the staffing shortages, said Ethan Ruskin, a health educator at Kaiser Permanente in San Jose. Patients have to wait longer than usual for appointments, he said, only to face more delays in the waiting rooms.

“If they see something on your mammogram and send you for a sonogram, you’re going to be waiting weeks for a scan,” Ruskin said. “Meanwhile our sonographers have huge injury rates — things like stress fractures — because they are expected to see twice as many patients as they should.

Reed Abelson and Emily Baumgaertner are reporters with The New York Times. Copyright 2023, The New York Times.