SACRAMENTO — The California Primary Care Assn. and five clinics filed a civil lawsuit in federal court Friday accusing SEIU-United Healthcare Workers West and its president, Dave Regan, of racketeering and using ballot initiatives to “shake down” community health centers.
The association alleges that Regan and his union orchestrated a “multi-year campaign of coercion, threats, and economic pressure” to “extort” what the lawsuit describes as “valuable property rights” and “labor-organizing terms” from CPCA and the health centers the association represents in California, according to a copy of the complaint obtained by The Times.
The suit says Regan pushed Proposition 44, which if approved by voters in November will restrict spending at nonprofit community health clinics, as political leverage against the industry. Regan then offered to call off the measure if CPCA agreed to support the union’s efforts to unionize 25,000 industry workers, the lawsuit states.
In the complaint, CPCA estimates that 25,000 new union members would generate $2.37 million in monthly revenue from dues paid to UHW.
“This is about Dave Regan and UHW in particular adopting a strategy to create harmful legislation and harmful ballot initiatives to force people to the table to negotiate favorable agreements that will benefit them financially and then when those agreements don’t go through, they allow these initiatives to go through to create punishment for the organizations that can’t come to terms, and then they keep coming back, over and over and over again,” said Brandon Thornock, chief executive of plaintiff Shasta Community Health, echoing claims in the lawsuit.
“It’s a complete waste of resources and it’s amoral.”
A spokesperson for UHW did not immediately respond to a request for comment on the lawsuit. In an interview in July, Regan denied asking the clinics to support his unionization efforts in exchange for dropping Proposition 44.
“We wanted to construct a relationship with the clinic association that prioritized appropriate funding of the community clinics in California, including restoring the healthcare cuts that were introduced by the ‘One Big [Beautiful] Bill,’” Regan said previously. “It was a strategic relationship where we’re working in a mutually cooperative way to properly fund the healthcare system to respect workers, and they were not interested in that.”
Regan is a powerful figure in California politics who has a history of using the ballot box to try to force the healthcare industry to unionize. The union leader has come under scrutiny this year over claims about his extreme political tactics, intimidating behavior toward and threats against women, and an allegation of assault more than 15 years ago, all of which he denies.
Regan is also the architect of California’s billionaire tax, a proposal on the November ballot to apply a one-time 5% tax on the net worth of billionaires that has splintered labor and divided Democrats.
The CPCA lawsuit, in the federal court in the Eastern District of California, alleges that Regan’s political tactics are not designed to win initiatives, “but to subjugate and terrify.”
The union, the lawsuit states, has filed dozens of punitive ballot measures in California “targeting hospitals and dialysis providers with the implied threat or directly stated purpose of coercing health care providers into acquiescing to their union organizing or bargaining demands.” UHW has spent over $216 million, the suit says, on measures to “harm patients, destroy services, and drive providers out of business.” The vast majority of the UHW-backed measures have been withdrawn, usually after the industry agrees to concessions, the suit states.
“No other singular entity or individual has engaged in such widespread corruption of California’s initiative process,” the suit states.
Proposition 44 requires that community clinics spend 90% of revenue on patient services, which Regan has said ensures that money is aligned with the mission of the health centers.
CPCA and health centers say restricting the funding would dramatically reduce money for other essential services and leave some clinics at risk of closing their doors.
The CPCA lawsuit alleges that Regan’s demands on Proposition 44 were sent in an email in January from a legislative staff member on behalf of the union. The offer, presented as a joint submission from UHW and two union affiliates, included a requirement that community health centers “hold elections for at least 5,000 employees in each of five years the agreement would be in effect, resulting in elections for 25,000 employees over the five-year period.”
The complaint says the email also disclosed that UHW said it would drop the initiative if CPCA agreed to the terms.
“The e-mail unambiguously shows that UHW and the Union Affiliates — bullied and instructed by Regan — agreed and intended to participate in an endeavor to abuse the ballot initiative process to extract valuable labor concessions from CPCA and CHCs, in violation of federal and state law,” the complaint states.
Negotiations to withdraw the measure fell apart on June 24, the day before the deadline to rescind initiatives from the statewide ballot.
The lawsuit alleges that the union offered a new deal that same day.
“UHW would withdraw the Clinic Penalty Initiative if, in exchange, CPCA reversed its opposition to UHW’s billionaires’ wealth tax initiative and took the funds it raised to oppose the Clinic Penalty Initiative and instead used that money to assist UHW in passing its wealth tax,” the lawsuit alleges. “The next morning, Regan, through an intermediary, offered the same ‘deal.’ CPCA refused to entertain such discussions.”
The lawsuit states that California’s community health centers served 6.7 million people in 2025 and 67% are enrolled in Medi-Cal, state subsidized healthcare coverage for low-income Californians. In many rural areas, health centers are sometimes the only source of primary care.
Thornock said Shasta Community Health has patients who travel more than an hour to get care and provides a program that transports them to health facilities. Under Proposition 44, the program would not be considered patient services.
“It was designed to create for us what becomes an existential crisis in many cases,” he said.
The CPCA lawsuit states that Regan and the union began seeking to extort unionization from nonprofit hospitals through ballot measures in 2011 and used the same strategy to try to grow their membership among dialysis center workers beginning in 2017. In early 2022, they began targeting CPCA and health centers through legislation, the lawsuit stated.
The suit also alleges that Regan and UHW are in violation of a California law that prohibits a proponent of a ballot initiative from seeking, soliciting, bargaining for, or obtaining any money or a thing of value from any person or entity for abandoning or preventing an initiative from moving forward.
A week before the lawsuit became public, The Times reported that independent investigators hired by SEIU found in a report that Regan had tried to “extort” an SEIU state council endorsement of the billionaire tax from other California union leaders. An outside law firm that investigated internal charges against Regan found that he suggested to David Huerta, then president of SEIU California, that the state council could be investigated for “governance issues” if the council did not endorse the billionaire tax on the November ballot. The state council later voted to remain neutral on the measure.
The law firm’s investigation, which was paid for by Service Employees International Union, substantiated an allegation that Regan threatened Tia Orr, executive director of SEIU California, over the council’s position on the ballot measure. The SEIU probe found an allegation that Regan also assaulted one of Orr’s predecessors in the job, Courtni Pugh, in 2009, to be credible.
A second investigation conducted by an outside law firm hired by SEIU California found sufficient evidence to substantiate a complaint that Regan bullied Jessica Bartholow, the council’s government relations director.
In interviews with investigators hired by the union and with The Times, Regan admitted to swearing at a staff member for SEIU California and adamantly denied bullying, threatening and assaulting women or seeking to force the state council to back his measure.
Regan remains in his job and alleges that he’s being unfairly targeted over his advocacy for the billionaire tax. SEIU, the national umbrella organization that represents local SEIU affiliates, has not taken any disciplinary action against him while an internal administrative review process moves forward.
Sources involved in negotiations over the billionaire tax said Regan also asked for concessions to grow his union in exchange for rescinding the measure from the ballot this year, which The Times previously reported.
Regan’s list of demands included union contracts with two private hospitals and a health clinic, an organizing neutrality agreement with healthcare clinics statewide, recognition of his union from dialysis clinics and for billionaires to remove measures they launched in response to his tax, according to two sources familiar with the talks who were granted anonymity to share details of the discussions.
The union leader called the allegation “categorically false” and denied that he asked for concessions for his union in exchange for removing the billionaire tax from the ballot.
