(Editor's Note: The following article was published in the print version of
Labor Notes' August, 2000, issue. Some concepts were editorially telescoped
for space considerations. All Massachusetts RNs will be welcome in the new
Massachusetts Nurses Association. The language of the published rationale for
the bylaw proposal on declaring independence from ANA, which is focused on
patient and nurse advocacy, will be included in future issues of this
bulletin. MNA is united in pursuit of passage of Question 5 on the November
7th Massachusetts ballot for universal health care by July 1, 2002, and a
moratorium on further for-profit conversions of health facilities until such
a universal system is in place. Go to <http://www.voteforhealth.org> for
particulars. MNA also vigorously supports the project that sees single-payer
health care as the real solution to the quest for universal, just, equal,
quality care. Voters in some Massachusetts communities will actually be able
to register their support for this as well. Go to
<http://www.masslaborparty.org> for ways to promote this campaign. Go to
MNA's official web site <http://www.massnurses.org> for ongoing information
on these campaigns, as well as for links to many valuable labor, nursing and
healthcare sites. These bulletins and many articles relevant to issues raised
here are archived on 'Sandy's Links' <http://users.rcn.com/wbumpus/sandy>. -
Sandy Eaton, RN)


Massachusetts Nurses Consider Leaving American Nurses Association

by Sandy Eaton

By the end of last year's American Nurses Association House of Delegates
meeting, some Massachusetts delegates had reached the conclusion that efforts
to transform that organization were futile.

The ANA includes nurses who are represented for collective bargaining by
their state nurses association, and many who are not. It has traditionally
tried to be all things to all nurses - including those who are in management
or otherwise allied with corporate health care. The association has at best
pursued a moderate course. That was no longer tolerable to these delegates
from the Massachusetts Nurses Association, who wanted serious advocacy for
patients and bedside nurses. They decided a new beginning would be necessary.

This ferment grew, so that this fall MNA members will decide whether to
divorce themselves from the ANA.

The question will be decided at the MNA annual convention in November, at
which any member in good standing is entitled to speak and vote. A two-thirds
majority is required to amend the bylaws. A vigorous campaign has begun, with
committees pushing each side of the issue.

The precedent for this move is the California Nurses Association, which left
the ANA in 1995, and has successfully focused its resources on organizing and
political advocacy for patients and nurses. The Maine State Nurses
Association will also be considering an independence vote this fall.

Democratize the ANA?

Efforts to democratize ANA in the wake of CNA's departure centered on two
initiatives: an annual staff nurse summit to explore ways to empower working
nurses within their state nurses associations (SNAs) and within ANA, and the
formation of an SNA Labor Coalition.

Various large labor constituents of ANA took turns, from 1996 on, hosting the
annual summit. Minnesota, Massachusetts, Ohio, New York and Illinois each
took a turn organizing speakers and workshops.

In 1997, the nine largest state nurses associations - large because they
successfully pursue collective bargaining programs, which most SNAs are
unable or unwilling to do - formed a coalition to push for a national labor
agenda. The culmination of efforts by this labor coalition was the proposal
to create a national nurses' union within the ANA, which would possibly
consider affiliation to the AFL-CIO.

The resultant United American Nurses (UAN) was approved overwhelmingly by the
1999 ANA House of Delegates. But Massachusetts and Maine objected because the
UAN would not be democratically run by staff nurses. The ANA's executive
director would be the chief executive of the new UAN, hired and fired by the
management-dominated ANA Board of Directors, which in turn is elected by the
management-dominated House of Delegates.

A Massachusetts amendment to democratize the UAN and guarantee an independent
funding stream was resoundingly defeated. In October, the Massachusetts Labor
Program members unanimously voted not to join the UAN. Then in March, the
leaders of this union component of the MNA, joined by two other elected
leadership bodies, put forth proposals to leave ANA altogether.

Coincident to the developing Massachusetts campaign to leave ANA, 600 newly
organized nurses in Worcester moved to the fore by striking Tenet Healthcare
Corporation because of its insistence on the unsafe practice of mandatory
overtime. By their courage and purity of purpose, aided by nurses everywhere
and a broad array of labor and community backing, they in May beat the second
largest for-profit hospital chain in the world.

Divisions, and New Unity

The divisions within ANA were deepened at this year's House of Delegates in
June. By this time many UAN members acknowledged that Massachusetts was right
on the democracy question, but urged us to stay and continue the fight. We
pointed out that reform was impossible, as proven by further efforts on the
floor of the House.

At the convention, Tipper Gore received a standing ovation and then told
delegates that incremental steps toward universal health care were needed.
(Massachusetts had led a decade-long effort, successful in 1999, to get the
House of Delegates on record in support of single-payer universal health
care.) Tenet Healthcare was allowed to have an information booth at the
convention, until MNA delegates' leafletting got it removed.

Many of us wore T-shirts bearing the words across the back, "Ask me! I'm from
Massachusetts." This simple act provoked hundreds of heart-felt discussions
on why many in Massachusetts were actively campaigning to leave ANA.

In the meantime, nurses are organizing in many parts of the country. Strikes
and threats of strikes are on the rise. Nurses are fed up at unbearable
working conditions and threats to patient and nurse safety.

A new beginning, at least for most organized nurses in Massachusetts, is on
the horizon. The tactical support between nurses' organizations that
intensified during the strike in Worcester should lead to closer
relationships. CNA and the new independent nurses union, the 6,000-member
Pennsylvania Association of Staff Nurses and Allied Professionals (formerly
affiliated with the Pennsylvania State Education Association) have formed an
alliance that is aimed at building a national, independent nurses movement.

The Cabinet for Labor Relations of MNA - the executive board of the
association's union section - recently passed a resolution calling for
"exploration of and discussions about future relationships and alliances with
other nurses' groups and associations."

It would be premature to declare the imminent creation of a new national
nurses' federation, but the building blocks of a truly revolutionary
organization are emerging - an organization united not just around the least
common denominator of bread-and-butter issues, but also around the vision and
the program to take on and defeat the industry, inspired by our vanguard in
Worcester, Massachusetts.

------------------------------------------

Hospital Chain's Critics Call Recovery Incomplete

by KATHLEEN SHARP

August 6, 2000

As he built the nation's second-largest hospital chain and achieved stellar
profits in a battered industry, Jeffrey C. Barbakow, the chief executive of
the Tenet Healthcare Corporation, has taken a lot of heat. Over the last
seven years, people from Philadelphia to Los Angeles have watched Tenet buy
their community hospitals, streamline operations and cut back on staff. Labor
relations have suffered. Union leaders and some public health advocates
question whether Mr. Barbakow's economizing will harm patient care,
especially for the poor.

Mr. Barbakow says the financial skills he honed in a career outside the
hospital business have let him improve Tenet's performance for shareholders
and patients alike. But his mission now is to keep patients and employees as
happy as he has Wall Street.

At the least, he has turned Tenet, formerly National Medical Enterprises,
from one of the most scandal-ridden chains into one of the most admired among
its peers and on Wall Street.

Since he took over in 1993, Tenet's revenue has grown fivefold, to $11
billion a year. After four years of erratic earnings, Tenet reported a 20
percent jump in profits for the year that ended May 31, to $302 million, and
its stock price has doubled in the last year.

Many analysts say they think that its days of draconian cutbacks are over.
"Tenet's operating performance has been extremely good in a tough
environment," said John Hindelong of Donaldson, Lufkin & Jenrette. "It could
help undo the damage to the reputation of for-profit hospitals."

As hospital reimbursements have shrunk, especially from Medicare, hospitals
have lost either money or integrity. The nation's largest hospital chain,
Columbia/HCA, paid $745 million this spring to settle the government's
charges that it defrauded Medicare.

Tenet itself has problems in its history. Its predecessor, National Medical
Enterprises, owned the second-largest chain of psychiatric hospitals when Mr.
Barbakow became a company director in 1991. At the time, former patients
contended that employees had routinely restrained and drugged them in order
to loot their insurance funds. In 1993, not long after Mr. Barbakow was hired
as chief executive, F.B.I. agents arrived one morning and seized company
records.

Over the next two years, the company paid more than $600 million in legal
settlements, agreed to install a hot line for employees to report abuses and
started ethics training.

In 1995, the company changed its name to Tenet and next year moved from Santa
Monica, Calif., to Santa Barbara, where Mr. Barbakow already had a home.

But in trying to rebuild his company, Mr. Barbakow faced employees who
already suspected him of being in it only for the money. They recalled how
Mr. Barbakow, a former investment banker, spent two years in the late 1980's
helping Kirk Kerkorian, the financier and deal maker, sell his troubled
MGM/UA Studio. Even though the sale unraveled, Mr. Barbakow pocketed $20
million. "He's a junk-bond salesman who's interested in fees," said Jorge
Rodríguez, an officer of the Service Employees International Union, Local
399, of Los Angeles.

After taking over at Tenet, Mr. Barbakow shed psychiatric hospitals and
focused on acute care. He also consolidated Tenet's purchasing, saving million
s of dollars.

Then Mr. Barbakow acquired weaker chains, like American Medical International
in 1995, and OrNda Healthcorp in 1997.

He sold or closed unprofitable hospitals, some with occupancy rates as low as
20 percent.

The closings forced some patients to travel farther and required some urban
hospitals to absorb more emergency room visitors.

"We often lose access to care for the people who need it most," said Dr.
Michael Cousineau, a professor of health administration at the University of
Southern California. "But it's part of the industry's consolidation trend."
Tenet, in response, says it has increased charity care at some hospitals.

But cases of business practices run amok continue to recur. In 1998, doctors
at two Tenet hospitals in California refused to give poor women epidurals to
relieve their labor pains unless they each paid $400 in cash. Tenet, which
confirmed the episode, reprimanded the doctors.

In St. Louis, an uninsured patient at Lutheran Medical Center, a Tenet
facility, was refused a $1,250 operation in 1997 for endometriosis, a
condition of the uterus that threatens fertility. Lacking the credit to
qualify for even a hospital loan, she borrowed a down payment from her
grandmother.

When Tenet tried to buy the prestigious St. Louis University Medical Center
that year, Archbishop Justin Rigali opposed it, saying, "The poor will pay
the price." Likewise, when Tenet wanted to buy the Queen of Angels/Hollywood
Presbyterian Medical Center in California, Cardinal Roger Mahoney threatened
to go to the pope.

Mr. Barbakow persevered and bought both hospitals.

"You have to fight the battle every time you enter a community, and show
people that you are going to do the right thing," he said.

Lately, Tenet has at times even been seen as a savior. The Allegheny Health,
Education and Research Foundation, with eight nonprofit hospitals in
Philadelphia, had lost $2.5 billion and was about to fold in 1998. Gov. Tom
Ridge lobbied for Tenet's $345 million purchase, which was completed late
that year. Tenet immediately began cutting expenses like golf club
memberships for some Allegheny officers and trustees.

Medicare cutbacks have forced Tenet to reduce costs more broadly by laying
off administrative staff, subcontracting janitorial services and selling 17
hospitals last year, leaving 110.

To achieve growth, Tenet is looking to the Internet. The company has invested
$37 million in Internet start-ups, mostly related to health care, and
realized $73 million in gains. "We got lucky in the beginning," Mr. Barbakow
said.

Tenet was also co-founder of Broadlane.com, which hospitals can use to buy
supplies, compare vendors and track orders. Not yet a year old, Broadlane,
which plans to go public, has contracts with about 2,500 hospitals that buy
$7 billion in supplies.

Tenet employees, however, say the company is not sharing the wealth. Earlier
this year, union negotiations between Tenet and Massachusetts Nursing (sic)
Association members in Worcester stalled over mandatory double shifts two
times a quarter. The nurses went on strike, and Tenet hired expensive
replacements.

After nearly two months, Gov. Paul Cellucci and Senator Edward M. Kennedy
forced the parties back to the bargaining table. (sic)

In a new contract, the nurses agreed to work some overtime, but only
voluntarily. "Now, it seems that Tenet is more interested in working with
us," said a union spokesman, David Schildmeier.

In California, the nurses' union in Tenet's hospital in San Luis Obispo,
formed in 1995, struck last year for the third time before winning its first
contract. The nurses' union at its hospital in Palm Springs picketed this
year and won 3 percent raises. "Tenet consistently prolongs negotiations,
provokes nurses into striking and refuses to have discussions with us about
patient care," said Rose Ann DeMoro, executive director of the California
Nurses Association.

"It's almost their policy."

Mr. Barbakow, however, says that keeping his staff satisfied and productive
is his top priority.

"Now we need to make sure that all of our employees are doing the best
possible jobs, that they're happy and they focus on quality and service," he
said. "Everything else flows from that." He cites new management training for
supervisors and an online educational system that employees can use to obtain
degrees from Tenet's many academic hospitals.

Employees, however, are no longer willing to accept Tenet's contention that
it cannot afford to give them more control and better pay.

Despite the Medicare cutbacks, Tenet is doing so well that Mr. Barbakow,
besides receiving $1.8 million in compensation last year, also received stock
options worth $26 million. His pay has become a target for union leaders and
public health advocates. It is a sensitive topic for Mr. Barbakow, who
dismisses the required calculations of his options' value as unfair because
they vest over three years, and adds, "It's embarrassing."

But Mr. Barbakow works in an industry in which an embarrassment of riches is
hard to find these days.

------------------------------------------

Kaiser-AFL-CIO Partnership: Silencing Patient, Union and Caregiver Voices

California Nurse, June-July, 2000

Late last year, the AFL-CIO and Kaiser announced the signing of another
agreement concerning their 1997 labor-management partnership pact. ("HMO to
Provide Far-Reaching Job Protections" Los Angeles Times, November 10, 1999)
The new agreement contained a new wrinkle buried in a very old corporate
twist. The wrinkle: some employees will receive enhanced but fleeting job
protections. The twist: the cost of union member's admission to the
partnership is silence.

That silence is the single most defining characteristic of the two-year-old
Kaiser/AFL-CIO partnership. Its impact is most severe on two fronts: silence
about what the union can and cannot publicly say about Kaiser (commonly known
as a gag order), and; the exclusion of patients and the public from access to
patient care issues only an outspoken healthcare provider rank and file can
guarantee.

The agreement is no bargain, except in the Faustian sense, for the membership
of the partner unions. The job security in the new pact is subject to so many
"extraordinary circumstances" - facility closures, Kaiser "divestitures,"
employer economic distress, HMO membership declines, technological
displacement of employees, "obsolete" employee skills, etc., that it is
difficult to see exactly what, if anything, is genuinely guaranteed in way of
employment security. In effect, the unions have abandoned collective
bargaining as the principal means of protecting their members and improving
quality of care. They have instead given tacit consent to any and all
restructuring programs that Kaiser in its slavish adherence to the dictates
of market-driven healthcare may pursue.

The agreement is even grimmer for the public. By agreeing to shield Kaiser
quality of care shortcomings from public view, the AFL-CIO unions, in effect,
agree to make the public health a private matter, suitable for discussion
only among the "partners."

For both union members and the public, a defining element of democracy and
human equality is lost: the freedom and ability to advocate for one's own and
the interests of others without fear of reprisal. The unions' silence
eviscerates their own member's free speech and the public's right to know.
For example:

The unions must be publicly silent about employer practices that threaten the
quality of patient care and about healthcare restructuring schemes that erode
the skills and autonomy of the caring professions and threaten patient care.
They must further be silent that the business interests of the corporation
are not the same as the healthcare interests of patients, and that the
marketing of a corporation by a healthcare union destroys the uniqueness and
patient advocacy role of the union by reducing it to a de facto sales force
for the corporation.

Most critically, the union must be silent that it has given up its
independence, the advocacy role of collective bargaining as a means of
achieving workplace justice for employees and quality care for patients, and
that the union now in a very real sense is an arm of the employer.

The upshot here is that the union must remain publicly silent that its first
allegiance is to the business concerns of the employer - not to patients or
the long term economic health or workplace democracy concerns of its members.
The unions have moved to increase their membership by offering themselves up
as a "strategic asset" to Kaiser. They have in effect become "stand-ins" for
the management-consulting firms, and at a bargain basement price

Common sense and a little history demonstrate that the collapse of the
organizational distinction between the AFL-CIO and Kaiser is ill advised.

First, physicians are and have always been the kind of "partners" in
healthcare organizations, particularly in HMOs that the Kaiser/AFL-CIO pact
spells out. Yet, physicians are becoming some of the most ardent public
critics of their employers and some are joining unions to address their
concerns over patient care and their own working conditions. Even the AMA has
softened its tone to physicians joining unions. Physicians are going public
with their concerns for the simple reason that their "partnership" with their
organizations simply does not work.

Secondly, the California Nurses Association is not a member of the
Kaiser/AFL-CIO partnership - our partnership is with patients and the public
trust. Yet, CNA RNs succeeded in forcing Kaiser to hire back about 1,700 RNs
over the last couple of years.

We also succeeded in getting California Assembly Bill 394 - the Safe Staffing
Bill - signed into legislation in California - the first of its kind in the
nation to make sure that there are minimum numbers of RNs available in
California hospitals to safeguard patient care. We did not succeed by giving
up our member's independent patient advocacy voice guaranteed in collective
bargaining. We succeeded through our members exercising their union protected
voice, bringing to public attention the dangers to patients that healthcare
restructuring induced RN layoffs, and the resultant low numbers of RNs to
patients incurs.

RNs are, in today's bottom line driven healthcare environment, the best and
only voice patients have when they are too ill, too confused or too
frightened to speak for themselves. That is why CNA put forward and was
successful in securing passage of new "Whistleblower" protection legislation
bill (California Senate Bill 97) to further protect RNs that openly criticize
dangerous heath care practices of their employers.

CNA RNs will never join a partnership where the price of admission is the
silencing of the voice of patient advocacy. The price is too high and would
subject their patients to a market that clearly values crude economic cost
benefit analysis over alleviating human pain and suffering.

-------------------------------------------------

Recent Letters:

Boston Globe Magazine - August 6, 2000

"Critical Care"

Horrible Memories came pouring back as I read the story about Barry Adams and
hospital understaffing. ("The Nurse as Whistle-blower," June 25). The lack of
quality care due to understaffing is not unique to Youville Hospital.
Following his hospitalization after a heart attack in 1998, my husband spent
three weeks at Spaulding Rehabilitation Hospital, and it was as if he had
been transferred to a hospital in the Third World.

A normal day at Spaulding consisted of too few nurses scrambling to care for
the 10 to 12 severely incapacitated patients in their care. Every day, my
husband had to instruct the medical staff on how to deal with his
medications; we lost track of the number of medication errors that were
narrowly averted. One even forced me to call the patient-affairs office to
prevent a grievous error.

Clean linens were scarce, and common items such as wash basins were a rare
commodity. I bathed my husband and changed his bedding (with hoarded sheets)
when I arrived in the evening. One nurse both apologized to me and thanked me
for doing these tasks; he wanted to do it but just didn't have the time. At
the end of his stay, my husband made me promise never to allow anyone to send
him back there.

I cringe whenever I hear Spaulding referred to as the best rehabilitation
hospital in the country, because I fear it may be true. And no hospital is
immune to these staffing and patient-care issues.

JACQUELYN MILLER
Woburn

-----------------------

Boston Globe - August 7, 2000

Nightingale was a revolutionary for her times

The reference to the Massachusetts Nurses Association sounding less like
Florence Nightingale and more like Karl Marx says more about your writer and
the public image of nursing than about history ("Mass. nurses group considers
seceding from its US parent," Page A1, Aug.2).

Nightingale was indeed revolutionary in her times. She trained in Germany
because 19th century English medical practices were so backward. When she
arrived in the Crimea with her trained nurses, Nightingale's revolutionary
practices - sanitary ward conditions, clean air, water, and dressings for
wounds, handwashing by nurses - cut the mortality rate of wounded and
diseased soldiers dramatically.

Her boldness earned her the enmity of some military physicians and generals,
but Queen Victoria knighted her, saying she wished she had more generals like
Nightingale. She was hardly just a kindly lady wiping the sick's fevered
brow. Oh yes, and she did that too.

KATHLEEN THIES, RN
Chair, Department of Nursing
Colby-Sawyer College
New London, NH

----------------------------------------------

School for Nurse Activists and Patient Advocates

September 17 - 20, 2000

Claremont Resort & Spa, 41 Tunnel Road, Oakland, California

Sponsored by the California Nurses Association

Co-sponsored by:
Pennsylvania Association of Staff Nurses and Allied Professionals
Labor Relations Department of the Massachusetts Nurses Association
Maine State Nurses Association
Minnesota Nurses Association
Rhode Island United Nurses and Allied Professionals
Canadian Federation of Nurses Unions
Federation of Nurses and Health Professionals AFT

School's purpose: Nurses throughout the US, Canada, and Europe are gathering
together in this breathtaking environment to discuss the future of our
profession, the future of health care delivery, strategies to take on the
health care chains, and the implementation of an action plan to reclaim the
health care agenda for our patients and our communities. Time will be
allotted to share our social and cultural diversity with an opportunity to
take time to engage in outdoor activities.

We will create an international forum to discuss, analyze, and strategize
ways to:

1. Resist corporate dominance of healthcare
2. Connect with union nurse's struggles for patient rights
3. Implement safe staffing ratios (AB394) in California & achieve safe
staffing elsewhere
4. Integrate current campaign successes with your particular experience
including learning how nurses are beating back corporate take over of the
healthcare industry throughout the US, Canada and Europe
5. Build viable coalitions with RNs nationally and internationally in
order to have the necessary power to create universal access to healthcare
6. Build a national and international movement led by RNs

Learning Environment:

* Focus on Nurse's experience
* Small group discussion
* Practical application
* Celebration of our past success
* Graduation ceremonies with certificates of completion awarded to
graduates

Subjects we will cover:

* The Political Economy of Corporate Dominated Healthcare
* Labor history of Nurses
* Health & Safety: injury prevention in a Practice Setting, A case study
presented by the Minnesota nurses
* Patient Rights & Advocacy: Legislative, Regulatory, and Workplace
* The professional definition of staff nurse from the perspective of
staff nurses
* Organizing to build New Leadership
* The efforts by Nurses to create publicly funded Universal Healthcare
* Getting the message Out: Public Speaking and Media Relations

For more information, contact Helen Lee, Education Director, (510) 273-2284
or e-mail her hlee@calnurses.org.

FAIR USE NOTICE: This site contains copyrighted material the use of which has
not always been specifically authorized by the copyright owner. I am making
such material available in an effort to advance understanding of
environmental, political, human rights, economic, democracy, scientific, and
social justice issues, etc. I believe this constitutes a 'fair use' of any
such copyrighted material as provided for in section 107 of the US Copyright
Law. In accordance with Title 17 U.S.C. Section 107, the material on this
site is distributed without profit to those who have expressed a prior
interest in receiving the included information for research and educational
purposes. For more information go to:
<http://www.law.cornell.edu/uscode/17/107.shtml>. If you wish to use
copyrighted material from this site for purposes of your own that go beyond
'fair use', you must obtain permission from the copyright owner.