(Ed.'s Note: Bill Bumpus from the Somerville Labor Party Club has begun posting these daily strike bulletins on his web site [http://users.rcn.com/wbumpus/worcester.html]. So if you deleted any articles you wanted to read again, here's your chance. Also, by writing in html, Bill has linked sites and email addresses that appear in these bulletins for easy access. Maybe I'll learn to do that myself some day! - SE)
-----------------------------------------------------------
Sandy Ellis' Testimony before the Joint Committee on Health Care:
Testimony in Support of H. 4977, An Act to Protect the Rights of Patients and to Promote Access to Quality Health Care for All Residents of the Commonwealth
April 18, 2000
Dear Chairman Moore, Chairwoman Chandler, and Members of the Joint Committee on Health Care,
My name is Sandra Ellis RN, BSN. I have been a nurse for 14 years, primarily in the area of psychiatry. I have worked at St. Vincent Hospital for nearly 8 years. I am speaking before you today in support of the ballot initiative provision that calls for a moratorium on future conversions of non-profit health care facilities to for-profit status. I come before you not as a financial expert who can describe the impact on the health care marketplace and not as an academic who can site research studies, but as a nurse who has experienced the negative impact on patient care when non-profit hospitals are converted to for-profit entities.
As many of you may be aware, Worcester's St. Vincent Hospital was purchased by the for-profit OrNda in 1996, which at the time was the third largest hospital chain in the country. Later that year, OrNda was acquired by Tenet Corporation, the country's second largest hospital chain. Tenet's previous name was National Medical Enterprises, otherwise known as "NME". Tenet touts that its new name reflects "its core business philosophy: the importance of shared values among partners---including employees, physicians, insurers, and communities in providing a full spectrum of health care." While the former CEO was replaced, the Board of Directors remained the same when the name was changed. While under the NME name, over half of the Tenet hospitals pleaded guilty to criminal charges for Medicare fraud and paid the largest settlement in US history. It has paid over $600 million to settle medical fraud related court actions. Tenet Corporation is based in Santa Barbara California. Twenty five percent of Tenet's 112 hospitals are located in California.
Nurses from St. Vincent hospital and the Massachusetts Nurses Association have had several discussions with California nurses whom previously or currently work in Tenet facilities. We did this so that we could compare reactions and understand the impact that Tenet has had and would have on our employment, patient care, and the community. In those discussions, four common Tenet corporate policy themes surfaced:
1. Ratcheting down of labor costs by diminishing the number of RNs at the bedside
2. Outsourcing or subcontracting of ancillary services
3. Union Busting
4. Closure of a number of patient services after which, if no change in profits, may later befall the closure of the entire institution
1. While St. Vincent Hospital was a non-profit entity, a nurse's patient assignment averaged 5-6 patients. The primary focus at that time was on patient care. Nurses had time for very necessary issues such as: pre-operative, post-operative, medication management, and discharge teaching. We had time to grieve with family members of dying patients, give back rubs an d bathe patients properly. Post-operative patients were properly cared for, ambulated, and assessed to prevent injury and complications. In psychiatry, nurses cared for 5-6 patients on the day and evening shifts, had time to run therapeutic and rehabilitative nursing groups, and time to counsel patients troubled with mental illness. Now under Tenet management, nurses are caring for up to 9 patients per shift. In the psychiatric department this only leaves time for documentation and to medicate patients, which can rarely be done within the specified timeframe. I very often hear from co-workers from all nursing departments the comment that they often go home feeling as though they did not do enough for their patients, that they needed to prioritize which of their patients got their attention on any given shift. Because of changes in admission criteria, hospitalized patients are much sicker than they were in the past, requiring a great deal of care. Because of concerns like these, nurses at St. Vincent Hospital have filed an unprecedented 475 Unsafe Staffing Forms. These are MNA documents utilized by bedside RNs that are designed to allow nurses some protection when they feel that their assignments jeopardize patient care and the nurse's license to practice. Never in any of the 85 MNA represented hospitals have so many Unsafe Staffing Forms been filed. Also very alarming, is Tenet's demand for mandatory overtime. Mandatory overtime has never existed at St. Vincent Hospital. The nurses' greatest fear was that under Tenet, hospital administration intended to implement mandatory overtime as a means of staffing the hospital rather than hire the appropriate number of nurses to care for patients. At the nurses' last negotiating session with Tenet, our worst fears became reality when the hospital's negotiating team articulated in their contract language that mandatory overtime would, in fact, be used to fill staffing holes. Hiring an adequate number of nurses could easily rectify the hospital's staffing concerns. Instead, they insist that they need to utilize mandatory overtime as a "safety net" in instances when there may not be enough nurses to care for patients. The nurses argue that mandatory overtime is no safety net, quite the contrary. Not under any circumstances should a nurse, who is too tired to practice safely, be required to care for patients. In contract negotiations with the MNA, Tenet administration has said that a nurse may not refuse a mandatory overtime shift, even if she/he feels that she/he is legitimately too fatigued. The true safety net is having the necessary number of nurses available to care for patients. Tenet Corporation refuses to even entertain this notion. For them it is much more cost effective to pay nurses overtime pay, mandate tired and fatigued nurses to care for very ill patients, rather than to keep the appropriate number of nurses on the payroll -- even if it places patients' safety at risk. During the nurses' organizing effort with the MNA and at the time of our election for union representation, St. Vincent Hospital employed 645 nurses. At this time, the hospital reports that there are 535 nurses at St. Vincent/Worcester Medical Center. Tenet has eliminated from their report the over 80 per diem RNs once utilized to supplement staffing needs. This demonstrates that the loss of nurses at the bedside is very real.
2. All St. Vincent Hospital employees were guaranteed that their employment status would not be jeopardized by the move to the new Worcester Medical Center by CEO Robert Maher during preparation for the move. Tenet also engaged in a Tax Increment Financing (TIF) agreement with the City of Worcester. The TIF was designed to promote employment and Worcester's economic development. Despite Mr. Maher's guarantee and the TIF agreement, approximately 200 St. Vincent employees, most of whom were performing ancillary services, have lost their jobs or were forced to re-apply for their positions when Tenet closed or outsourced hospital departments in an effort to save or make more money. Many of those who applied for jobs through the new subcontracted companies, had to settle for jobs at a lower rate of pay, along with a loss of benefits, if they were hired at all. In a recent Bloomberg Press report, it was noted that Tenet Corporation enjoyed a 23% increase in net income in the third quarter of fiscal 2000. Tenet attributes this to an increase in patient admissions, and a decrease in labor costs, which they attribute to "outsourcing initiatives". The report notes that Tenet's financial gains can also be attributed to a decrease in supply costs, the termination of 440 physician employment agreements, and the sale of two of its hospitals. Departments at Worcester Medical Center that have already been outsourced include laboratory, dietary, and housekeeping. The laundry services at St. Vincent Hospital have been closed. An out-of-city company will provide that service. Before the move to the new Worcester Medical Center, three patient care areas were also closed because they were not genera ting sufficient revenue. They include the Transitional Care Center, the Geriatric Day Treatment Unit, and all of its outpatient Drug and Alcohol Services. The nurses who lost their jobs as a result of these closings were not offered positions elsewhere in the hospital. The closure of these areas has forced patients, their families, and social services workers to seek alternative treatment facilities in an already overcrowded healthcare system. Many of the patients who utilize these services are chronically ill, require financial subsidy, and/or are senior citizens most dependent on community resources and the services that St. Vincent provided for them. Many have since been made to travel outside of the Worcester community to access the care they need and have had to acquaint themselves with new caretakers creating unnecessary hardship on them and their families. This illustrates Tenet's lack of regard for the Worcester community, the patient population they serve, and for those in their employ.
3. Tenet Corporation is notorious for their antiunion sentiments. Tenet is adamantly opposed to their employees having a protected voice through unionization. At St. Vincent Hospital, we experienced this first hand during our organizing effort with the MNA. Tenet engaged in an elaborate and demoralizing union busting campaign. During that campaign our administrators threatened discipline, termination, and department closings. After the nurses won the right for union representation in a democratic election on February 5, 1998, the hospital attempted a lengthy de-certification campaign. They focused on this rather than negotiating fairly with the nurses during that time, in hopes that the union would dissolve and a contract would never be necessary. Finally, St. Vincent/Tenet administration demanded the right for an open shop as a contract provision with the MNA. An open shop would have severely limited our bargaining unit's ability to generate revenue for the work of our own members. Tenet knew this. This further demonstrated their desire to divide the nurses and diminish the power of the union. Also until the MNA threatened unfair labor practice charges, Tenet administration even failed to allow nurses the right to wear buttons or insignias relating to the union movement or to demonstrated solidarity among the nurses.
4. Tenet historically closes departments where they have not been able to make money. We have seen this come to pass in the departments noted above. The California nurses we spoke with state that in order to eliminate no-pay or low paying clients, Tenet has closed Emergency Departments which ultimately resulted in the closing of the entire institution. Tenet is not committed to Worcester ... where there is no profit, there is no commitment. Worcester is at its greatest risk. Since there have been tremendous mergers and closures, Worcester has witnessed a drop from 8 hospitals to 2. If Tenet does not produce sufficient profit, its trends and past practices are clear. It is probable that Tenet will further reduce services including closure of its Emergency Department. If such a strategy were implemented in Worcester, it would force patients to use the only other hospital in the city, U-Mass/Memorial. Worcester, as the second largest city in the Commonwealth would suffer from severe access problems for its citizens.
Some may argue the changes I've highlighted are not specific to for-profits, but a fallout from market competition. I do not disagree that competition has led non-profits to act very much like for-profits. However, in no instance have we experienced the callous disregard for patient care and those who deliver that care than with Tenet. Emulating a for-profit versus being a for-profit has proven to be dramatically different in the day-to-day lives of our patients. I would like to articulate some more specific examples that set for-profit Tenet apart.
Another alarming factor in Tenet's pursuit of profits at the expense of patient care is the diminished availability and cheapening of the quality of basic patient care and medical supplies. The examples I have chosen may shock you as much as they anger and frighten my coworkers and me. Not long ago, nurses were told that we are to issue only one blanket per patient. The reason for this is that hospital thermal blankets weigh 4 pounds and are more expensive to launder than the other linens. If a patient complains of being cold, we are to double-fold a sheet and place it over the blanket. I can assure you that nurses do not abide by this rule. Fortunately, nurses have great moral difficulty with being asked not to meet the most basic of human needs. My colleagues who work in medical and surgical areas of the hospital have shared with me their experiences with Tenet's conversion to less expensive and lower quality medical supplies. They report that the IV tubings chosen by the hospital are not compatible with each other. The hospital orders from different systems that nurses must manipulate so that they fit together. Also, the tubings used to transfuse blood are inferior to what was used by St. Vincent Hospital. The filters in these lesser quality tubings clog easily. Whatever blood is left in the tubing when it needs to be changed is lost, wasting that blood that comes from a very limited resource, and never transfused into the patient, meaning that the patient does not receive the full amount of blood that is necessary. Tenet also refuses to purchase a needle-less IV catheter system which most hospitals have adopted to protect nurses and other providers from unnecessary needle sticks. The needle-less system is more expensive.
St. Vincent Hospital is gone. Tenet has destroyed the institution that was once renowned for its close ties to the community and its service to the people of Worcester from cradle to grave. Our community hospital was once focused on providing excellent patient care. It is now known as a money saving and making machine whose only focus is on return on investment for its stockholders and generates great fear among those who must access its services. The majority of my colleagues are graduates of the St. Vincent Hospital School of Nursing, who are deeply saddened by what this hospital has become. The persona of what it once was is all but lost, what with the new Worcester Medical Center and its grand waterfall and hotel atmosphere. Its emphasis is on satisfying its stockholders rather than providing the highest quality of patient care. The only exception to this is the people who still work there and their memories not yet forgotten of what St. Vincent Hospital used to be.
While we do not have the benefit of hindsight, if we knew then what we know now, we would not have allowed this for-profit entity into Massachusetts. Massachusetts Legislation gave me a license to practice nursing and mandates me to be a patient advocate. My employer, Tenet Corporation, has forced me, by mandating 16-hour shifts, to jeopardize my license in exchange for employment and so I am here today as a patient advocate. You do not need to wait for the data to come in about the dangers of for-profits in healthcare. I am living it. Rhode Island has passed legislation to prevent this from happening there. It is time for Massachusetts to shut the barn door. The moratorium is vital and needs your support. The citizens of the Commonwealth of Massachusetts cannot afford for us to make this mistake again.
Thank You,
Respectfully Submitted,
Sandy Ellis, RN
Bargaining Unit Spokesperson
MNA
Tenet/Worcester Medical Center
------------------------------------------------------------------
Message from Mary Marengo, VP of MNA's Unit VII & member MNA's Labor Cabinet:
The candle light vigil tonight went extremely well - enuf turned out to
encircle the med city block in a walk about immediately post-vigil dispite
the rain - spirits were high.
Mary
--------------------------------------------------------------
Message from Physicians for a National Health Program (PNHP):
Medical Errors Higher at For-Profit than Not-for-Profit Hospitals, Harvard Study Finds
Journal of General Internal Medicine Editorial Cites Cuts in Nursing, Focus on Profits
-- According to a study and editorial released today, patients at for-profit hospitals are two to four times more likely than patients at not-for-profit hospitals to suffer adverse events such as complications following surgery or delays in diagnosing and treating an ailment.
"This study is another warning for those who would trust hospital care to the marketplace," said Dr. Gordon Schiff, author of the editorial ("Fatal Distraction" JGIM, April, 2000).
Previous research has found death rates 25 percent higher at for-profit hospitals than at teaching hospitals and 6 to 7 percent higher than at non-profit, non-teaching hospitals. In addition, for-profit hospitals employ fewer nurses, charge higher prices (costing Medicare an additional $5.2 billion annually) and spend a higher percentage of their budgets on overhead.
A study published last year in the Journal of the American Medical Association also found that for-profit HMOs are lower quality than not-for-profit HMOs on 14 quality measures.
Dr. Schiff cited a remarkable study on blood donation by Dr. Richard Titmuss ("The Gift Relationship"), published three decades ago which found that for-profit blood centers were less efficient, more costly, and more dangerous to patients than voluntary, non-profit centers.
"Hospital managers and even medical staffs are preoccupied with survival in the marketplace," said Dr. Schiff. "This preoccupation represents a "fatal distraction" from the real business of health care -- caring for patients and improving quality."
"We're very concerned that non-profit hospitals will be forced to adopt the same cost- and quality-cutting measures of the for-profits," continued Dr. Schiff. "It's much easier to measure money than quality of care."
Public non-teaching hospitals also had higher rates of adverse events than not-for-profit hospitals and teaching institutions, which the study suggests may be due to insufficient funding during the study period. The study examined 15,000 patients hospitalized in Utah and Colorado in 1992, and many small public Colorado hospitals experienced financial losses that year.
"The competitive free market described in textbooks doesn't and can't exist in health care," says Dr. Claudia Fegan, an internist in Chicago and former medical director of Michael Reese hospital in Chicago. "Seriously ill patients can't comparison shop or accurately judge quality. We need a not-for-profit national health system to increase access for the millions of uninsured, to strengthen our nation's health care safety net, and to improve quality for all."
###
Physicians for a National Health Program (PNHP) is an organization of over 9,000 physicians that support national health insurance. Copies of the editorial ("Fatal Distraction" Schiff G, JGIM, April, 2000) and study ("Hospital Ownership and Preventable Adverse Events," Thomas E, Orav J, Brennan T, JGIM, April, 2000) are available from PNHP at (312) 554-0382.
-------------------------------------------------------
Striking nurses blast hospitals
For-profit health care is scorned
Wednesday, April 19, 2000
By Shaun Sutner, Telegram & Gazette Staff
BOSTON-- Striking nurses from Worcester took their battle to the Statehouse yesterday, delivering a broadside against for-profit hospitals such as their employer, Tenet Healthcare Corp., and its Worcester Medical Center. Sandra A. Ellis, a leader of the striking St. Vincent nurses, told the Legislature's joint Committee on Health Care that Tenet's for-profit approach is lowering patient care standards and putting nurses' safety at risk. Yesterday was the 19th day of the nurses' strike against Tenet. Ms. Ellis was one of several dozen people who testified at a hearing on a ballot initiative that would put a moratorium on the conversion of nonprofit hospitals and nursing homes to for-profit status. Some 200 people filled the Statehouse's Gardner Auditorium as the hearing started at 11 a.m. The initiative, which is expected to be on the ballot for the Nov. 7 election, also would require the Legislature to provide health care for all residents by July 1, 2002, and establish a "patient bill of rights" under managed care.
An "alarming factor in Tenet's pursuit of profits at the expense of patient care is the diminished availability and cheapening of basic patient care and medical supplies," Ms. Ellis said. "Its emphasis is on satisfying its stockholders, rather than providing the highest quality of patient care." The initiative already has some high-profile sympathizers, including Secretary of State William F. Galvin, a strong critic of health maintenance organizations, who also gave testimony at the hearing.
Mr. Galvin said HMOs are the only part of the health care system that has not been adequately regulated. While stopping short of actually endorsing the proposed moratorium, he said that "we owe a debt of gratitude to the proponents of the petition for crystallizing the debate." "However imperfect this petition may be, it imposes a guidepost," he said.
Several of those who spoke, including one of the committee's co-chairmen, state Rep. Harriette L. Chandler, D-Worcester, expressed hope that a legislative compromise could be reached and backers of the measure would drop the initiative.
But Mr. Galvin predicted that the initiative would not only make it onto the ballot, but also be passed by voters.
"This was a necessary act on the part of many citizens, I believe, to get the ball rolling," he said.
The health care system, the secretary of state said, "is broke."
"We must fix it," he said. "It is time to fix it."
Opponents of the ballot measure also testified yesterday. They said the measure is poorly thought out, would drive health care costs sky high and would generally wreak havoc in the state's already fragile health care industry.
Dr. Harris Berman, a physician, medical school professor and chief executive of the Tufts Health Plan HMO, told the committee that passage of the initiative would raise Tufts' costs $80 million to $200 million next year. "This could basically bankrupt us," he said. "I feel the patients' bill of rights portion of this petition would effectively destroy HMOs." Another critic, Richard Lord, president of Associated Industries of Massachusetts, warned that the Legislature would have little or no chance to modify the petition if it is approved at the polls.
If the measure passes on Nov. 7, the bill of rights and for-profit conversion moratorium would take effect Jan. 1. However, the Legislature would not even be in session from November to January, Mr. Lord said. "The reality is the petition can't be amended," he said.
Members of the committee primarily focused their questions on technical issues, such as petition language and the dates on which various parts of the initiative would go into effect.
The other co-chairman, state Sen. Richard T. Moore, D-Uxbridge, emphasized that the initiative's backers have given legislators no guidance on how to provide the so-called "universal access to health care" mandated by the measure.
"I wish you could tell me how we will, in fact, decipher what is the will of the people," Mr. Moore said to Dr. Timothy McCall, a physician and executive director of the Ad Hoc Committee to Defend Health Care, who testified for the initiative.
Mr. Moore also took issue with an official from the League of Women Voters who said universal health care could be financed by an 8 percent payroll tax and a 2 percent income tax surcharge. He said that would be expensive.
As for Ms. Ellis, the striking Worcester nurse, it was clear that her paramount concerns were quality of care and the connection of an institution to its community.
In her testimony, Ms. Ellis lamented the demise of Worcester's St. Vincent Hospital, which is largely empty now after Tenet moved most of its operations to the $215 million Worcester Medical Center on April 3. The new hospital has functioned with replacement nurses since its opening.
"St. Vincent Hospital is gone. Tenet has destroyed the institution that was once renowned for its close ties to the community and its service to the people of Worcester, from cradle to grave," Ms. Ellis said.
"Our community hospital was once focused on providing excellent patient care. It is now known as a money 'saving' and 'making' machine," she said.
© 2000 Worcester Telegram & Gazette
---------------------------------------------------------
Overtime, flex time remain bones of contention
Wednesday, April 19, 2000
By Jim Bodor, Telegram & Gazette Staff
WORCESTER-- What will it take to end the Worcester Medical Center nurses strike? If the participants know, they were not saying yesterday. "Divine intervention?" suggested Worcester Medical Center Chief Executive Officer Robert E. Maher Jr. "I don't think I know the answer to that question."
The nurses union also was careful about predicting when the end might come.
"I wouldn't even hazard a guess," said David J. Schildmeier, spokesman for the Massachusetts Nurses Association, which represents the striking nurses.
Today is the 20th day of the strike, and all eyes are focused on Friday, when the two sides will sit down at the bargaining table for the first time since April 7.
The nurses and Mr. Maher remain divided about the issue of mandatory overtime. The nurses have offered to work up to two hours of overtime per shift, with the option to extend that two more hours per shift in case of an emergency.
The hospital wants the right to require up to eight hours of overtime per shift, paid at double-time. Or the hospital is willing to accept a so-called flex policy that gives management the right to send nurses home without pay when patient counts are low.
The nurses have been critical of the hospital for connecting the mandatory overtime and flex issues. Earlier in the negotiations, the hospital had tentatively agreed to phasing out, over three years, the flex days, the union points out.
But the two issues are inextricably linked, Mr. Maher said yesterday. Without mandatory overtime, the hospital would be required to increase staffing to cover all of its shifts, he said. A flex policy then becomes necessary to keep costs under control when patient counts are low, he said. With mandatory overtime, the hospital can operate with lower staffing levels, and then require nurses to work extra when patient counts are high, he said.
"Flex allows us to keep a larger work force, but if you give up flex, you would have to fill in with per diems and with mandatory overtime," he said. The hospital must adopt one system or the other, he said.
"We feel strongly that we need flex or mandatory overtime," he said. "Our position hasn't changed, nor will it."
To the nurses, however, the two issues are not connected, said Mr. Schildmeier. If patient counts are low, nurses can spend more time with the patients they have, help other nurses who are busier, or catch up on paperwork and other things that need to be done each day, he said. The hospital has traditionally operated at eight or nine patients per nurse during the day, and 11 to 15 patients per nurse at night, Mr. Schildmeier said, ratios that hospital officials do not dispute. The union would like to bring those ratios down to 6-to-1 during the day, and 9-to-1 at night, he said.
"These two issues are not connected at all," he said. "Our position is and always has been that instead of sending nurses home, they should hire more nurses and then you wouldn't need mandatory overtime. They don't have enough staffing right now."
Tenet Healthcare Corp., which owns the medical center and St. Vincent Hospital, where most of the nurses worked before the opening of the new medical center, can afford to hire more staff, Mr. Schildmeier said. The company reported an increase in profits of 23 percent last quarter, he said. "They were bragging about their profit going up because of lower labor costs," he said.
Tenet's profits rose from $124 million in the third quarter to $152 million, a 23 percent increase, according to the company. The increase came from a jump in admissions and a decrease in labor costs driven by a decision to contract out dietary and housekeeping services, according to Tenet chairman Jeffrey Barbakow.
Despite the division over mandatory overtime, there are signs that both sides want to see a settlement soon.
The hospital is eager to get its regular nurses back to work, Mr. Maher said. About 120 nurses have crossed the picket lines so far. About 535 full-time nurses are on strike, in addition to 80 per-diem nurses, according to the union and the hospital.
The hospital is using 125 replacement nurses supplied by U.S. Nursing Corp. of Denver, who rotate in and out of the hospital based upon availability, Mr. Maher said yesterday. He acknowledged yesterday that the rotation of such nurses is not ideal.
"The fact is, in any hospital, you don't always have outcomes you want, whether you work with nurses from St. Vincent Hospital or U.S. Nursing," he said. "We're hanging in there very well, but we'd like to have our nurses back."
Mr. Maher declined to say how much the hospital is spending on the replacement nurses. U.S. Nursing Corp. pays its nurses as much as $4,000 per week to work in hospitals involved in labor disputes. It also pays for their room and board, and travel to and from a job site.
Mr. Schildmeier said as well that nurses plan to go into Friday's negotiations looking for a settlement. But it will depend on what the hospital is willing to offer, he said.
"We'll wait and see what the hospital wants to do to alter its position," he said. "But we will go into Friday looking to see if we can iron things out."
© 2000 Worcester Telegram & Gazette