(Ed.'s note: Stung by strong testimony against for-profit health care given before the Joint Committee on Health Care at the State House in Boston on Tuesday, and in anticipation of a return to the negotiating table tomorrow [Friday], Tenet has fostered posturing in the media intended to isolate the striking nurses from the overwhelming support that they have been receiving. Interest in the strike and in the issues surrounding it only grows. Yesterday I was interviewed by Massaya Nishio, a correspondent for the Japanese daily newspaper Akahata, before he traveled to Worcester to visit the strike office and the picket line. He heard about the strike while covering the hearing at the State House. This morning I spoke with Sue Reinert of the Patriot-Ledger, inquiring about nurses' work these days in light of the issue of mandatory overtime brought to the fore by the strike. She promised to talk to the nurses in Worcester as well. National and international attention and concern is focused on Worcester right now. And remember, these unofficial bulletins are also posted on the Internet at http://users.rcn.com/wbumpus/worcester.html -- SE)
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Message from ANA:
From: Anna Gilmore
Sent: Thursday, April 20, 2000 11:10 AM
To:
pres-ed@lists.ana.org
Subject: Picket line - US Nursing Corp - April 25, 2000 - Denver. Co
As many of your know, NYSNA and MNA have nurses out on strike at NYACK hospital in New York and at St. Vincent's Hospital in Massachusetts. The nurses are striking over important staffing and patient care issues - particularly the hospitals' practice of using mandatory overtime as a means of staffing, rather than hiring adequate numbers of nurses. Nurses from around the country are being hired by US Nursing Corporation in Denver Colorado to go to these strikes, cross picket lines and work - in the hopes of breaking the strike. ANA is conducting a picket line outside the offices of US Nursing Corporation on April 25, 2000 from 11:30 AM to 1:00 PM in the hopes of demonstrating our support for the striking nurses in Massachusetts and New York, as well as our concern about patient care in these facilities. We encourage all SNAs to participate in this effort. If you can attend the picket line, notify Ron Harleman, ANA staff organizer at rharlema@ana.org or 303-757-7483 X 17. If you can not attend the picket, send letters of encouragement to the strikers in Massachusetts and New York. Send letters to the Colorado Nurses Association to be read on the picket line. Colorado Nurses Association is coordinating these efforts with ANA. Mary Foley, ANA President and other ANA and SNA officals will be attending.
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Article on Tenet cutbacks in California:
Emergency Rooms Becoming an Endangered Species as Local Hospital Mergers Continue
April 14 - 20, 2000
By Chris Thompson, East Bay Express
This week, local Kaiser members got welcome news when the health-care giant announced that it would not close its 290-bed Oakland hospital after all. But the news was much less pleasant a few miles up the road. Last week, the Tenet Healthcare Corporation, one of the nation's largest for-profit HMOs, closed its emergency room in Pinole and sent city officials, nurses' unions, and health care activists into a funk. The west end of Contra Costa County-the I-80 corridor that runs from the Carquinez Bridge south to Richmond and El Cerrito-now faces, if not an officially substandard supply of emergency medical care, an emergency response infrastructure that critics claim is no more than barely adequate to cope with a major disaster. Experts have long warned that the region's cluster of large oil refineries perched near the northern Hayward Fault poses a serious threat to public health in the event of a major earthquake-an event that seismologists have given a seven-in-ten chance of happening in the next thirty years. Last year, when the Chevron Richmond hydrocracking facility went up in flames and released hundreds of pounds of deadly hydrogen sulfide, 1,400 neighbors scrambled to the nearest emergency room. If the worst-case refinery scenarios play out-if an earthquake ruptured one of Chevron Richmond's 220,000-pound ammonia storage tanks, for example-the prospect of uninformed residents choking a gridlocked I-80 freeway in search of emergency rooms that no longer exist is unsettling. But some observers say that the Pinole emergency room closure was far from an act of God; indeed, that it has everything to do with recent events right here in Alameda County. In January, when a federal judge denied Attorney General Bill Lockyer's motion to block the merger of Oakland's Summit Hospital and Sutter Health's Alta Bates Medical Center, health workers around the East Bay wondered what the new face of health care would look like. Some critics now claim that Tenet's decision to back out of Pinole is a direct result of the merger-thus even before Sutter has time to announce a rollback in services at Summit or Alta Bates, patients were already losing health care facilities up north in Contra Costa County. When Sutter sneezes, Tenet catches a cold, and unless Lockyer and state Assemblymember Dion Aroner succeed in pushing through their latest efforts to shore up the medical infrastructure of California, the result could bode very ill for the sickest among us.
Up until last week, Tenet ran two emergency rooms in West Contra Costa: one at Doctors Medical Center in Pinole, and one at a similarly named facility in San Pablo. The two facilities provided a variety of medical services ranging from emergency and acute care-with both intensive and cardiac care units-to urgent care and other, less dire services; think of urgent care as what you need when you break your arm and acute care as what you need when you break your hip. According to Catherine Zaharko, the chief development officer for Doctors Medical Center San Pablo, Tenet noticed that three-quarters of patients seeking treatment at its Pinole campus could be handled by its urgent care facility and so decided to close the emergency room and consolidate emergency care onto its San Pablo campus. "The master plan [drawn up] three years ago was to consolidate services, so that acute care like open heart, oncology, or nuclear medicine would be located at San Pablo, and outpatient services and long-term care at Pinole," Zaharko says. "It was a better idea to have these facilities complement one another rather than compete with one another."
To ease the transitional period, Tenet has embarked upon an expensive public education program, repeatedly warning in a series of ads that the Pinole campus is no longer the place to go for emergency care. If West County residents still haven't gotten the message, Zaharko says that the campus has a back-up system to cope with emergency patients who show up looking for a crash cart. "We will have an ambulance parked outside 24 hours a day for the first thirty days," Zaharko says. "And there is a phone outside, and if someone still hasn't gotten the word and shows up, they can pick up the phone and be patched right to 911. We've gone to great lengths to accommodate those who haven't heard that the ER is closed."
From a bottom-line perspective, streamlining services and eliminating redundancy makes sense, but the maintenance of health care for people who are often uninsured or dependent upon Medi-Cal is seen by Pinole officials as a public trust that cannot be abandoned in service of a fatter profit margin. Pinole City Manager Marc Grisham made his feelings quite clear in a letter to Art Lathrop, the director of Contra Costa County's emergency medical services. "We are aware that Tenet's argument for this closure is purely one of economics," Grisham wrote. "We could appreciate this health care argument if it was focused on elective medical services. However, Tenet is cutting into the heart of basic medical service provision when they reduce our emergency medical services by fifty percent. The lives of our residents should not be reduced to an earnings statement or the price of [Tenet's] stock."
No one is sure whether the loss of Pinole's emergency room will actually result in lives being lost, but closing the facility will certainly be an expensive inconvenience. According to an impact evaluation report drafted by Contra Costa's Department of Health Services, West County still has, at least on paper, the capacity to absorb an average 72,000 annual emergency visits; now that Doctors San Pablo has added thirteen emergency stations to its Brookside campus, the region is technically over the industry standard of one emergency station per two thousand residents. But a number of factors may complicate this per capita formula, the most prominent of which is gridlock on I-80. The average time to transport patients to the Pinole emergency room ranged from six to just under twelve minutes, depending upon the city. Now that patients must be driven to San Pablo, the estimated transport time has been reassessed to from ten to sixteen minutes. And that's only the average time; no one has a handle on how long it could take during rush hour.
In addition, about 85 percent of Pinole's emergency patients came by private automobile; without the sirens and flashing lights to move traffic out of the way, the time it takes to crawl down I-80 could prove fatal. In the end, however, Gil Martinez, the district representative for the state Department of Health Services, concluded that the added time to transport patients would not be an undue burden upon the system. "Given that seventy percent [of patients would theoretically still come to Pinole for nonemergency services], we didn't consider the four and a half extra miles to San Pablo to be particularly egregious," Martinez says.
The county's estimates do not address disaster scenarios on the scale of a major earthquake, but county officals would be remiss in their duty if they didn't prepare for such an eventuality. Doctors San Pablo has state-of-the-art disaster preparedness capacity, including a helipad and one of the finest burn units in the state (on the other hand, the facility is less than a mile from the Hayward Fault and, until it is seismically upgraded in 2008, could be one of the first buildings to fall down). Still, critics maintain that in the event of an earthquake or refinery disaster, all hell could break loose. "The other day, we had a truck flip over on the highway, and they shut down westbound I-80 for four hours," says Kevin Reilly, the Pinole representative for the California Nurses Association. "If that were a couple of miles east, that would have shut down the highway right near Doctors San Pablo. Our nurses are just waiting for [someone to die]. We've done everything we could to stop this; we've written letters, we've marched on Sacramento. Now we're just waiting for the tragedies to start happening."
In 1997, when the decision to close the Pinole emergency room was tentatively announced, Tenet wasn't the only East Bay hospital looking at its bottom line. "Summit knew they had to partner up with somebody given how they were going," says Carolyn Kemp, the spokesperson for the new Summit-Alta Bates complex. "In the end, it was down to Sutter and Tenet."
When, three years ago, Summit issued a request for proposals to find a merger partner, both Sutter and Tenet were very interested. Whichever organization secured this plum would be in a commanding position to dominate health services in the East Bay and set up economies of scale to guarantee its survival.
When Tenet officials learned that Summit had decided to go with Sutter and would merge with Alta Bates, they couldn't have been happy. With this one decision, Tenet went from being one of many players in the East Bay health care provision market to competing with the latest pumped-up arm of the Sutter machine. Unless Tenet made some cost-cutting decisions fast, critics claim, such consolidation of services could put a big cramp in their capacity to compete with the newly merged Summit-Alta Bates conglomerate. "Summit's the largest private hospital in Oakland," Reilly says. "If Tenet had gotten Summit, they would have had a nice system. With Pinole and San Pablo, they could share resources, divide up duties. But because Sutter and Alta Bates got Summit, that makes the competition that much more fierce."
For Reilly, Tenet's comparatively comfortable financial situation made Summit's decision all the more galling; whereas Summit posted a loss of $13.5 million in 1998-99, and Sutter's Sacramento-area hosptials are staggering under huge financial losses, Tenet posted $152 million in profit last quarter, and both West County operations are in the black. "Since they didn't get Summit, they're not able to meet their profit targets for San Pablo and Pinole," Reilly says. "It's not that they're not making money, it's that they're not making enough. So I think they're going to divest altogether from West County."
Reilly is just one of many observers, from unions to patient advocates and county officials, who worry that Tenet's long-term plans include getting out of West County altogether. Under a 1993 state mandate, California hospitals must seismically upgrade their facilities to survive a significant earthquake by 2008, and, by 2030, to be able to provide full emergency care, even if they were at a quake's epicenter. Hospitals must submit plans on how they will accomplish this ambitious goal by 2001, and the fact that Tenet has not taken any visible steps toward completing its written plans for Doctors Medical Center San Pablo has spooked Contra Costa health officials. "Significant concern exists within the community regarding Tenet's commitment to maintaining emergency services at the San Pablo campus following a closure of services at the Pinole campus," county officials wrote in the Pinole impact evaluation report. "The loss of emergency services at both Pinole and San Pablo would be devastating to the West County communities and to the Contra Costa emergency medical services system."
"Before Tenet took over [Doctors San Pablo], it was run by the [West Contra Costa Hospital] district," Reilly says. "They had never kept up with the maintenance, and it always served a lot of Medi-Cal and uninsured patients. The perception in West County is that Doctors San Pablo was the Highland Hospital of West County. If you had a choice, wouldn't you rather go to Alta Bates?"
But Doctors San Pablo chief development officer Catherine Zaharko promises that such concerns are unwarranted. "We are working on our seismic retrofit plan, just like every hospital, and will have it ready by 2001," Zaharko says. "We have spent $20 million over the last three years on this facility alone. I don't think Tenet has any plans to walk away from here soon. No one knows what the future holds, but you don't spend $20 million on a facility if you're not planning to stay. I think it's safe to say that whenever there's a major change in public service, speculation abounds. It's absolutely normal for people to be worried about these issues. It's an emotional issue for any community. It would be wonderful if health care were such that every community had its own hospital. But when you consider [the competitive situation], the only way to preserve health care is to consolidate services."
Up in Sacramento, Assemblymember Dion Aroner is working to make sure that such consolidations never result in communities losing reasonable access to emergency care. Under Assembly Bill 421, which Aroner authored, county health departments would be empowered to deny hospital requests to close emergency rooms if officials deem that such closures would reduce emergency care to unacceptably low levels. Not surprisingly, the Hospital Council has fought the bill with a passion, but AB 421 narrowly passed the Assembly and is currently being tinkered with in the state Senate, mostly around provisions to aid hospitals with legitimate financial hardships. In addition, Aroner plans to use an anticipated state bond to finance the retrofitting of state hospitals as an incentive, to essentially buy off hospitals with retrofit subisdies and keep emergency rooms open around the state. Now that Kaiser Oakland has stunned observers by choosing to save its Oakland hospital, perhaps it'll be one of the first in line for whatever goodies come out of Sacramento.
"Next year, we'll begin discussion around the retrofit funds," Aroner says. "Meanwhile, I wanted 421 to be the lightning rod that begins a discussion about public health planning. And you know, in the back of all these legislators' minds, they're all thinking, 'Oh my God, what if I can't find an ER for my kid?'"