Plan Ahead!

Join the National Nurses' Week Nurse Day Picket
to Support the St. Vincent Hospital Nurses -
Help Send the Message: Exhausted Nurses = Unsafe Care

DATE: Sunday, May 7, 2000
TIME: 12 noon - 4:00 PM
PLACE: Worcester Medical Center

May 6 - 12 is National Nurses Week. What better way to celebrate this week
then to join the St. Vincent Hospital nurses on their strike line outside of
Worcester Medical Center? We hope that hundreds of nurses from hospitals and
health care facilities throughout the Commonwealth will have representatives
at this picketing, displaying signs of their different facilities. We need an
army of supporters from the nursing community to demonstrate to these
courageous nurses and to their community that their cause is just and that
they are not alone in decrying Tenet's demand to use mandatory 16 hour shifts
as a means of staffing a hospital.

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Message from Washington RN:

Dear Sandy:

I was shocked to read the comments (Worcester T&G, May 04) of William G.
Wood, Division of Registration director, regarding the manner in which US
Nursing Corp nurses were fast-tracked through the licensing process. In
defense of this practice, he says, "Hospitals are our customers. We responded
to our customers. This was standard operating procedure."

I don't understand. I thought the public was the customer. The Division's
mission, as published on their web site, is "to protect the public health,
safety and welfare by licensing qualified individuals who provide services to
consumers and by fair and consistent enforcement of the statutes and
regulations of the boards of registration."

I'm confused. Who does the Division of Registration serve?

Carrie Lybecker, RN
Olympia, WA

Editor's Response:

Yes, that's precisely the question we're wrestling with here in Massachusetts
every time we go up to the State House. In the early 90s, the governor at the
time proclaimed a goal of 'entrepreneurial government.' This is what he had
in mind, and his successor agrees.

Sandy

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Letter to Tenet Executives:

Hello Mr. Barbakov and Mr. Maher,

I should divulge to you right away that, while my wife is not one of the
nurses on strike at the Worcester Medical Center, she is the chairperson of
the MNA bargaining unit across town at the UMass Memorial Medical Center.

Having said this, it doubtless will not stun you that I request that you
withdraw the demand of up to 16 hours of mandatory overtime for your
Registered Nurses and end this dispute which is hurting both the nurses and
your shareholders (and ?perhaps your share in this market).

I understand your assertion that you need this level of mandatory overtime
for reasons of patient safety.

However, your publicly stating that you must have either mandatory overtime
or the option to "flex down", indicates to me that your actual intent is cost
containment.

I am convinced (and have been repeating this explanation as widely as I can:
to my State Senator down to my coworkers) that your goal is to always
staff-up to the minimum, legal, safe level of RNs needed for a particular
shift.

If you have the flex-time and you determine you're over-staffed: send some
home.

If you have mandatory overtime, then always staff under your historical,
seasonal patient population and then "mandate" up to what that particular
shift needs.

Did you think the public wouldn't understand this? We're doing our best,
through word-of-mouth, the Internet, Letters to the Editor, etc. to expose
this situation.

It's unclear at this time who will prevail. We don't have access to any
patients' health care premiums to use for advertising, so you do have that
advantage: you have much more money than we do.

Please withdraw your demand for mandatory overtime and end the strike.
You'd be wiser to take the money you're paying to your Scabs 'R' US Nursing
Corp. and use it to rehabilitate your reputation in this community.

I welcome any responses you may care to make.

I hope you will not think me facetious when I say: we have a monumental
difference of opinion on this topic, but I do sincerely wish you both health
and peace,

Regards,

John Healey

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

Express Yourself:

Send a message to St. Vincent CEO, Bob Maher and tell him you support the
nurses and their stand on these contract negotiations. Tell him to go back to
the "table" and settle this contract NOW.

Phone: 508-363-6211
Fax: 508-798-1117
Email: robert.maher@tenethealth.com

Send another message to Bob Maher's boss, Tenet CEO, Jeffrey Barbakow.

Phone: 805-563-6800
Fax: 805-563-6808
Email: jeffrey.barbakow@tenethealth.com

Call the employment agency that is providing replacment nurses to cross the
St. Vincent picket line. Ask them how much they are paying those nurses and
politely remind them that such services are only prolonging the strike and
creating hardship for certain members of the Worcester
Community: 800-726-8773.

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

Help the Department of Public Health do its job:

Please have folks call the DPH hotline, especially the families and docs.
They don't have to identify themselves if they are concerned about
retribution, just provide information that can be assessed. DPH Hotline
number is 800-462-5540.

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

Short Internet Directory:

<http://www.massnurses.org> official news, background, directions, solidarity
ideas, links.

<http://www.califnurses.org/cna/watch/tenet/> background on Tenet, actual
contract language.

<http://users.rcn.com/wbumpus/worcester.html> archive of daily unofficial
Worcester strike bulletins, with links.
------------------------------------------

After nurse firings, DPH begins inspection of Worcester hospital

By Michael Cohen, Globe Correspondent, 5/4/2000

WORCESTER - In the wake of the firing of three nurses for alleged lapses in
patient care at the Worcester Medical Center, the state Department of Public
Health has launched a full-scale inspection of the hospital.

A team of 12 inspectors walked into the medical center unannounced late
Tuesday afternoon to begin the review, which could take a week, state
officials said.

''This will be a top-to-bottom review of the entire facility,'' said Paul
Jacobsen, deputy commissioner of public health. Jacobsen said the inspection
was ordered in response to a request from Governor Paul Cellucci to step up
oversight at the hospital, which is in the throes of a 35-day nurses' strike.

''We were a little surprised with this en masse arrival of people, but we are
cooperating fully with the DPH,'' said Paula Green, spokeswoman for the
hospital.

The move for a comprehensive review of operations at the medical center
follows Monday's disclosure that nurses recruited to work at the hospital
during the strike had been fired for poor patient care.

''The directive from the governor was to make sure that patient safety was
paramount,'' said John Birtwell, Cellucci's press secretary.

According to state and hospital officials, two nurses were fired April 25
after they left a patient unattended for nearly an hour in a recovery room
following surgery. A third nurse was discharged April 28 after she failed to
check identification bracelets and brought a newborn to the wrong mother, who
proceeded to breastfeed the child.

Yesterday, William Wood, director of the state Division of Registration,
defended the fast-tracking of license checks for out-of-state nurses who are
replacing strikers at the medical center.

Responding to criticism from Secretary of State William Galvin, Wood said
that the licensing was faster but still thorough.

Wood also said that two of the three nurses who were fired were previously
licensed Massachusetts nurses and had not be cleared under the fast-track
system.

Since the strike began, DPH has had one or two inspectors in the hospital on
a daily basis. As of yesterday afternoon, the daily monitoring had not turned
up any new problems, Jacobsen said.

The Worcester Medical Center is the new home of the former St. Vincent
Hospital. Tenet Healthcare, the nation's second largest for-profit health
care company, bought the old St. Vincent and moved operations to the newly
constructed medical center April 1. (Ed.'s Note: The move occurred on April
3rd. -- SE)

The former St. Vincent nurses walked off the job March 31 after failing to
reach a contract with Tenet. Staffing levels, and a requirement for mandatory
overtime at the discretion of management, are the issues blocking an
agreement.

To staff the hospital, Tenet has used more than 200 replacement nurses from
an employment service in Colorado.

Galvin asked the Legislature and the state inspector general Tuesday to
investigate the propriety of the fast-track approach to granting credentials
to the out-of-state nurses.

But yesterday, state Representative Harriette Chandler, House chairwoman of
the joint health care committee, said she is satisfied that the registration
board acted properly.

''I'm not in favor of scabs, and you can underline that. But we can't allow
an unsafe situation to occur here,'' said Chandler, a Worcester Democrat.
''The board has to protect the public safety, and I can't believe it would be
in the best interest of the public to not have the replacement nurses
available and force the hospital to shut down.''

This story ran on page B05 of the Boston Globe on 5/4/2000.
© Copyright 2000 Globe Newspaper Company.

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

Inspection team arrives at hospital
Nurse licensing procedures defended

Thursday, May 4, 2000

By Chris Pope, Telegram & Gazette Staff

WORCESTER-- Responding to a state official's accusations, the director of the
state Division of Registration yesterday defended procedures used in
reviewing the credentials of replacement nurses at Worcester Medical Center.
Meanwhile, the state Department of Public Health has launched a full
inspection of the center, where nurses are on strike. The inspection comes
after two incidents of bungled patient care that led the hospital to fire
three replacement nurses last week. However, a state health official said the
inspection had been planned before those incidents.
William G. Wood, Division of Registration director, countered a charge
by Secretary of State William F. Galvin on Tuesday that the Board of
Registration of Nursing, which licenses nurses in Massachusetts, rushed
through the licensing review in what Mr. Galvin called a "reckless effort to
assist Tenet Healthcare Corp. import strike-breaking nurses."
Tenet is the owner of the medical center.
Mr. Galvin's request that the board's action be investigated by state
Inspector General Robert Cerasoli and the Legislature's joint committee on
governmental regulations came a day after the state Department of Public
Health released reports revealing that three replacement nurses had been
fired for patient mistakes.
The DPH report indicated that two of the nurses had left a surgical
patient unattended and the third brought a newborn to the wrong mother for
feeding.
When Tenet-employed nurses announced in March their intention to strike
the newly opened medical center, Tenet brought in about 125 replacement
nurses hired through U.S. Nursing Corp. of Denver. Those from outside
Massachusetts had to apply for in-state licenses.
Mr. Wood said the board did nothing reckless or improper in expediting
the application process.
"If following the law is being reckless, maybe he has a point," Mr. Wood
said. "The board followed the same procedures as it always does. It verified
the same information. It just put extra staff on to do that."
Mr. Wood said the nursing registration board often accelerates the
licensing process for out-of-state nurses in response to a hospital's
request. For example, he said, hospitals on Cape Cod sometimes make such
requests to bring on extra nurses from other states to handle increased
patient loads during the summertime influx of tourists.
"We don't take sides in labor disputes," said Mr. Woods. "Hospitals are
our customers. We responded to our customers. This was standard operating
procedure."
Mr. Wood added that two of the three nurses fired by Tenet had held
Massachusetts licenses for several years and did not need to have their
licenses verified before being hired for duty at Worcester Medical Center.
The third nurse, who did hold a license from another state, met the
registration board's licensing standards in that the board was able to verify
that the nurse was a graduate of an approved school, had passed the national
nursing exam and had no criminal actions or disciplinary history.
Fran Brown, spokeswoman for Mr. Cerasoli, said the inspector general is
prohibited by law from disclosing whether and how he intends to respond to a
request for an investigation.
Neither state Sen. Michael W. Morrissey, D-Quincy, nor state Rep. Daniel
E. Bosley, D-North Adams, responded to phone calls yesterday requesting
comment on Mr. Galvin's call for an investigation. The two are co-chairmen of
the governmental regulations committee.
With the strike now in its 35th day, a 12-member team is scheduled to
continue its inspection of the medical center.
According to Paul R. Jacobsen, deputy state commissioner of health, the
inspection crew consists of five nurses, a social worker, a dietitian, two
life-safety code workers, a laboratory surveyor, a radiation technician and a
representative of the federal Health Care Finance Administration. They
arrived at the center Tuesday afternoon and will remain for several days.
Mr. Jacobsen said the "top to bottom" inspection, launched at the
request of Gov. Paul Cellucci, is designed to uncover any deficiencies that
might affect patient care.
The inspection team entered the hospital the day after the DPH released
its report revealing the firing of the replacement nurses, but Mr. Jacobsen
said the inspection had been previously planned and was not motivated by that
event. He said that under DPH regulations, any deficiencies found during the
inspection must be relayed to medical center officials, who will have 10 days
to come up with a correction plan.
Mr. Jacobsen said that while all hospitals in the state are subject to
such comprehensive inspections every three years, the decision to inspect the
new medical center was spawned by the DPH's desire to do everything possible
to maintain patient-care standards during the strike.
"We're holding this hospital to higher standards," Mr. Jacobsen said.
"We want to ensure that care quality is up to the standards that everyone
expects."
Worcester Medical Center spokeswoman Paula L. Green said her
understanding is that the inspection team would be at the hospital at least
through tomorrow.
"We're not quite sure why this is happening, but they're here, and it
seems to be going fine," she said. "We have been working with the Department
of Public Health since the strike began, so I can't imagine they will find
anything new, unique or different."
"If they're doing a legitimate inspection, they'll find some things,"
responded David J. Schildmeier, spokesman for the Massachusetts Nurses
Association, which represents the striking nurses. " ... We think a closer
look should be taken."
Ms. Green said she was not aware of any other nurses beyond the three
fired last week to be terminated for patient-care errors, but she said it's
possible others may have been asked not to return after working an initial
shift or two.
"There may have been some that had some probationary period, and we did
not ask them to return, but these were the first where we said 'This
happened. You have to go.' "
Both sides in the contract dispute are slated to return to the
bargaining table at 10 a.m. today. The meeting is the first between medical
center management and representatives for the striking nurses since April 21.

© 2000 Worcester Telegram & Gazette

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

Fallon sending some patients from center
Fallon begins shifting day-surgery patients

Thursday, May 4, 2000

By Chris Pope, Telegram & Gazette Staff

WORCESTER-- In a move to prod Tenet Healthcare Corp., owner of Worcester
Medical Center, to settle the nurses strike, Fallon Community Health Plan
yesterday said it will start sending some day-surgery patients to Worcester
Surgical Center instead of to the new medical center.
Fallon spokesman Richard P. Burke said the decision to take what he
called a "significant portion" of its day surgery business away from the
strike-bound medical center was another step in the health maintenance
organization's effort to encourage Tenet to resolve the strike.
Mr. Burke said the agreement with the privately owned surgical center at
300 Grove St. was also necessitated by difficulties that Fallon physicians
have had scheduling outpatient surgical procedures at the medical center
since the strike began March 31.
He declined to estimate the economic impact of Fallon's decision on the
medical center, but said the agreement with the surgical center could be
"quite sizable."
Fallon's announcement comes a week after a plea by Eric Schultz,
president and chief executive of Fallon, for Jeffrey C. Barbakow, Tenet chief
executive, to become directly involved in the strike negotiations.
Mr. Burke said yesterday that, to his knowledge, Mr. Barbakow had not
responded to Mr. Schultz's request.
Paula L. Green, Worcester Medical Center spokeswoman, said the
hospital's management was "surprised and shocked" at Fallon's move.
"No one is trying harder than we are to settle this," she said. "Putting
pressure on like this doesn't really help. We don't need to be sidetracked by
these kind of tactics."
Ms. Green, who also declined to estimate the economic impact of Fallon's
decision, acknowledged that at the opening of the medical center and the
onset of the strike, the hospital had difficulty finding enough operating
room nurses with proper qualifications and experience. While that caused some
elective surgery to be postponed, she said that delays are now minimal.
In another effort to persuade Mr. Barbakow to join the negotiations, all
12 members of Massachusetts congressional delegation yesterday signed a
letter urging the Tenet chief to personally negotiate an end to the strike.
"We are writing to urge you to come to Worcester, Mass., and conduct
face-to-face negotiations in order to settle this labor dispute," the letter
stated. "We encourage you to travel to Worcester to complete these
negotiations. We look forward to your response."
Harry Anderson, senior director of corporate communications for Tenet,
said Mr. Barbakow is fully informed about the Worcester strike and involved
in the issues.
"His belief is this is a local labor situation, and he has full
confidence in those conducting the negotiations," Mr. Anderson said. He added
that the issues in the dispute, including mandatory overtime, concern
hospital operators nationally and are critical to the future of the health
care industry.

© 2000 Worcester Telegram & Gazette

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

Nurses Declare Hospital Staffing Practices Unsafe

Updated 11:53 AM ET May 3, 2000

By Nancy Deutsch

NEW YORK (Reuters Health) - People worried about upcoming surgery and how
fast they will recover may have something else they should be worrying about:
whether or not they will receive safe nursing care.

There is an alarming trend among hospitals to force registered nurses to work
mandatory overtime, warns the president of the American Nurses Association
(ANA). This leads to overworked and tired nurses who can more easily make
mistakes, Mary Foley told Reuters Health.

The problem seems to be uniform across the country, she noted. While nurses
in New York and Massachusetts have specifically addressed this issue as a
concern during their recent strike action, Foley said she has heard from
nurses in California, Ohio and Illinois with the same concerns.

"By what we are gathering, it's a nationwide event," she added. In emergency
situations where there is a sudden need for more staff, nurses have always
been willing to stay and help, she said. But this is a different issue.
Nurses are being told they have no option but to stay, sometimes as long as
four extra hours, with very little notice if someone calls in sick at the
last minute or when patients require unusually high levels of care. In
addition, nurses may be required to do this on several days close together,
Foley added. "It produces wear and tear on the individual."

There are several reasons this is happening, she noted. Employers are not
anticipating staffing needs based on the types of patients in-hospital, there
is inadequate healthcare reimbursement so hospitals are letting the staff
pool be depleted, and there is a recent increase in demand for hospital
nurses leading to a shortage of those available for work, Foley said.

Administrators need to look carefully at how they are using the nursing
staff, she said. They should also be sure to always have enough nurses on
staff to ensure no one is overextended.

In addition to what excessive overtime can do to the nurses, there is the
issue of patient safety, Foley noted.

The ANA recently commissioned a study that shows there are five adverse
outcomes that can be tracked to inadequate nursing care. They are: length of
stay in hospital, postoperative infection, bed sores, pneumonia contracted
while in hospital, and urinary tract infections that develop in the hospital.

Foley suggested that people considering entering a hospital for surgery first
check out the condition of the nurses who work there.

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