For Profits or For Patients
Healthcare unions are working with their allies in the community and the statehouse to ensure that the mission of their hospitals is to provide the best care for patients.
FOR YEARS, Meadowlands Hospital Medical Center has served as a safety net for the people of Secaucus, N.J., and the surrounding areas. So when the community and members of the Health Professionals and Allied Employees learned that a private, for-profit group of investors planned to buy the hospital, there was real concern about it remaining an acute care facility.
Of particular concern was that the purchase meant yet another nonprofit community hospital in the state was going to be run by a for-profit entity with questionable business and medical practices. A decade ago, there were no for-profit hospitals in New Jersey, but in recent years, there has been a rapid expansion of for-profit hospital ownership in the state. In fact, eight for-profit hospitals are now in operation in New Jersey, and more may be on the way.
“These hospital conversions from not-for-profit to for-profit, I believe, are at a tipping point—threatening to undermine access to care and affordability of care for our communities,” HPAE President Ann Twomey told a state Senate committee in May. “The companies buying up our hospitals are notorious for aggressive billing and coding, and for business models that rely on out-of-network care, downsizing staff and service cutbacks.”
To date, the owners of Meadowlands have been cited by the state health department for violating staffing requirements, im-properly storing sterile supplies, failing to get informed consent from patients, inadequately cleaning operating rooms and more. There have also been layoffs of workers, a fourfold increase in health insurance deductibles, and federal and state investigations into the hospital owners. In May, the state, at the behest of HPAE, consumer advocates and state lawmakers, appointed a financial monitor for the hospital.
‘This is the trend now’
The increase in for-profit hospital ownership in the United States has come at a rapid clip over the last 20 years. All across the country, corporations have been snapping up publicly funded nonprofit hospitals, along with dialysis clinics, outpatient surgical centers, home care agencies and doctor practices, with one goal in mind: making profits.
In New Jersey, HPAE, which represents thousands of workers in for-profit hospitals, including the 450 nurses and health professionals at Meadowlands, is calling on the state to provide more oversight of for-profits by requiring more financial transparency and a long-term commitment to keeping the hospitals open.
HPAE’s “Patients, Not Profits” campaign is also aimed at slowing the proliferation of for-profit healthcare in New Jersey and gaining greater accountability of existing hospitals.
“We once thought that if we set strong enough standards and protection, we could maintain quality services and safe staffing and working conditions. But we now know that we need to strengthen our laws and oversight,” says Twomey.
“This is the trend now, and it has been a struggle because the state has not taken a strong stance on the things we have advocated for as a union,” says Nicole Mankowski, a nurse at Christ Hospital in Jersey City, N.J., and the president of the local there.
With the help of a community engagement campaign, HPAE members at Christ Hospital were able to fight the sale of their hospital to a for-profit company with a questionable track record. In the end, however, the hospital was bought by another for-profit, and it is now part of a burgeoning corporate health system called Carepoint.
The members at Christ Hospital are determined to remain vigilant and continue to work on safe staffing, stricter health and safety rules, and maintaining the availability of services for the community.
“We are not opposed to the hospital making a profit, but we want to make sure that patient care and working conditions don’t change, and that the needs of the system don’t supersede the needs of the patients,” says Mankowski.
HPAE is also entangled with another for-profit, Community Health Systems, a large hospital chain based in Nashville, Tenn., that operates healthcare facilities throughout the United States.
The corporation is refusing to bargain a first contract with the nurses at Memorial Hospital of Salem County, N.J., who organized and won their election to join HPAE nearly three years ago.
Memorial Hospital is not the only facility that has had difficulty negotiating with Community Health Systems. In Youngstown, Ohio, the nurses at Northside Medical Center are also at odds with CHS. Northside is an award-winning hospital that was a locally owned nonprofit until CHS bought it in 2010.
“Our members are the frontline bedside care providers to patients at Northside,” says Eric Williams, president of the Youngs-town General Duty Nurses Association, which represents the 480 nurses at Northside. “We are proud of the role we have played in helping Northside win recognition for the quality of care it provides.”
The nurses, who are part of the AFT-affiliated Ohio Nurses Association, have been without a contract since July 2012. CHS has taken a larger role in the Northside negotiations in recent months. This fall, nurses at the Youngstown hospital conducted a one-day walkout, which was supported by U.S. Sen. Sherrod Brown (D-Ohio), who called on hospital management to reach a “fair and equitable agreement” with Northside nurses, and offered his assistance in the process.
CHS’ refusal to even discuss issues related to quality care and patient safety is holding up an agreement.
“We’re ready and willing to bargain around the clock to reach an agreement,” says Williams. “But we have to have someone to talk to—and Northside management and CHS have been unwilling to discuss issues we have raised that relate to the quality of care.”
Several issues have been sticking points at the bargaining table. CHS has demanded a change in the staffing system that would allow management to send nurses home when the patient population falls below a certain point, and then call them back if it grows. This form of “nurse rationing” is a typical corporate-pushed strategy that puts profits before patients. Nurses fear that the nursing care their patients need won’t be there when they need it, and that the quality of care will inevitably suffer.
CHS has also demanded a broad management rights clause that would effectively put a “gag order” on nurses and prohibit them from speaking out for patient quality and professional standards.
The one-day strike resulted in a lockout of the workers, but it also helped solidify community support for the nurses and added to Youngstown residents’ understanding of what is at stake, says Williams. “Nurses are committed to efficiency and quality care. Northside Hospital should welcome a partnership with nurses, rather than trying to cut corners in ways that could undermine what has worked so well.”
And all of this is happening at the same time CHS is enjoying record profits, he adds.
‘Nonprofits acting like for-profits’
While for-profit hospital ownership has grown in recent years, hospitals owned by nonprofits are still the most common in the United States; they are profit-makers as well, and they are tax exempt. The expectation is that in return for not having to pay taxes, these nonprofit hospitals will provide certain benefits to their communities.
However, policymakers and healthcare unions are questioning whether these hospitals are providing enough benefits to the community to justify the exemptions. Many healthcare unions are fighting decisions by their nonprofit hospitals to cut vital services in their communities and lay off caregivers in spite of sound finances.
Take, for example, Lawrence & Memorial Hospital in New London, Conn. L&M is apparently having an identity crisis. The hospital’s owners can’t decide if Lawrence & Memorial is a nonprofit community hospital or a for-profit organization.
“They are a nonprofit acting like a for-profit,” says Harry Rodriguez, a health unit coordinator and the president of AFT Local 5123, one of three locals at the hospital. Together, the locals represent 1,600 registered nurses, licensed practical nurses, technologists and healthcare workers at the hospital and its satellite locations.
Creating alter egos to boost their profits and bust the union is not what community hospitals do, the hospital’s workers say. But at the beginning of this year, Lawrence & Memorial Hospital did create an alter ego, moving services it once provided to a separate office: the Lawrence & Memorial Medical Group.
Although L&M Medical Group provides the same services as L&M Hospital, there is a distinct difference: The 150 nurses and support staff now working at the newly formed group are no longer members of the AFT Connecticut healthcare locals that once represented them.
“It is a classic alter ego case,” Rodriguez says.
To fight the hospital, the locals filed a formal charge with the National Labor Relations Board. They have also reached out to the community for support. After a four-month investigation, the NLRB found merit with the union locals’ charges, and in August of this year, the labor board issued a complaint indicting Lawrence & Memorial Corp., which owns the hospital and medical group, for violating federal labor laws.
The NLRB’s proposed remedy to the charge is for Lawrence & Memorial Corp. to officially recognize the services performed at L&M Medical Group in the same way as those performed at L&M Hospital, while providing retroactive pay and benefits to the affected workers. A hearing on the matter, which was scheduled for late October, was postponed because of the government shutdown.
However, neither the union locals nor Lawrence & Memorial are letting any grass grow under their feet. In spite of record-breaking profits earned by the hospital this year, 33 workers have been laid off, and the hospital is threatening nearly 200 more workers with layoffs if concessions are not made by the unions. But the locals have no intention of making concessions.
In fact, the locals have launched a public awareness campaign, called “I Am L&M,” to hold the hospital accountable for actions that threaten the quality of patient care. The campaign includes TV and print ads featuring health professionals from the hospital and community activists.
“This campaign is about the people of this community saying ‘no’ to putting profits before patients,” says Rodriguez. “Lawrence & Memorial has been the community hospital this whole region has counted on for generations. That’s why we can’t let the corporation drive away patients and their families with reckless and irresponsible decisions. A responsible employer takes care of its people and the community it benefits from.”
To be sure, the business of healthcare will continue to grow. But healthcare unions like the ones at Meadowlands, Northside and Lawrence & Memorial are working with their allies in the community and the statehouse to ensure that the mission of their hospitals—whether for-profit or not-for-profit—is to provide the best quality of care for patients, not just to enhance the financial bottom line.
Stephanie Johnson, a sleep lab technician at Lawrence & Memorial Hospital and the president of the local that represents L&M’s LPNs and technicians, says a community hospital should not be putting its profit margin first.
“I’m concerned that the corporation running our hospital doesn’t share our values,” says Johnson. “I worry that it is more concerned with saving dollars than saving lives. Our community deserves better.”