Baystate won’t negotiate

WHEN BAYSTATE Health Systems (BHS) took over Franklin Medical Center (FMC) in 1986, it was pitched as a partnership that would help the small county hospital better survive financially while maintaining its level of quality medical services to the community. The BHS conglomerate includes three hospitals, over 80 medical practices, 25 laboratories, an ambulance service and its own health insurance company.

There have certainly been some benefits to being part of a larger health care system. But as FMC became more fully integrated into the BHS corporate entity, particularly in the 2000s, policies from manufacturing industries were introduced into the hospital: speed-ups, productivity measurements, lean staffing, and the hiring of the notorious anti-union consultants Jackson Lewis.

BHS also began restructuring its services moving some out of FMC and consolidating them at its central location in Springfield, Mass. This has led to a decline in the number of services and the quality of health care offered locally, while BHS has seen its profits soar.

The first targets of BHS in its corporatization of health care were the nurses represented by the Massachusetts Nurses Association/National Nurses United. With 10,000 employees, BHS is one of largest employers in Massachusetts, but only the 185 registered nurses at FMC and the 55 nurses of the Springfield Visiting Nurses Association are unionized.

The registered nurses at FMC have been in contract negotiations for over two years. On November 4, the nurses voted overwhelmingly to authorize a three-day strike if necessary. The union has not set a strike date, and by law has to give the hospital a 10-day notice before the strike.

I SAT down with Donna Stern, an RN and co-chair of the MNA negotiating committee, and Suzanne Love, an RN in the emergency room, to learn what led up to the strike vote. According to Stern:

Since 2005, they have successfully eroded our contract. They have turned it into a two-tier contract. We have two different pension plans. They have made our health care benefits abysmal. They own the health insurance company, and that¹s the only health insurance we're offered, and it's not great health insurance: big deductibles, huge co-payments. They changed the sick policy; now they have a punitive sick policy. So leading up to this contract negotiation, we could see the writing on the wall--that if we don't draw a line in the sand, we¹re in big trouble. And what drew that line in the sand was they wanted to take away overtime.

Management wants to eliminate overtime pay beyond the end of the regular daily shift and only begin paying when nurses work over 40 hours in a week. But most nurses are hired for less than 40 hours a week. Since 2005, the number of nurses at FMC has declined from 220 to 185 today. To make up for the shortage, the hospital wants to routinely force nurses to work overtime, but just not pay them for it.

This policy would do away with a fundamental protection of nursing practice and jeopardize patient safety. The MNA has made it clear, forced overtime is dangerous. The evidence from countless studies has shown it leads to fatigue that increases the likelihood of infection rate and medication errors. At one time, overtime pay after one's shift was the norm for all Baystate medical workers, but because they are unionized, the nurses at FMC are the only ones left in the system that still have it.

"We know that if we also lose this, it's just the beginning," said Stern. "They can do anything they want to our contract. It's union busting. Baystate is fighting so hard about this because they don¹t want the rest of their workers to see what a union can do."

For Baystate, it's certainly not about the financial costs of overtime pay. Baystate is a $1.8 billion corporation that made $46.6 million in profits last year. Its CEO Mark Tolosky makes almost $2 million a year. This is a fight about power and control that goes far beyond just FMC. Daily overtime pay is the industry standard for all hospital nurses represented by the MNA. Baystate, as part of the Massachusetts Hospital Association, is leading the attack against it as part of a statewide effort to reduce the benefits of all nurses.

SUZANNE LOVE explained how the reduction in nursing staff has impacted her job and patient care in the ER:

Baystate says, "There isn't a need for these nurses because insurance companies are not paying for people to stay in the hospital for as long as they used to. That means we have less patients. There's less patient contact hours."

That's how patients are thought of by Baystate, as how many hours they are in the hospital. There are less "patient contact hours," so we're laying off and cancelling shifts for a lot of nurses. Now, they have it running at very slim core numbers. And so overnight, there are two nurses on the medical/surgical floor.

I had a patient the other day who came into the ER and was septic--which means extremely sick. The bacteria had gone from his lungs, where the pneumonia is, into his bloodstream. He needed to be hospitalized. He sat in the emergency room for three hours waiting for his room to be ready.

With another patient who needed to be admitted, there was a room available very quickly. I was initially really pleased. But when I called upstairs, the nurse couldn't take a report because she had just gotten in two new admissions and had to discharge another patient. So I called again in half an hour. I called again in an hour. That nurse was still busy. They finally called me back about 20 minutes after my third phone call, and they got the patient upstairs.

It was not something that the nurse could have done faster because there were only two nurses on the floor--because they laid people off. This was my third patient in two days who had waited a prolonged time. It's not that they are not safe in the ER while they're waiting to get a bed upstairs. But what it does is it creates a backlog.

This person who is stuck for three hours is taking up a bed that someone coming in for emergency care might need. This person is no longer an emergency room patient. They are considered in-patient. It's a different doctor now taking care and responsible for that patient. It's a hospitalist, not the emergency room doctor. So it becomes much more difficult for me to contact this doctor.

I have to page this doctor now with any concerns that I have. I'm the emergency room nurse, I'm not trained to be an in-patient nurse, but now I'm responsible for someone who maybe has diabetes. I need to order meal trays for them. I need to keep check on their blood sugar. I need to be in contact with the hospitalist who is responsible for their care. And the patient is lying on a stretcher, not a hospital bed, which is much more comfortable for them. Those stretchers get pretty uncomfortable after half an hour, let alone three hours. They aren't getting the full care; they are in limbo.

ON OCTOBER 5 of last year, the nurses held a one-day strike and were joined on the picket line by hundreds of community supporters. But management has continued to demand concessions and refused to seriously negotiate. According to Stern:

The nurses agreed to go to binding arbitration; Baystate rejected it. In our last negotiation, which was number 40, they said we're here to negotiate, but we're not going to talk to you, and we're not going to listen to anything you are going to say. They said they wanted federal mediator to have a more active role. So the mediator offered ideas and they outright rejected them, but claimed they were not "not negotiating."

It would have been like the St. Louis Cardinals showing up for game six of the World Series saying, "We're here to play, but we¹re not coming out of the dugout."

Though the October 5 strike didn't change management's hardline attitude, the mass outpouring of support for the nurses did change how the nurses saw their struggle. "What came out of it was an opportunity to look beyond our own contract," said Stern. "What else is going on with Baystate? What other practices are they doing? How do these impact the people we serve? What is happening to this community hospital?"

Their fight for a decent contract is directly tied the needs of the community for quality local health care. In March, a community meeting was arranged at which over 200 people had a chance to express their grievances. A major concern was the elimination of some services once offered at FMC. Baystate likes to say that FMC loses them money. But they have it set up that way by moving and consolidating all the most profitable services at their main facility in Springfield. According to Suzanne Love:

There used to be an ambulance in Greenfield at FMC but Baystate moved it all to their Springfield office. There's no urologist based at FMC anymore. So anyone with a urology issue has to go down to Baystate. There's only one ear, nose and throat specialist. Pediatrics was moved to Baystate. And now parents have to go all the way to Springfield to see their sick child and this poses a real hardship for them.

Both nurses agree that the most important thing to come out of the meeting was "an awareness that this is our hospital and we need to reach out to the community. Beyond our contract we need to educate the community and help the community realize they need to take this hospital back. That if they don't, they are not going to have a community hospital," stated Stern.

A Community Healthcare Initiative was organized as a watchdog to put pressure on Baystate. This group along with the MNA have worked to get resolutions passed in all the towns in the county in support of the nurses. They have also helped collect signatures for a statewide ballot initiative mandating safe staffing levels for all hospital units. And will be mobilizing the community to support the nurses in case of a strike.

According to Stern, the nurses' struggle for a decent contract has helped make people aware that:

It is no longer Franklin Medical Center, it is Baystate, and it is a corporation. And this is not a phenomenon that not just happening to our hospital, it's happening across the state and across the country. It's all about what makes money. It's all about reimbursement. It's not about what your community needs. And that this is indicative of a larger corporate problem in health care.