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Flat Line, Bottom Line

LAST FRIDAY’S ROUND OF CONTRACT TALKS between Hospital Corporation of America and the Service Employees International Union was held at the Pasadena Masonic Lodge, an austere building from the 1920s whose cavernous meeting halls are filled with thronelike wooden chairs and the symbolic globes of Freemasonry. By afternoon a Baja Fresh buffet that was laid out in Room 2’s vestibule was hardly fresh. As about a dozen HCA management negotiators caucused across the street at the Sheraton Hotel, the union’s 40-member team milled about during the long break, while SEIU vice president Dana Simon took stock of the food situation.

“Make sure we switch from Coke to Diet Pepsi,” he told a member of the bargaining team. “Coca-Cola is killing union organizers in Columbia, and we don’t like that.”

The negotiations cover nearly 4,000 nurses, certified nursing assistants (CNAs), clerks, technicians, housekeepers and other hospital staff, and affect five HCA hospitals, located in West Hills, Thousand Oaks, Riverside and San Jose, which has two. Although SEIU has placed on the table wage, health, retirement and other traditional proposals (including one that calls for a single master contract to serve all five hospitals), union members say they are mainly fighting for staffing language to guarantee patient safety. They specifically point to personnel cuts in the chain that have drastically reduced the number of CNAs — the aids who bathe, clean, feed and turn patients in their beds, as well as answer call lights, change linens and help patients to the restroom. R.N.s perform the more technical duties of changing dressings, administering drugs, providing IV medications and discussing patient assessments with doctors.

On July 31, Grant Golz, a patient who had been placed on a suicide watch at HCA’s Riverside Community Hospital, jumped to his death while his CNA sitter had left his room to check on another patient. “When someone’s on suicide watch you never leave the room,” says Simon, a former Bostonian in his early 40s. “But they assigned this nursing assistant to two separate patients.”

The suicide was a devastating PR blow to the Riverside facility, which, three days before, had ordered a “call-off” of nursing assistants, sending most of them home for the weekend. “The administrators,” says Simon, “told our members that they were going to start calling them off indefinitely because the June budget numbers had come in, and they weren’t where they wanted to be.” The Riverside hospital denies this, claiming that call-offs are a routine occurrence and are determined by patient needs.

However, memos obtained by the L.A. Weekly depict a health-care company deeply concerned with the bottom line. Although the Riverside hospital had posted a $22 million profit in 2005, the memos, which are between hospital administrators or between the hospital and janitorial contractor Sodexho, are obsessed with stopping overtime wages. One, dated May 23, 2006, is from the hospital’s clinical supervisor, Mary J. Howington, on the subject of staffing hours. “We have been required to ‘cut back’,” Howington’s memo cheerily states, “because we have been over budget with our staffing hours. I am sure most everyone has wondered ‘Well how could that be??????????’ Well let me tell you!” The memo then identifies overtime as the villain and lays out a regimen of canceling staff work days while admonishing people not to punch out past their quitting times.

An earlier message, from the director of nursing, Barbara A. Frank, plainly tells nurses to get ready to care for more labor-intensive “total care” patients without nursing assistants, “in order to meet budget requirements.”

Another memo, dated August 1 — the day after the patient suicide — from Sodexho supervisor Juan Portillo, reviews a plan to cut custodial duties that “eliminated as much scheduled OT as was possible to maintain minimal standard for cleanliness.”

Tracy Dallarda, a media-relations spokeswoman for the hospital, flatly denies that Riverside Community would do anything to endanger patients’ safety. “Call-offs are done all the time,” she says. “We’re in the middle of contract negotiations and [these] allegations have been flying ever since.”

When asked to name the date of the last call-off before the one preceding the patient suicide, Dallarda says she cannot recall.

“The suicide happened after the call-off,” Dallarda says, “but the union’s been trying to make a connection between the two, and it’s despicable. The call-off had already ended and it wouldn’t have mattered anyway because we always have sitters for psych patients.”

THE HCA-SEIU FACE-OFF IS ONE INNING in the game of gloveless hardball being played across America between profit-driven corporations and unions that publicly shame their adversaries by spotlighting alleged improprieties. At the heart of the contract battle is the union’s proposal for a committee that would consider employee allegations of safety violations, act on those allegations within a set time frame and, if no agreement follows, have an outside arbitrator settle the matter. This, SEIU has pointed out, is now standard practice at such California health-care systems as Kaiser Permanente, Sutter Health and Catholic Healthcare West.

Yet the Nashville-headquartered HCA is no ordinary hospital chain; with 182 hospitals and 94 surgery centers, it is the country’s biggest for-profit health-care provider, posting $1.4 billion in net earnings last year. It is also a company storied with documented cases of fraud — a few years ago HCA had to cut the government a check for $1.7 billion to cover fines for illegal billing. Founded by Senator Bill Frist’s father and brother, HCA is a public firm about to go private in a $33 billion deal that will be America’s largest leveraged buyout. It’s no secret that such a privatized corporation will remain in the hands of its new owners (Merrill Lynch, Bain Capital, Kohlberg Kravis Roberts and Co. and, of course, the Frists) for only a short time before it is flipped for a spectacular profit. Among many other subsidiaries, HCA also owns its own temp agency, from which it outsources union jobs.

“We went from 330 to 275 union service and tech clerks and nursing assistants,” says R.N. Stella Chavez, a 15-year veteran of West Hills Hospital who serves on SEIU’s bargaining committee. “Patients now have more bedsores because there’s not enough staff to turn them over every two hours as they’re supposed to be. We’ve had so many nurses out on workman’s comp because of lift injuries.”

Chavez and others claim that HCA increasingly relies on community volunteers to perform tasks that were once done by union employees.

“They come in and deliver medicines from pharmacies — some of them controlled substances,” Chavez alleges. “The volunteers will discharge patients, answer phones and regulate visitors.”

West Hills Hospital spokeswoman Jill Dolan denies that the volunteers are taking away union work or that their numbers have been increasing.

“These volunteers do jobs of a nonclinical nature and provide no hands-on services,” Dolan says. “They can’t even adjust a bed, [and] they do not deliver narcotics at all.”

The night before Friday’s contract talks (which shuttle back and forth between Pasadena and San Jose), Assemblyman Lloyd Levine chaired a town-hall meeting of about 100 people at Canoga Park’s Our Lady of the Valley Catholic Church to air employee and community grievances against HCA and its nearby affiliate, West Hills Hospital. During a break, West Hills R.N. Alicia Taboada explained that even though California mandates a 5-to-1 nurse-to-patient ratio, she’ll often show up for work to find herself assigned to six patients. She said that, like many nurses, she’ll file Assignment Despite Objection forms complaining of understaffing, but that since Governor Schwarzenegger cut funding for the state’s Department of Health Services, it takes six to eight months for the department to investigate these claims.

Taboada says that in addition to having deeply cut its nursing-assistant numbers, West Hills increasingly relies on lower-paid, short-term “traveling nurses” and one-day temps — neither of whom have company benefits.

The contract negotiations have dragged on since January. Union employees at all five hospitals have authorized a strike, although such a walkout will likely only last a day. Last Sunday, the union, which is required to give 10 days’ notice before striking, set August 31 as the strike-notification date.


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