Contradiction erupt over the union issue

National Catholic Reporter, June 16, 1995 by Arthur Jones

Catholic hospitals are frequently at odds with themselves. Despite extensive good works and a century of prolabor social justice teaching to draw on, Catholic health care systems generally are as antiunion as any others in what one labor official describes as "a virulently antiunion industry."

It is an industry, said Jerry Shea, an official with the AFL-CIO, that has "fought unionization of janitors, kitchen workers, nurses' aides, tooth and nail. This industry pioneered the consultant form of antiunion campaigning that became the model of contemporary union-busting for the entire U.S. economy," said Shea, a union organizer in the 1970s.

When medical facilities use the consultancy form of antiunion activity, they hire an outside firm of specialists who are given tight control over the facility's supervisory network through which to conduct an intense antiunion "scare stories" campaign.

The consultants then organize a very disciplined election campaign, said Shea.

"The particular irony I find with Catholic facilities," he said, "is not that they're any worse than the others, but that (their attitude) stands in such sharp contrast to how good they've been in regard, say, to health reform.

"What Catholic hospitals did locally on health reform, and through their trade association (the Catholic Health Association), stands head and shoulders above the rest of the industry, above general hospitals and teaching hospitals -- which were bastions of self-interests -- and certainly above for-profit facilities," he said.

"Catholics were stand-up people on health reform," said Shea, "and yet their labor relations policy hasn't changed much."

The most vigorous union, the fastgrowing Service Employees International Union, or SEIU, has 450,000 of its 1 million members in hospitals, health maintenance organizations, nursing homes and clinics.

To SEIU health care division director Mary Kay Henry, organizing Catholic hospitals can be "particularly tough (for employees) because of the contradiction in a belief system of people caught between church social justice teaching and the church as the employer."

Often enough, said Henry, "the workers were Catholic-educated and -raised, and went to Catholic institutions" from choice. "On the whole," said Henry, "the (social justice teaching) you want to believe would make a Catholic employer different doesn't exist -- but I can point to some exceptions," she said.

"Our (union) local in Michigan has had what they feel is a very productive relationship with Muskegon hospital run by the Mercy System; the Mercy Hospital, Wilkes-Barre, Pa., is trying some innovative labor-management" approaches, she continued. Henry said her union is watching out particularly for megamergers. "We don't know what it foreshadows in terms of behavior when we want to try organize a part of that system," she said.

Henry described the structural changes in health care, and unionizing's response, this way: "The shift of power from health care providers to large (payer) entities affects organizing because economic incentives to make money in this industry have fundamentally changed," she said. "Instead of providing more services so that they can make money, the idea is to provide the least amount of service possible at a fixed rate of capitated payment.

"The dynamic we're seeing," she continued, "is more and more capital or cash being amassed by the big providers in order to increase their market share. What we were worrying about -- about this being unchecked and unregulated -- is coming true. She said that local unions report the health care industry is trying to impose a fundamental altering of consumer expectations: "less frequent referrals to a specialist, less preventive care, increased care expected from family members in terms of acutely ill people discharged sooner from a hospital, to the amount of self-care we're seeing in (health maintenance organizations)," said Henry.

"We've just heard about a new notion, group visits, so that if you and I have a like diagnosis we wouldn't see the doctors separately, we'd see them together," she said. As a result of the structural changes, she said, "when we organize it's not buildings but geographic markets or integrated delivery systems."

She gave as examples a unionized hospital merging with a nonunion hospital, or a union hospital moving into hospice care, home care, long-term care or skilled nursing facility. "We use our bargaining rights for whatever the existing (union) members are and extend those rights to the nonunion workers. We think about systems, not employers."

In the nursing home industry, that means the SEIU is "trying to reach agreements with employers that anticipate integration of that sector of the industry," she said.

Many hospitals are now sending acute or postoperative patients to nursing homes for care because it is cheaper than keeping them in the hospital. "So we're in a struggle with Hillhaven in California, which is one of the largest providers there, and with Beverley in Pennsylvania and with 80 different homes belonging to several different systems in Michigan," said Henry.