Dismissive, Degrading, and Dangerous

Saint Vincent nurses walked out on March 8 this year, after trying for eighteen months to make their employer fix serious safety problems at the hospital. The union says the nurses waited until the second surge of COVID-19 cases subsided before planning the action. According to Marlena Pellegrino, cochair of the local MNA bargaining unit and Saint Vincent nurse for thirty-five years, their concerns included a lack of COVID safety procedures and personal protective equipment (PPE), and “dismissive” and “degrading” treatment from management.

Their primary concern, however, involved a pattern of understaffing at the hospital that they say imperiled patients and prevented nurses from adhering to ethical and professional standards. In the two years preceding the strike, the MNA says nurses at Saint Vincent filed more than a thousand official “unsafe staffing” reports, recording harrowing conditions that made it impossible for nurses to give patients the dignity and lifesaving care they needed. Problems included dangerous delays in the provision of medication, increases in patient falls and bed sores, and possibly even preventable COVID-19 transmission and death.

The direct relationship between nurse-to-patient ratios and patient care outcomes has been demonstrated time and again. Research has shown that nurse staffing ratios are crucial in predicting patient safety within a hospital, with the chances of inpatient death jumping as much as 7 percent with each additional patient a nurse is assigned to care for.

In 2018, the MNA fought for Massachusetts to follow California, the only state that has set legal limits on nurse-to-patient ratios. California’s nurse staffing law, which went into effect in 2004, has improved care outcomes, particularly for poor patients. The hospital lobby managed to crush the Massachusetts ballot measure proposed in 2018, reversing initial public support with the help of a prestigious Democratic-affiliated consulting firm.

This current work stoppage is the second time MNA nurses have struck over staffing levels at Saint Vincent since the Dallas-based, for-profit conglomerate Tenet Healthcare, one of the nation’s largest healthcare systems, first acquired the Catholic hospital. (Tenet later sold it, then bought it back in 2013.) It takes place amid a wave of collective actions by US health care workers in response to understaffing and other problems with our for-profit health care system that the COVID-19 pandemic has thrown into stark relief.

Tenet has faced organizing and action at a number of its other facilities over chronic cost-cutting measures like understaffing and PPE-hoarding, as well as vindictive treatment of workers. Although it was ultimately forced to concede to many of the patient care improvements the nurses sought, it’s now bent on punishing strikers by displacing them from their positions.

“Bodies Double-Stacked on the Floor”

In the lead-up to the 2018 ballot measure, nursing economist and former MNA president Judith Shindul-Rothschild showed how hospitals could “trim administrative fat” in order to cover the cost of additional nurses. Tenet’s former CEO collected a compensation package totaling more than $24 million last year — about 452 times the average pay for Tenet workers. Its new CEO, Saum Sutaria, collected nearly $14 million in his previous role as COO and president.

Tenet’s profits soared during the pandemic, while nurses at Saint Vincent Hospital reportedly wore garbage bags because protective gowns were kept under lock and key. Rather than spending the $2.6 billion in CARES Act relief it received to boost staffing at its facilities in response to the influx of COVID patients, Tenet used layoffs, “flexing,” and widespread furloughs to “maximize [its] cash position” and expand its business.

Along with the MNA and the California-based National Union of Healthcare Workers, multiple federal lawmakers have suggested that Tenet criminally misused COVID-relief funds, pointing to, among other things, its recent cash purchase of forty-five surgery centers. Representatives Katie Porter and Rosa DeLauro are calling on the Federal Trade Commission to investigate Tenet for illegal acts during the pandemic, painting a ghastly picture that aligns with the reports from Saint Vincent’s nurses.

Tenet has a well-documented history of unlawful behavior, including retaliation against workers who stand up for patient safety. Earlier this year, the company was ordered to pay $10.6 million to two cardiologists when a federal judge concluded they were fired with malice from Tenet-owned Detroit Medical Center (DMC) after they reported violations at the facility. Four ER nurses are currently suing Tenet for wrongful termination from DMC’s Sinai-Grace Hospital, saying they were dismissed after raising alarms about preventable patient deaths due to understaffing. Photos leaked to CNN showed, as an anonymous ER worker explained to the outlet, “bodies double-stacked on the floor” because “there [was] no help to put the bodies on the shelf.”

To date, the MNA says it has filed ten charges of unfair labor practices at Saint Vincent Hospital with the National Labor Relations Board, alleging “unlawful threats against striking nurses, retaliation and discrimination towards striking nurses, promises of benefits to non-strikers, and bad-faith bargaining tactics.” As part of its back-to-work demands, the hospital is insisting that the union retract all these charges with no resolution.

Marie Ritacco, vice president of the MNA and Saint Vincent nurse for thirty-eight years, told Jacobin she believes the fact that most nurses are women plays a role in why Tenet thinks it can push them around.

The hospital’s recent bullying behavior includes asking the Massachusetts Department of Unemployment Assistance (DUA) to revoke the nurses’ assistance and order them to return past payments. Multiple state legislators have argued that Tenet chose to scale back critical services at Saint Vincent in August purely in order to convince the DUA that the nurses no longer deserve their benefits, which are contingent upon the hospital’s ability to maintain normal operations. Given the exorbitant sums Tenet has shelled out to intimidate nurses and prolong the strike, it’s evident that the service reductions were not prompted by financial necessity.

The MNA says Tenet’s stubborn insistence on displacing strikers amounts to more of the same: an attempt to set an example by punishing the nurses who spoke up for patient safety.

Workers Win, Management Retaliates

While hospital administrators have come and gone, many of the striking nurses have been serving the Worcester community at “Saint V’s” for a long time — including through multiple COVID-19 surges prior to the arrival of the vaccines. David Schildmeier, the MNA’s director of public communications, told Jacobin that the hospital’s eleventh-hour return-to-work demands would cause several hundred nurses to lose positions they worked years to attain.

Marlena Pellegrino explained that this means novices could replace nurses with decades of service in high-stakes areas such as the operating room, the cardiac catheterization lab, labor and delivery, and the special care nursery that houses sick and premature infants as young as thirty-two weeks.

In addition to violating the standard practice for strike resolutions, such replacements would undermine the patient safety gains that the MNA nurses put their livelihoods on the line to win. Indeed, multiple local news stories have reported a deterioration in care since the seasoned nurses went out on strike. Jacobin spoke with Saint Vincent patient Margot Northam, who described a distressing experience she had with surgery at the hospital in May of this year, including nurses who seemed “nervous” and unprepared to educate her about her health needs.

Saint Vincent’s leadership has declared that its nonstandard back-to-work provision is needed to preserve the jobs of nurses who worked through the strike. But because it was severely understaffed prior to the walkout (and because its parent company is flush with cash), the hospital could give the strikers their positions back and allow the line-crossers and replacement nurses to continue working, albeit in less specialized roles. Pellegrino argues this would be better all around, explaining that when the hospital throws a newly graduated nurse into an overwhelming situation, they “are setting that nurse up to lose her license at some point.” This perspective is bolstered by reports of continued vacancies and high turnover among the replacement nurses.

A chorus of local, state, and national politicians have joined with organized labor in condemning Tenet’s decision to extend the strike during a public health crisis, long after the nurses were prepared to sign a new contract. Last month, Worcester’s mayor, Joe Petty, stated that “we cannot allow Worcester to be a testing ground for the imposition of unprecedented labor practices that harm unions and all workers.” The PRO Act, which passed the House and has been partially included in the reconciliation bill (currently being held up by moderates), would enable the NLRB to impose hefty fines each time a company permanently fills the vacancy created by a striking worker.

Both Pellegrino and Ritacco emphasized to Jacobin how dangerous it is when nurses are prevented from advocating for their patients. Pellegrino noted that, if Tenet is allowed to displace the strikers, it “will change the landscape of healthcare in this country.”

She pointed out that some patients are not capable of self-advocacy and lack loved ones at the bedside. “If nurses don’t speak up, who will? We know that we are the last line of defense for the patient when they are at their most vulnerable,” she said. “This is a relationship with the patient that nurses hold with absolute reverence.”