Attorney General’s Approval of Major Hospital Merger Fails to Strengthen Protections for Nurses, Patients

California Attorney General Kamala Harris’ decision today to give a green light to a proposed merger of two large Catholic hospital chains does little to strengthen needed protections for nurses and patients, said the California Nurses Association/National Nurses United.

The proposed merged system includes some 40 hospitals operated by St. Joseph Health and Providence Health and Services, in California, Oregon, Washington, Alaska, Montana, New Mexico, and Texas. Harris’ ruling only affects the California hospitals.

“It appears that the Attorney General has given an uncritical acceptance to this merger without addressing the serious concerns expressed by nurses, in their ability to advocate for patients, and the interests of women, and their need for access to a full range of health care services, including reproductive health,” said CNA Co-President Malinda Markowitz, RN.

CNA has been especially critical of the role of the St. Joseph system noting a sharp erosion of care standards, including inadequate staffing and insufficient supplies in St. Joseph hospitals, egregious violations of nurses’ rights, a weak commitment to providing essential services, and grossly inadequate levels of charity care.

The nurses have also objected to St. Joseph practices in investing patient care and tax subsidized funds into for profit companies, including hedge funds in the Cayman Islands.

“While the decision falls short of defending the rights of RNs and patients, CNA applauds the courageous activism of St. Joseph RNs whose testimony helped win modest improvements in preserving services and community benefits,” Markowitz continued.

“And while we appreciate that the Attorney General did require most of the hospitals to maintain their present acute care status, the approval process completely failed to protect the rights of the largely female RN workforce who have suffered under a coordinated, system-wide union busting campaign by St. Joseph Health administrations,” Markowitz said.

Both systems, for example, has reaped millions of dollars in tax subsidies from California taxpayers while providing among the lowest level of charity care as a percent of their operating expenses of any Catholic system. Harris’ decision fails to do much beyond a slight increase in the current substandard levels of charity care and community benefit.

Approval of the merger as is effectively endorses the other practices, including widespread violations of the rights of nurses by St. Joseph that includes regular harassment and intimidation of RNs who want to advocate for improved patient care and working conditions. The National Labor Relations Board has found merit to more than a dozen unfair labor practices charges made by CNA and late last year issued a number of complaints against St. Joseph hospitals.

“St. Joseph Health is now among the worst violators of RN rights to advocate for their patients in the nation," Markowitz continued. “These blatant abuses were ignored in the Attorney General’s review.”

Corporate hospital mergers, like mergers in other segments of the health care industry, have done little to protect patients and communities. For the most part they have resulted in tacit or explicit endorsement of higher prices, and closures and other reductions in patient services, all while resulting in higher corporate profits.

Indeed, a recent University of Southern California study, as Los Angeles Times columnist Michael Hiltzik noted June 14, documented that similar hospital mergers “not only drove up prices everywhere their institutions were located, but allowed even nonaffiliated hospitals to charge more.”

“Experience suggests,” Hiltzik similarly wrote May 27, “that regulators can have only one response if they’re serious about protecting the public interest. Just say no.”

“CNA will continue to fight for nurses and patients in these communities, even if the Attorney General has refused to do so,” Markowitz said.