Local Rns To Testify at Public Hearing, Share Concerns About Merger Impact on Patients, RNs

(ORANGE) Registered nurses will speak out at a public meeting held at the Orange City Hall Friday morning, on the potential merger of St. Joseph Health System (SJHS) and Providence Health & Services (PH&S)—asking California Attorney General Kamala Harris to deny the merger, California Nurses Association announced today.

After reviewing the impact reports prepared by AG consultants Medical Development Specialists (MDS) and the resulting recommended conditions of approval, nurses say that even these conditions do not go far enough in protecting the public and nurses.

"We appreciate that the AG’s consultant has recommended certain conditions that CNA advocated for, to any approval of the merger,” said Melinda Markowitz, RN, Co-President of California Nurses Association. “We are deeply troubled, however, that neither SJHS/Providence nor MDS have addressed other critical issues we have raised about access to essential healthcare services, patient safety, and the working environment in SJHS and Providence hospitals."

AG Public Meeting

Friday, April 15: ORANGE (St. Joseph Hospital of Orange and St. Jude Medical Center)— 9 a.m. at the Orange City Hall, Council Meeting Room, 300 E. Chapman Ave., Orange, CA 92866

This public meeting is part of a series of hearings held across the state this month, in communities impacted by the potential merger. In particular, nurses have the following key concerns regarding the proposed merger:

• Insufficient commitment to continue providing essential services. Nurses say commitments by SJHS and PH&S to guarantee “key services” for five years are questionable, as “key services” have been defined in the application to exclude certain basic services currently provided in their hospitals (e.g., Cardiac Care, Pediatrics, and General Surgical Services at Petaluma Valley Hospital; Pediatrics at Queen of the Valley Medical Center, and more). SJHS and PH&S have also discussed “restructuring” mental healthcare—currently experiencing huge growth under the Affordable Care Act—and women’s reproductive health services and end of life care are also at a risk, due to ethical and religious directives for Catholic healthcare. Nurses call on the AG to ensure that there will be no reduction in the level of services for local communities and that all services continue at current levels for a minimum of 10 years.


• Grossly inadequate charity care. Throughout their application to the AG, nurses say, SJHS and PH&S only claim in vague terms that the proposed merger would enhance healthcare for the “poor and vulnerable” and other underserved communities. Yet in recent years, SJHS has a track record of providing far less charity care than other nonprofit hospital systems in California as a percentage of operating expenses. Publicly available data shows that PH&S too, has, provided dramatically lower levels of charity care in the past two years. Nurses say that if the AG approves the merger, access to charity care and other community benefits must be increased so that the underserved, poor and vulnerable may share in the financial benefits the systems claim will result from consolidation.


• Alarming patient care and working conditions in SJHS hospitals. Nurses have raised a litany of concerns about the commitment of SJHS to patient care—including unsafe staffing levels, insufficient supplies and resources, and elevated infection rates.  These concerns are documented in a report CNA released in August 2015 available at SJHFallFromGrace.org. Nurses call on the AG to deny the merger if it will not result in significant improvements in patient care and in working conditions for SJHS employees.


• Increased cost of healthcare and insurance premiums for patients. Though SJHS and PH&S contend that this is a mission-based merger, nurses say it is obvious from the their filings that the primary purpose of the merger is to allow SJHS and PH&S to obtain substantial financial benefits through access to capital, by means of a “single obligated group”—an arrangement that will benefit them financially through increased size and market power, and leveraging combined net assets. Meanwhile, the hospital systems have not specified what will happen with their increased profits—and whether they will benefit patients and communities. According to several studies, including a 2007 Journal of Economics study, mergers cause patient costs to go up. Nurses say the merger must not raise healthcare costs for patients and communities.


• Egregious violations of nurses' rights. The National Labor Relations Board (NLRB) has found merit to more than a dozen unfair labor practice charges filed by CNA against SJHS California hospitals, and in late 2015, the NLRB issued complaints against 6 of the 9 SJHS hospitals. Nurses call on the AG to deny the merger unless SJHS puts and end to the daily harassment and intimidation of registered nurses who want to advocate for improved patient care and working conditions by forming a union—and takes affirmative action to remedy the damage to RNs’ rights and patient care caused by these illegal union-busting campaigns.

"Even if the Attorney General is inclined to approve the merger, she should impose conditions that are more robust and durable than those SJHS and PH&S have proposed,” said Markowitz. “She should require at least 10-year commitments for continued operation of the existing hospitals, strong enforcement of nurses’ rights to advocate for their patients, and much stronger commitments to continue providing all essential services—and charity care and community benefits at the highest levels in recent years.  Only in this way can what is currently a good deal only for the two extremely wealthy healthcare systems, become one that benefits the communities served."