With the official signing this week of a definitive agreement to merge between Providence Health & Services and St. Joseph Health, California Nurses Association/National Nurses United (CNA/NNU) called on California Attorney General Kamala Harris to hold public hearings and carefully review the proposed merger—to assure patient protections and nurses’ rights are not infringed.
 
CNA, which represents nearly 90,000 California RNs, including thousands employed by the two big hospital chains, “has substantial concerns about the impact of the proposed merger of these two large hospital systems on patients, California taxpayers, RNs and other employees, and the affected communities,” said CNA Co-President Zenei Cortez, RN.
 
“We are opposed to any and all mergers that don’t guarantee our patients and the community we serve a higher standard of care,” Cortez said.  “This merger must ensure that all the hospitals remain open, that all jobs and services are maintained—and that the new organization is held accountable for providing charity care and community benefits to the communities it serves. St. Joseph has an abysmal record in that regard, spending less on charity care than any other major Catholic hospital system in the state, and we want to make sure that a merger includes a plan to improve this performance.”
 
The merger would create one of the largest Catholic hospital systems in the country. Providence currently operates 34 hospitals and 500 clinics in Alaska, California, Montana, Oregon and Washington, and St. Joseph Health (SJH) runs 16 hospitals in California, New Mexico, and Texas.
 
The two chains have asked the AG for a waiver of the normal review process by which she would approve or disapprove of the merger of two nonprofits. Nurses say they are especially concerned about a truncated process, without independent healthcare impact statements and public hearings—for a transaction which involves a change of control or governance of at least 16 different nonprofit hospitals in California alone.
 
Together, the new system would have an especially large footprint in California, and a near monopoly in some regions—exactly why Harris should intervene, says CNA.
 
In conducting a full review, CNA is urging the Attorney General to assess the impact of the proposed merger on:

• Existing issues with nurse and patient rights at St. Joseph Health System, including its record of poor charity care performance, its reduction of caregivers and services while recording record profits, as well as its documented violations of federal labor law in attempting to block nurses from forming a union;
• Women’s reproductive health services in communities throughout California;
• Ethical and religious directives for Catholic healthcare, which prohibit Catholic healthcare providers from offering a rang of “beginning of life” and “end of life” services;
• The expansion of a near monopoly of hospital services in key markets in California;
• Negative impacts on cost and accessibility of healthcare services, as numerous studies have shown that hospital mergers often increase costs to patients while limiting access to care;
• The potential for closures of hospitals and/or patient services, layoffs or outsourcing of skilled, experienced employees;
• Whether St. Joseph’s many for-profit ventures, and its investments in hedge funds and offshore accounts in the Cayman Islands, are compatible with the charitable trust in which the nonprofit system’s assets are held.

 
Until these and other issues of concern to RNs and patients are adequately addressed, CNA said it cannot support the proposed merger. Sharon Bryan, an RN at St. Joseph’s St. Mary’ Medical Center in Apple Valley, said, “As nurses, we have many reservations about the proposed merger.”
 
“St. Joseph,” said Bryan, “has lost its moral compass, and we are witnessing a hospital system that once cared for its employees and patients evolve into a corporate entity motivated by profit. One cannot help but wonder whether the recent draconian cuts to RN benefits and working conditions have been part of a process in creating the conditions for a business merger. Before moving forward, St. Joseph needs to immediately return to a just, caring culture.”
 
In a research report on St. Joseph, issued in August, “Falling from Grace: St. Joseph Health RNs Raise Ethical and Patient Care Concerns,” CNA cites a number of areas that reflect what CNA calls “priorities of present day corporate management who increasingly value maximized profits at the expense of patients, RNs, taxpayers and SJH’s own stated principles.”
 
In particular, SJH and its hospitals, the report asserts, have:

• Reaped millions in tax subsidies from California taxpayers, while providing among the lowest amount of charity care of any Catholic system;
• Invested patient care and tax subsidized funds into for-profit companies, including hedge funds in the Cayman Islands;
• Launched a system-wide campaign to illegally restrict the rights of its RNs to organize a union to advocate for improved treatment of patients and RNs;
• Been charged with scores of violations of federal law in the past year as a result of their anti-union campaign against their RNs;
• Imposed sweeping cuts in disability, medical leave, and retirement security on thousands of SJH employees, while paying exorbitant executive salaries and benefits.

The full report is available at: SJHFallFromGrace.com