Doctors, nurses, others embracing unions

Art Nadler

Monday, Aug. 16, 1999 | 11:26 a.m.

What once was considered sacrilegious within the medical community is becoming commonplace today. Doctors and nurses are openly embracing unions.

Currently, three hospitals in Clark County are engaged in collective bargaining negotiations with the Nevada Service Employees International Union. University Medical Center reached a tentative agreement on Thursday.

In the last two years alone unions have been asked to represent employees in three of the four largest hospitals in Southern Nevada.

Registered nurses and technicians at Valley Hospital Medical Center and technicians at Desert Springs Hospital voted in July to have the union represent them.

Nurses at Desert Springs Hospital have been represented by the union since May 1997.

And in December, after four years of trying to organize nurses, technicians, service workers and the business office, the union won support and is now negotiating with administrators at Sunrise Hospital Hospital and Medical Center.

UMC has been unionized since 1987; employees have been working without a new contract since July 1998.

But nurses and technicians aren't alone. In June, after years of lobbying by doctors, the American Medical Association voted to give its blessing to the marriage of physicians and unions.

The only stipulation is that doctors must be employees of hospitals. Federal antitrust laws prevent independent physicians -- the majority of practicing doctors -- from being associated with unions for fear that they might conspire to fix fees.

Even that could change if the Quality Health-Care Coalition Act of 1999, introduced in Congress in March by Rep. Tom Campbell of California, is passed. It would allow independent doctors to negotiate with insurance companies and hospitals, if talks are perceived to enhance quality of patient care.

Doctors employed by UMC, because they are also part of the University of Nevada School of Medicine, recently voted to have SEIU represent them.

Attempts to get UMC doctors to say why they sought union representation were unsuccessful. One physician said he couldn't talk because of a "gag order" issued by the hospital. But a UMC spokeswoman said the order didn't exist.

However, doctors who aren't employed by UMC spoke freely about concerns that have driven doctors to seek unions for protection.

"Physicians have lost control of the health care of their patients," said Dr. Jeffrey Cichon, president of the Clark County Medical Society. "Care is being denied by insurance companies. Basically, you have to convince them (insurance companies) that treatment is necessary."

Cichon, an orthopedic surgeon, said 80 percent of his diagnoses recommending further treatment are denied by insurance companies. Also, he said, many times his requests for braces or rehabilitation are denied by insurance companies. And in some cases, he said, lesser-quality braces are approved to save insurance companies money.

"We get these contracts with insurance providers, and they tell us to take it or leave it," a bitter Cichon said. "On top of this, we have to hire more office personnel to do all the paperwork to get care approved. Sometimes, it may take two or three weeks to get authorization for treatment."

In an attempt to hasten authorizations, some orthopedic surgeons in Las Vegas, Reno and Carson City formed a union called the Federation of Physicians and Dentists a little more than a year ago. It's associated with the AFL-CIO.

Dr. Donald Mackay, a Las Vegas orthopedic surgeon and a member of the union, said it was formed to improve relationships with insurance companies. But because neither the union nor insurers are required to seek or abide by binding arbitration, he doesn't feel the union has any strength.

"This is a very awkward and inefficient system," Mackay said. "Unless the law changes, we won't be able to accelerate bargaining."

Mackay said Campbell's bill is crucial to giving physicians collective bargaining power.

Another solution may lie in what Texas did in May. At the urging of state Rep. John Smithee, R-Amarillo, the state Legislature authorized independent physicians to collectively bargain as long as the state's attorney general oversees procedures.

The attorney general's office was brought into the proceedings, Smithee said, to guarantee that physicians wouldn't conspire to fix prices. This satisfied federal antitrust concerns.

"We have tried to maintain a balance between the various entities," Smithee said. "I think this (collective bargaining) will be used very rarely. It shouldn't be much of an issue, but we have it."

Under the Texas law, scheduled to take effect by the end of this month, physicians may collectively negotiate for clinical practice guidelines, coverage criteria, methods and timing of physician payments, dispute resolutions involving health benefit plans and what physicians want and patient referral procedures.

Larry Matheis, executive director of the Nevada State Medical Association, said his organization may consider drafting similar legislation when the 2001 Legislature reconvenes. For now, he said, passage of the Campbell bill in Congress is the best way to guarantee physicians will be represented properly.

"We are nearing a crisis where something needs to be changed," Matheis said. "Either the federal laws need to be changed or there will have to be some state relief. There needs to be something to ensure a balance of decision making."

Keith Beagle, chairman of the Nevada Association of Health Plans, said doctors unions will just complicate matters. Because health plans tend to cover several states, it wouldn't be feasible for administrators to sit down and negotiate separate contracts with each group of doctors in every state.

"We will certainly listen to physicians on local issues of quality, but there isn't a lot of freedom on the administrative end," Beagle said.

Beagle said if doctors join unions to improve patient care, insurance companies would probably support them.

Nurses, like doctors, say they have sought union representation not to get more money, but to have control over patient care.

Theresa Morrow, a nurse at UMC, said nurses want to have a say in acuity care, or care based on the severity of patients' conditions. She said nursing supervisors arbitrarily select the number of nurses for each shift, rather than basing them on acuity per floor.

Another concern of nurses, according to Jerri Woolston, a registered nurse at Sunrise Hospital and Medical Center, involves on-call policies. Nurses in all four hospitals say they are on call too long and have very little time off when they are not on call. They say patients' safety may be in jeopardy when nurses are tired all the time.

Hospital administrators denied that the ratio of patients to nurses is based on arbitrary numbers. They say charge nurses alway take into account the number of critically ill patients on each floor per shift.

They admit that nurses are on call a lot, but blame this on a national shortage of nurses.

"Years ago, the two choices women had (for a career) were nursing and teaching," Ann Lynch, a spokeswoman for Sunrise Hospital and Medical Center, said. "Today there are more opportunities for women. The nursing pool has shrunk, but the demand is still growing."

Lynch said the hospital is currently recruiting for more than 100 open nursing positions.

Ray Brown, a spokesman for Valley and Desert Springs hospitals, also blamed the nursing shortage for placing more nurses on call. He said Las Vegas, with its rapidly growing population, is in a crisis situation.

While patients' severity is a factor in determining how many nurses are brought onto a shift, Brown said, other considerations might include the flu season.

"It's not the nurses job to set (patient/nurse) ratios," Brown said. "That's the job of the hospital. But it still comes down to quality of care."

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