July 12, 2018

With nurses going on a two-day strike at Vermont’s biggest hospital, Nolan Rampy writes from Burlington on some of the main issues involved — including how managers draw fat checks while overseeing dangerous staff shortages.

SOME 1,800 nurses at the University of Vermont Medical Center (UVMMC) are set to begin a two-day strike starting Thursday, in what will be one of the state’s most significant labor actions in decades.

The main demands of the nurses — members of the Vermont Federation of Nurses and Health Professionals (VFNHP) — are safe-staffing levels and competitive wages needed to recruit and retain a well-trained, competent staff.

The union is demanding a 24 percent increase in salaries over three years. Management has offered raises ranging from 7 to 14 percent — but the higher number includes longevity increases that nurses with less seniority already receive.

While UVM claims it can’t afford to pay nurses the prevailing wage, hospital President Eileen Whalen announced that administrators have found the funds to bring in 600 replacement nurses to scab on the strike.

Nurses at the University of Vermont Medical Center rally for a fair contract (Tula Adie)

When the union looked at salaries for nurse practitioners in the region, they were unable to find a single institution that paid less than UVMMC — and Vermont has some of the lowest salaries in the country. In fact, the union found that a nurse practitioner at UVMMC would have to work 15 years just to reach the national median wage for nurse practitioners.

As a result of these low wages, there are 180 vacancies at the hospital — creating a crisis of understaffing that affects patient care in every unit.

“We have nurse practitioner positions that sit open for months and even years,” said VFNHP member Tristin Adie at a rally in May, “which means our patients suffer because it’s much harder to get timely appointments in many clinics — and we suffer because we’re trying to cover the shortfall.”

Nurses Julie MacMillan and Sarah Ferguson explained in a Socialist Worker roundtable discussion how other areas of care are impacted.

“In the operating room,” said MacMillan, “they’re supposed to start with 34 nurses per day, but now they’re starting with 26.”

Ferguson added: “For the IV department, short-staffing means we aren’t able to get to dressing changes on central lines or take out IVs that come from outside hospitals that have an increased chance for infections. We’re seeing an increase in bloodstream infections from central lines and IVs because we don’t have enough staff to get to those, and we’ve had patients who have died from it.”

“Now our big problem is ancillary staff,” added MacMillan. “We don’t have enough aides, transporters and housekeepers. Nurses are constantly getting pulled away to do non-nursing functions, which can exacerbate the lack of RNs in general. So another part of our platform is a $15 minimum wage for all support staff — to help keep people at the hospital and allow nurses to do what we’re there to do.”

Vermont’s Sen. Bernie Sanders spoke to this issue at a press conference in support of the nurses:

This is not a complicated problem. If the medical center doesn’t pay competitive wages for the vitally important work nurses do, we will continue to see high vacancy rates and high turnover rates. If nurses don’t earn enough to live in dignity and raise a family here in Vermont we will continue to lose these nurses to other states that pay more competitive wages.

THOSE WHO didn’t know any better might assume that UVMMC is a small, cash-strapped nonprofit, just struggling to make ends meet.

Nothing could be further from the truth. It’s a rapidly expanding regional behemoth — and a symbol of everything that’s wrong with this country’s for-profit health care system, including our supposedly “nonprofit” hospitals.

UVMMC is the flagship hospital of UVM Health Network, a network of six hospitals throughout Vermont and upstate New York. Over the past several years, UVMMC has generated hundreds of millions of dollars in profits and currently has an operating budget of $1.2 billion. According to CFO Todd Keating, the hospital has enough cash on hand to operate without any incoming revenue for 220 days.

So why are nurses at a nonprofit hospital that’s drowning in cash being forced to go on strike in order to get the minimal resources needed to provide quality care?

While UVMMC is technically a nonprofit, its top-heavy administration and aggressive expansion make it almost indistinguishable from private companies because it operates within a profit-driven health care market and is subject to many of the same market pressures and incentives as privately owned companies.

And when it comes to market competition, size equals strength.

Since merging with Vermont Medical Center in 2011 to form the UVM Health Network, UVMMC has dominated the health care industry throughout the state.

In 2015, UVMMC accrued $2.5 billion in gross revenue and $1.3 billion in assets. According to figures from 2016, UVMMC accounted for over 55 percent of all assets controlled by hospitals throughout the state.

The medical center has used its financial and political clout to stifle any competition that threatens to chip away at its monopoly.

In 2016, the Burlington Free Press documented UVMMC’s aggressive attempts to undermine potential competitors through frivolous lawsuits; sabotage real estate deals; and lobby at the state level to deny doctors the necessary permits to set up independent practices.

Former state Sen. Peter Galbraith told the Vermont Digger: “What’s happening is that instead of keeping costs down — using the extra revenue, lowering prices, so that its focus is entirely on the service — the extra money is going into empire-building and these outsized salaries.”

GALBRAITH WASN’T kidding about the outsized salaries. CEO pay at UVMMC has nearly doubled over the last 10 years, and many executives at this “nonprofit” make over $500,000.

In 2015, the top 15 individuals at the hospital received a total of $10.7 million. Last year, CEO John Brumsted made $2.2 million in overall compensation, making him by far the highest-paid hospital CEO in the state.

“It is a lot of money,” UVMMC’s Compensation Committee Chair Scottie Gin admitted about Brumstead’s salary. “I’m not going to argue it’s not, but it’s what we need to keep and attract the right leaders at our organization to help us do the right thing so we get the right health care for Vermonters and New Yorkers.”

This is the same management that claims it doesn’t need to pay competitive salaries to its nurses and other sub-millionaire employees who do the actual work that generates the hospital’s revenue.

Between 2001 and 2015, roughly three-quarters of total profits generated by Vermont’s 14 hospitals came from UVMMC. In 2017, the medical center exceeded predicted revenues by $23.7 million.

“We have been the beneficiary of some significant volume growth over the last five years,” explained Keating in 2016, “and what we’ve been able to do is see a lot of patients without an increase to our fixed costs.”

He’s right. As UVMMC has expanded, it’s received an influx of sicker, more medically complex patients sent by other providers who lack the necessary resources and infrastructure to provide adequate care. Rather than hiring more staff to keep up with the increased volume, management has simply increased the workload of its already overworked care providers.

The second way that UVMMC has avoided “an increase to our fixed costs” is by suppressing employee raises. Compensation at UVMMC ranks near the bottom, both nationally and regionally. Other hospitals in New England pay between $20,000 and $45,000 more per year for people who do the same work, often in positions that require fewer hours.

The board of trustees could easily use a portion of the hospital’s billion-dollar budget to improve patient care by hiring more staff and raising salaries. But that would cut into their cash reserves, which could jeopardize their ‘A’ bond rating, which in turn would raise interests rates on the loans used to fund future acquisitions and infrastructure projects.

Instead of investing in patient care, UVMMC has chosen to prioritize its regional ambitions to gobble up more competitors, build more buildings and provide executives with millions of dollars in compensation. These are the perverse priorities we get when basic social services like health care are subjected to the logic of the free market.

FOR YEARS, nurses have resisted striking, due in large part to their unwavering commitment to the patients they serve. They have sat at the negotiating table with the hope that, despite their differences, nurses and executives shared a fundamental goal of providing quality health care to the community.

But management’s excuses have worn thin. At a June rally, MacMillan explained that in the years after the 2008 recession, “we were just happy to stay above water. We’re now many years past that, but [management has] continued to say, ‘You swallowed 2 percent last time, what’s the problem?’”

It’s also become increasingly clear that the interests and values of hospital administrators run directly counter to not only those of doctors, nurses and support staff, but also the patients who rely on UVMMC for their health care.

When nurses raise the demand for livable wages and safe staffing levels, administrators don’t think about how this will improve quality of care. They think about how it will cut into their profits.

When doctors attempt to set up lower-cost outpatient surgery centers, administrators don’t see a new opportunity for Vermonters to access affordable health care. They see a potential competitor cutting into their market share.

Nurses aren’t just fighting for themselves, but for their patients and community members. They are demanding that this grotesque state of affairs be flipped on its head. They are demanding that human need be prioritized over profits.

“When they talk strike, I get a little nervous,” said nurse Cheryl Lynn Bodge at the June rally. “But when I think about it, I can’t afford not to. If that’s the route they take, to help everybody including myself, we’ve got to do what we’ve got to do. We’re trying to provide our community the best care we can, in the safest manner, and we’re just not being given the tools to do that.”

The determination of nurses to take a stand has been evident at rallies, solidarity meetings and negotiating sessions that have been attended by hundreds of VFNHP members.

At one session, when the hospital’s negotiator became frustrated that the union was uninterested in bringing in a mediator since “this has always worked in the past,” one nurse shouted a response that sums up the general mood: “This time is different!”