Struggling for a Solution - A fiery meeting splits Petoskey 50-50 - could binding arbitration be the answer?

Feb. 11, 2004

On February 14, 2002, “the day of love,“ Teamsters Local 406 was certified
as the bargaining agent on behalf of the nurses at Northern Michigan
Hospital in Petoskey. Two years later the community is still looking for a
little love and resolve to what has become the longest nurses‘ strike (now
in its 15th month) in United States history.
Enter into the mix Rep. Bart Stupak, who on February 2, 2004 held a
town hall meeting to discuss the status of health care at the hospital. The
meeting was billed as an opportunity to learn about the Centers for Medicare
& Medicaid Services‘ (CMS) December 8-11 complaint survey which revealed that
the hospital had “conditional-level deficiencies“ in infection control.
The event attracted several hundred residents looking for answers. Some came to voice their opinions, others to point fingers, and some offered support to hospital management or the striking services. By the end of the night, however, many left with more questions than answers and deepened old wounds that even the best surgeons present were unable to heal.

SPOTLIGHT ON STUPAK
Early media reports suggested Congressman Stupak was using the
forum as a “political ploy“ to gain support from the labor unions and even
to repay them for their support in his reelection campaigns. And that his focus on a preliminary complaint survey was doing more harm than good by creating a “health care scare“ that just doesn‘t exist.
Stupak asserted otherwise, stating that he was acting upon several constituent complaints about their health care at NMH. Stupak has said that he hasn‘t taken sides, but has sought an end to the strike. He has met with hospital administrators twice since the strike started, including hours before the forum, with the
meetings being cordial but with little being resolved.
At the forum, Bob Daily of CMS, which is based in Chicago and covers a six-state
region, outlined the process for his agency‘s involvement. He stated that
they, “usually don‘t survey accredited facilities, but several complaints
resulted in his department implementing a complaint survey.“
A complaint survey is only a partial survey and in the case of NMH the
survey team looked at just two of 18 possible areas: patient care and
infection control. During the three-day surprise visit last December 8-11
by a team made up of three health care professionals from the State Bureau
of Health Systems, the hospital was found to have “condition level
deficiencies.“
This is just a preliminary finding and at this time the hospital is not
required to respond or take any corrective action. Instead, a full survey
will take place in the near future looking at 18 compliance areas of the
hospital. If at that time any deficiencies exist, the hospital will have 15 days to respond and 90 days to implement a corrective plan of action.

FULL SURVEY COMING
Officials from the CMS regional office in Chicago said that a full survey
would be conducted in the near future. There was a possibility that the NMH
could pass everything and that no further corrective action would be needed.
They also stated that of the 88 hospitals they surveyed last year, eight that had condition level deficiencies. Their agency is seldom, if ever, invited to attend public hearings on such findings.
CMS is responsible for hospital oversight and to make sure corrective action is taken place so the health care providers remain in compliance of federal standards. “We work to correct action not close down and or withdraw funding,“ a CMS staffer noted.
The current controversy at NMH stems from Stupak‘s decision to release this preliminary survey and call for a public forum, since the hospital was told by CMS there was no need to respond to the complaint survey. CMS officials stated that
they normally don‘t release survey results, especially complaint surveys, but
Michigan has a more liberal Freedom of Information Act and so the survey was
made public.
Stupak defends releasing the results, since he had requests from several constituents asking for a copy.
Hospital management and supporters stated the Stupak erred in his decision to make an issue out of “preliminary findings.“ They feel that his decision to do so has wrongly cast doubt on the quality of health care being provided at NMH.

HIGHEST SCORE EVER
Hospital administration was invited to attend the forum, but not to
participate, so responses over the deficiency issue came from doctors and other NMH supporters. It was pointed out by those supporters that the hospital received a
score of 94, its highest ever, by the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO).
Prior to the forum, Teamster officials had suggested the JCAHO score was
irrelevant because it was bought and paid for by the hospital. Stupak
insinuated that as well during the forum.
Actually, the JCAHO is the largest accreditation organization in the country
and utilized by 16,000 health care facilities. In order to maintain
accreditation, health facilities are required to submit to a detailed survey every
three years by JCAHO. The survey findings and accreditation are recognized
by government agencies and are considered to be the industry standard.
Health care organizations, like educational facilities and other which seek
accreditation, must pay for the service. Payment, however, does not guarantee
accreditation or a high score. JCAHO is independent.
Proof of this is in the score that NMH received three years ago from JCAHO.
While the survey score form 2000 did not come out during the forum
discussion, the Northern Express learned through further inquiry from JCAHO
that NMH scored a 72 that year.

THEN & NOW
Hospital administration was asked about the low score from three years ago.
“This is true and it was a wake-up call for us,“ said Tom Spencer,
spokesperson for NMH. “We developed a corrective plan back then and the
result is we have a 94 today. That speaks to our daily commitment to provide
quality health care to the community. As for the current complaint survey, we
are aware of some the issues and in fact pointed them out to them. We
were written up for that despite letting them know we had a plan of action
being implemented. We work every day here to make improvements -- all
hospitals and any business are constantly trying to improve the services they
offer, and we are no exception.“
When queried further about the fact that the hospital scored a 72 with the
current-striking nurses and a 94 with the current combination of permanent
nurses and traveling nurses Spencer was unwilling to point fingers.
“Providing and managing quality health care is challenging and requires a
daily commitment to improve,“ said Spencer. “Look, no one in the community
was outraged when we scored a 72, they didn‘t call for public hearings then.
Providers of health care face many obstacles daily, regulations continue to
change and increase. Costs continue to rise; the system is not perfect here
or anywhere. We didn‘t point fingers then -- we looked at the areas JCAHO said
needed to improve and we developed a plan of correction.“

BEEN CALLED WORSE
At the forum, the audience seemed to show little interest in the JCAHO or CMS process. Rather, finger-pointing and passionate statements were the standard.
David Bailey, who volunteered as a chaplin at the NMH for 17 years, seemed more interested in identifying Stupak‘s motivations. He questioned the congressman over his position on “forced unionism,“ and even suggested that the Congressman‘s actions amounted to an act of “terrorism“ on the community.
After the forum Stupak said, “I have been called worse.“
Others came forward in support of Stupak‘s willingness to involve himself in
the heated debate, pointing to the fact that he worked closely with hospital
administration in the past to procure federal funding for NMH.
One of the evening‘s more moving speakers was local resident Mary Carpenter, whose husband was a long-time surgeon in the area. Carpenter had surgery last fall at NMH and incurred a staff infection while at the hospital. She is one of eight identified in a 30-day period to have obtained staff infections at NMH.
“First I want to say the physician care I received while at NMH last fall
was impeccable. It was as good if not better than what I would have received
anywhere else,“ said Carpenter. “However I can‘t say the same for my nursing
care. It was apparent that the nurses were understaffed, my room was filthy
and my husband and friends had to provide me with the basic nursing care
that I should have received from the hospital.“
In a follow-up interview the next day Carpenter spoke to what she feels
needs to be done to resolve the strike:
“Look, a staff infection can and does happen at any hospital and I am less
concerned about that than I am about the quality of nursing care I received,“ she said. “It was deplorable. My husband and many other physicians have worked side by
side with many of those nurses on that picket line, they have worked
together to give this community wonderful, quality health care. It pains me to see the situation where it is at, many of us in this community owe our lives, and myself included, to those nurses.
“I also understand the position of the administration,“ she added. “The problems our hospital faces are really a reflection of the larger national crises in health care as well as societal expectations that every problem can be fixed medically -- the belief that we are not going to die. Television and the media have painted
the picture that everything is curable -- our expectations of health care far
exceed what is humanly and scientifically possible. We need our community
back, our nurses back and binding arbitration is the solution. Look, we have
two kids in the sand box right now that are not playing nice, they need
their toys taken away and an adult to step in to settle this once and for
all.“

BINDING ARBITRATION
Binding arbitration was suggested several times during the forum. One speaker
suggested a panel of Petoskey Chamber board members from the area. Stupak, a
supporter of binding arbitration, explained how the arbitration process
works:
“There are federal laws that mandate the binding arbitration process,“ said
Stupak. “Three arbitrators are selected with each side getting to remove
one. The final arbitrator listens to both sides and then renders a final
decision.“
Teamster officials have said they would gladly accept binding arbitration:
“Absolutely, the Governor had suggested this several months ago in a letter
to us NMH and we responded and accepted her proposal of binding arbitration,“ said Sharon Norton, Teamsters Local 406 business representative. “We have endorsed binding arbitration and each time the hospital has rejected it. We are confident if both sides presented to a third party our issues, which we believe are reasonable, would win. The hospital has not been willing to accept this process.“
Hospital officials have a different view and don‘t welcome arbitration by a third party.
“We have heard from the governor, from the congressman and even Bishop
Cooney on this,“ said Spencer. “The position of management is that we are charged with the responsibility of operating this hospital and there are many factors that go into the operations. Our offer to the striking nurses is based on the operation as a whole and we don‘t believe a third party has a handle on the full scope of operating this hospital.“
The town hall meeting and forum did little to shed any light that the two
sides are getting any closer to reaching an agreement. NMH has stated they
have put forward their final offer, yet Teamster officials remain hopeful
that an agreement can be reached.

MEETING SOON
“Despite what has been said we continue to meet at the bargaining table, in
fact we will again meet later this month to address our economic issues,“
said Norton. “We haven‘t even discussed those, so the administration has
agreed to come to the bargaining table again. We do remain hopeful that an
agreement can be worked out and our striking nurses remain willing to strike
as long as it is necessary to reach a fair agreement.“
Key issues include the nurses‘ pension benefits and patient care.
“The hospital maintains that it wants the exclusive right to decide on
patient care without a committee process and nursing input that is common at
several hospitals,“ said Norton. “Certainly another sticking point is the
hospital doesn‘t want to have a union shop as well as issues on overtime and
compensation still exist.“
Norton stated that both sides have reached agreement on “a majority of the
grievance procedures,“ but still remain distant on day-to-day operational
issues.
The situation is complicated at best. Both sides seem to be putting forward
a tremendous amount of energy on propaganda and finger-pointing campaigns, but little energy on compromise.
What seems to be a stake in Petoskey is not the quality of health care at NMH: evidence suggests that quality is as good if not better than many hospitals. Rather, it is the possibility of a community‘s heart being
broken beyond repair. Life-long friendships have been destroyed, working
relationships have been strained, and resources, finances, emotional and
physical energy has been expended by both sides to further their positions
rather than utilizing these resources to work together at the challenge of
providing quality health care.