The health care debate, Santa Fe style

& The discussion was going along fairly smoothly for Ronald Aldrich Monday night in the jam-packed room at the Center for Progress & Justice on Cerrillos Road in Santa Fe, everything considered. Sure, he’d have probably rather been somewhere else — as it turned out he was a sort of stand-in for Alex Valdez, who is the big boss — chief executive officer, if you want to be formal about it — at Christus St.Vincent Regional Medical Center. I just call it St. Vinnie’s.

It was fairly smooth, that is, until Aldrich got an earful from Delma Delora.

Aldrich is the board chairman of St. Vinnie’s and, as such, is usually operates well above the day-to-day nitty-gritty of running the biggest medical care facility in northern New Mexico. Sometimes, it’s a little more gritty than nitty, and this month of June is one of those times. It’s contract negotiation time between the hospital’s owners — Dallas-based Christus* Health — and the local chapter of the National Union of Hospital & Health Care Employees. We’re told that there’s still a lot of bargaining to be done and compromises to be reached before the contract expires at the end of the month. “The parties,” you might read in a press dispatch, “are still far apart on issues such as staffing, workloads and communication between employees and administrators.”

Before I get down to the gritty part of it, I’ve got to say that you can probably ask just about any patient — or past patient, like me — and generally get a highly favorable report of the way they take care of you at St. Vinnie’s. They took fine care of me about a year ago, and I’m not going to forget it. But what you probably don’t know — because of the tight-lipped professionalism of a damn fine staff — is that tempers are fairly high, egos are a bit bruised, and some of the employees are on the warpath. And to top that off, the weather around here these days hasn’t been helpful — it’s been a miserable spring, what with cool temperatures lasting too long, winds blowing incessantly, and rain refusing to fall. Now, it’s hot, crackly dry and still windy, and the normally clear blue sky has been soiled with stinky, smelly, sooty stuff carried in on the breezes from the big forest fire in Arizona. So everybody’s in a rather pissy mood, to say the least.

Monday’s meeting was billed as a forum to discuss a variety of health care concerns in and around The City Different — and if you think you’ve got problems, Bucky, you should have heard some of these problems. There were 13 panelists, all of them bearing bad tidings about good people struggling to care for others in a time of increasing costs and declining revenues. The panel’s moderator, Hizzoner David Coss, summed the health care system in his town in on word: Chaotic.

Just to name a few — every one facing money problems: care and coaching for those preparing or planning for births, solace for those in the throes of death, agencies for Indians, programs for women, lobbying efforts for seniors, response systems for an overload of medical emergencies, and institutional programs for the incarcerated and those who Delma DeLora aptly described as “the people who live under the bridge.”

Enough fodder, certainly, to draw an audience in politically aware, community-conscious Santa Fe. But what really packed the room — I figured at least 200 humans and one dirty white poodle were jammed in there — was the main event, described by the union as its current “struggle for safe staffing ratios and fair working conditions.”

Simply put, the staff says the new bosses have violated the old contract, and “the situation is not good.”

There were plenty from the union side in the audience — the Center for Progress & Justice is, after all, a place where progressives hang out — but some of the seats also were salted with a few from the management side. And, for what was essentially a public airing of gripes in a union hall, it was pretty civil — if you’d compare it to something like Congress, for example, it was downright heavenly.

The mayor opened the session by allowing each of the panelists a few minutes to tell us what they want to do, what they can do, and what they are doing, and then started into a pile of written questions from the audience. There were a few for some of the panelists, but, Coss said, “a stack of questions” about the staffing issues at St. Vinnie’s. It’s a popular issue, given the ongoing negotiations and the fact that administrators recently announced a round of job layoffs and reassignments. It may not be the last, say some.

[For a detailed report and another’s perspective, visit Steve Stocker’s report on the meeting here, and his exhaustive, continually updated compliation of items called The Christus Files, which he maintains, he says, “to provide a more coherent, educational, and informative presentation of a lot of complex, convoluted, and IMO most important information.”]

During his opening presentation, Aldrich said that since Christus added Santa Fe to its 40-hospital chain in 2008, it has been trying to consolidate some of Santa Fe’s scattered medical services and create an “integrated system” of health care in the community in order to deal with a variety of changes and potential changes, not the least of which are impending adjustments to Medicaid and Medicare, and the expected loss to the hospital of $100 million in federal funding over the next five years. One of the possibilities — acquisition of the independent Physicians Medical Center surgical facility — has raised charges that Christus has designs on gaining a monopoly in northern New Mexico.

“Is Christus St. Vincent trying to gain control of all the medical facilities?” Aldrich asked himself.

“The answer,” he said, “is ‘no.'” That brought slight grumbling of disagreement from the crowd, but Aldrich — who sat amid this potentially rowdy bunch as the late Rev. Jerry Falwell might have sat amid a roomful of intelligent atheists — responded only with a slight, cordial grin pasted into a resolutely raised jaw. That’s what chairmen of boards do.

Sitting a few seats down the long panel table, but on the other side of the figurative fence from Aldrich was Delma Delora, a nurse who has been working at St. Vinnie’s one year short of a half-century, and is somebody who obviously has a right and ability to impart a true corporate memory. In her opening remarks, she had only fluffed the feathers of Christus when she said, forcefully, that the hospital, founded by nuns during the Civil War, was always designed to be there “for the people.” That meant, she said, all of the people, and she didn’t deny the new owners the right to “a little profit” (it is a non-profit, but one that’s trying to cut its costs). But, she said, “even the people who live under the bridge deserve the same kind of care that is given to others…we’ve got to keep [the hospital] for all the people.”

The union line on staffing differences between administrators and employees was first drawn in the discussion by Holly Beaumont, a religious minister who is the director of a group called Interfaith Worker Justice -NM, and who quoted from a Catholic church tract that she said “supports the rights of workers to organize,” and clearly states that “unions may also legitimately resort to strike” when justified. It was in the teachings of Christ,  she said without quite looking at Aldrich, that if cuts in staffing are to be made, they should be made among those who are less involved with caring for the sick. Christus St. Vincent, she said to the most rousing applause of the evening, should “start cuts at the top, not the bottom.”

It is the contention of nurses, it became clear, that they fear further reductions in the nursing staff, and one speaker cited studies showing that mortality rates in hospitals increase as the number of nurses-per-patient decreases. On one wall, someone had posted a sign listing “factors driving nursing turnover.” Among them, and apparently those matters high on the list of concerns of the local union at St. Vinnie’s: physically demanding, heavy workloads, lack of respect, recognition and rewards, poor communication with administrators, and insufficient opportunities for career advancement.

As the discussion turned toward the issue of staffing, Aldrich, still grinning but occasionally shifting slightly in his seat, reminded the audience that he was a board member, not an administrator, and “we simply are not going to be negotiating staffing levels at this meeting.” That, he said, is a matter for the people at the bargaining table, a process “which we support.”

Hospital staffing, Aldrich said, is a “very complicated and involved system,” and will always be subject to “different perceptions as to whether we have adequate staffing…not every issue can be addressed” by increasing staff. That, he said, is one reason the organization is looking at ways to make better use of existing facilities and integrating other services and functions.

To a loaded question from the audience about whether the hospital intended to “hire more staff or run the hospital with a short staff,” Aldrich said “No! We do not believe it is the case now, nor in the future.”

But that wasn’t enough to satisfy Delma Delora.

She questioned the abilities of the hospital’s recently hired nursing director, saying “I don’t know her experience…but it’s not helping our hospital.” The new director, who she did not name, “needs to show more compassion for the patients in those beds. That is our responsibility.”

The union, she said, is not as concerned about bargaining over salaries and compensation as it is “about the things that affect the patient. That is what our union is about.”

She questioned Aldrich’s reference to the complexity of staffing patterns: Before the arrival of Christus Health in 2008, she said, the management and union had agreed on “great staffing patterns.” Those patterns would be adequate, she said, “if you abide by them. But you don’t abide by them.” But the bottom line, she said, is “that in order to serve [the patients], you must have enough staff.”

Since the arrival of Christus, she said, there has been a major attitude adjustment: “Everything has changed.” The new management, she said, repeatedly violated the contract, has instituted changes without honoring commitments to notify the union and “decided to do whatever they please…there is no one there who really wants to listen.”

If Aldrich needed to carry one message from Delma Delora back to his negotiating team — described by Delora as “lawyers from San Francisco to go up against us” — it would probably be this: “We used to be equal partners. Now we are not. The situation is not good.”

Where does it end, what is the outcome? Aldrich, although he kept a benevolent smile in his firm jaw, didn’t give many hints. “We are committed to being involved in bargaining for wages, benefits and working conditions,” he said, and to developing strong working relationships between employees and management.

“There is no change in our position in wanting to be collaborative and supportive,” he said, adding that Valdez, the administrative boss (who was off somewhere picking up an award or honor), is “committed to a just and fair organization.” But, he said, the economic situation — drastic cuts in federal funding for community health providers, changes in Medicaid and Medicare among them — means “we’re going to have to change.” Christus, he said, is “committed  to providing safe patient care.” But his bottom line: “We are all going to have to work together.”

Sounded suspiciously like something written by San Francisco lawyers in sharkskin suits.

& A former patient practicing patience, I’m outta here.


*The marketers at the Catholic non-profit hospital chain would prefer it if I would always refer to them in print as the all-capitals CHRISTUS Health. But, inasmuch as “Christus” is not an acronym, like NAACP, or ACLU, and is simply the Latin word for Christ, who already gets plenty of publicity, I’ll just opt for the lower case. I hope to hell I haven’t lost my seat in heaven.



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4 thoughts on “The health care debate, Santa Fe style

  1. Well, Old Gringo, you have given it to the boys from christus, or at least to the boys who get paid by christus to speak on behalf of christus, not that there’s anything wrong with being from San Francisco or wearing a suit, for that matter. How we ever got ourselves in a place where our hospitals are for-profit ventures is just one of many stories about how the ‘golden rule’ — not the Golden Rule, mind you — can ruin almost anything it touches. It’s bad enough that we’re the only OECD country that has for-profit health insurance companies, but when the hospitals themselves become widgets, we gotta problem, and not just in Houston or Santa Fe, for that matter. Anyway, nicely done, and particularly for someone of your ‘golden years.’


  2. Gold by the Old Gringo. I love the way these rapacious “non-profits” pick names like “Humana” and now “CHRISTUS” to try to reassure us that they’re on the side of social justice. What nonsense.


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