Hospital Unions Make Inroads Through `Neutrality' Deals
Mischa Gaus, November 8, 2010
Thousands of health care workers in Florida could
unionize this fall as a result of neutrality deals.
Photo: Hilda Perez.
Ramiro Castillo, racing through his 12-hour shift as an
intensive-care nurse, needed a snack and stopped by a
conference room where the union had a spread. Lavaughn
Renner got a flyer in the mail telling her a union was
coming to Texas. Lizzette Lopez's mom encouraged her to
channel frustration into organizing.
None of these nurses considered themselves linchpins of
a new strategy to organize health care workers. But in
joining National Nurses United (NNU), these three
nurses-and 1,900 more who unionized with them at five
for-profit Healthcare Corporation of America hospitals
in Texas-reinforced the belief among many unions that
neutrality agreements which take the employer off the
field are the future of organizing.
Another 1,500 nurse aides, techs, housekeepers, and
other staff organized at four of the same hospitals
this summer with the Service Employees, as part of a
similar neutrality deal with HCA.
Now the two unions have launched a bid to extend their
gains, taking a run at seven HCA facilities in Florida
through the New Year. Each union could add around 2,000
The neutrality pact at HCA was the fruit of a years-
long corporate campaign and bargain-to-organize
strategy run by SEIU and the California Nurses, the
biggest union in the 155,000-member NNU. The unions'
cooperation was also the end goal of a truce SEIU and
CNA hashed out last year to settle their war over
organizing jurisdiction that had boiled through the
SEIU has organized thousands of HCA workers in
California and Florida through such arrangements in
recent years, but its willingness to sign secret side
agreements alongside its neutrality deals has stoked
Under their agreement with HCA, the unions have a 75-
day window in each campaign to collect a majority of
cards and trigger an NLRB-supervised election. They
have limited access to conference and break rooms in
the hospital. Managers are not allowed to campaign
against the union, and violations are rushed to an
arbitrator, who issues a decision within three days of
HCA nurses have reported a few management breaches.
Tardiness policies came into force all of a sudden
during one drive, while other managers tried to shut
down "visibility events," like wearing the union's pins
or red scrubs.
Still, one nurse fired during the campaign was back on
the job in a month.
To get a mostly neutral boss, the unions agreed to some
limitations. The deal stipulates the location and
number of facilities they're allowed to target, the
timetable on which they can be organized, and an
agreement not to disparage the employer, in the
facilities or in public. That means the unions' earlier
corporate campaign tactics that brought HCA to the
table are now off-limits.
The nurses' agreement says the contract that parties
eventually bargain must include a 10-day "cooling-off"
period before any legally required 10-day strike notice
Although a majority of workers voted the unions in,
many are apparently waiting to see what will come of
bargaining before they decide whether to join the
union. Lopez's El Paso hospital reached majority
membership among nurses in mid-October. Other hospitals
in the right-to-work state hover around 35 percent.
Organizers expect they'll face decertification attempts
by the employer, much as the NNU did last year at the
Cypress Fairbanks hospital in Houston. That shop was
organized as part of another deal, with the Tenet
health chain. The union defeated the decert and settled
its first Texas contract this summer.
The HCA organizing is spread widely. Votes in Kansas
City HCA hospitals this fall added 915 members to
SEIU's ranks and 600 to NNU's.
SECRET SIDE DEAL?
Previous neutrality deals SEIU has struck with health
care, food service, and nursing home chains have been
criticized for creating "template agreements" that pre-
arrange weak benefits, bar strikes even after the
contract has expired, and prevent workers from speaking
up about patient safety.
Ed Burke, president of SEIU Texas Healthcare, said the
union gave away no pre-conditions to gain HCA's
"There is no template on bargaining, and no
concessions," said Ed Bruno, who heads the NNU's
campaigns in Texas and Florida. "Bargaining will be
what it always is, a relationship of power."
Critically, SEIU's organizing deals with HCA have also
been governed by secret "labor relations accords," side
agreements to the election procedure.
One such accord, signed in Florida in 2006, agreed to
"convene a national-level panel to resolve the
contract"-noticeably omitting any mention of the
union's right to strike. The panel would be under the
control of the then-head of SEIU's health care
A new accord bargained in 2007 for SEIU members at HCA
in California guaranteed the right to strike and made
the terms public.
But the latest incarnation of this deal has gone back
under wraps, out of the view even of rank-and-file
members on the HCA bargaining team in California.
Arthur Fox, a union democracy attorney, says the
secrecy surrounding these side deals hamstrings members
by dramatically limiting their rights.
"Assuming these agreements do exist, SEIU has
maneuvered its members into a sort of Kafkaesque
conundrum," he said. "As long as the agreements are
kept secret by SEIU, the members are effectively
deprived of the information they would need to file
lawsuits alleging specific injury to their rights and
requesting specific remedies from SEIU and, very
possibly, their employers as well."
SEIU members, of course, have the right under their
union constitution and labor law to participate in the
union's bargaining efforts and to approve union
contracts. Whether they can claim those rights is
LONG ROAD AHEAD
The HCA drive won a union for thousands of workers in
the notoriously anti-union South. But in some ways the
real work remains ahead.
Can a local where members feel invested (and well-
represented) be built, when facilities are spread out
14 hours away from each other? When the union can't
openly take on the boss?
Even if a contract is achieved, how will members
control their union, if the deals are made at the top,
and exhausted staffers constantly on the move
essentially control events?
"Getting the union was like giving a 16-year-old a
car," said Lavaughn Renner, the nurse from Corpus
Christi. "If they don't have to work for it they don't
know what it means."
Like it or not, organizing that doesn't rely on the
National Labor Relations Act is increasingly common. In
a study for the Economic Policy Institute last year,
Kate Bronfenbrenner of Cornell University reported that
the number of union elections run through the Labor
Board has dropped by half in the last decade, falling
to 1,500 by 2007.
The neutrality model may produce impressive membership
growth, but organizers worry what kind of unions are
left behind after quickie campaigns.
"We had the beginnings of committees, but there wasn't
a lot of time to test the committee," said Karleen
George, who's leading NNU's Texas bargaining. "The
fights that strengthen your committee didn't happen
during the campaign, but in the post-election period."
NNU is running workplace campaigns to try to build
local structures that can withstand the employer
assault already underway. First up are a series of
"assignment despite objection" drives, borrowed from
the union's California playbook. The aim is to document
unsafe staffing situations, which feed into bargaining
demands and the work to pass state legislation that
sets nurse-to-patient ratios.
"The nurses are starting to realize that winning the
union isn't the end but the beginning," said Judy
Lerma, a San Antonio RN who volunteered in the HCA
NNU reports 30,000 of the state's 214,000 nurses have
paid $30 a year to join. These non-majority unionists
say some of their unorganized hospitals are already
improving staffing in response to the union's gains in
Next up is an assault on missed meal and rest breaks,
an endemic problem in understaffed hospitals.
The building blocks of a union culture, like phone
trees and union-pin days, are spreading info about
bargaining and cultivating leaders. Organizers are
confident the bar on corporate campaigning can be
overcome by strong worker-to-worker contact.
The boss knows these workplace leaders will make or
break the union, since an overstretched staff can't
represent the far-flung facilities on a day-to-day
basis. A pattern of retaliation against vocal nurse
union backers is emerging (though Burke says SEIU
supporters aren't being targeted).
Burke adds that SEIU is pursuing some of the same
tactics, identifying department leaders, presenting
petitions to the boss, and electing rank-and-file
leaders for bargaining.
"It's all so new here-it feels like a frontier kind of
a thing," Lavaughn Renner said. "We're the pioneer
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