For-profit health care makes us sick, say Kentucky nurses

For-profit health care makes us sick, say Kentucky nurses
October 1997

Gemma Zeigler is part of a grassroots organization of nurses in Louisville, Kentucky. Since 1989, Zeigler and her fellow nurses have been struggling to get union representation, with the help of AFSCME. Their job hasn't been made any easier by the string of corporate takeovers of local hospitals. The nurses are now up against the giant healthcare corporation Columbia/HCA, which owns Louisville's Audubon Hospital.

The Labor Party Press talked to Zeigler recently about what corporate ownership (and lack of a union) have meant for the nurses she represents.

What has changed in the hospital since it was acquired by Columbia/HCA?

The quality of care has just disintegrated, ever since Columbia took over. For instance, in the cardiovascular unit, the nurses used to take care of three patients each. And these are people who have just come out of heart surgery or they've had heart attacks, and they're on monitors--they're in very delicate condition. But since Columbia came in, those nurses are now taking care of up to seven patients.

Since Columbia got rid of the respiratory department--and several other departments--the nurse now has to do the respiratory treatment for each patient. Now, a respiratory therapist goes to school for two to four years to do that job. But Columbia gave the nurses two hours of training in a classroom with eighty nurses--and then they told them--got out and do respiratory treatments now!

We talked to a respiratory therapist who told us that every day he did not get to do the therapy for six, eight or ten patients who needed it. He just physically couldn't get to it. He said he knew when he started his shift that he wouldn't get to everyone, and he had to choose which patients were the least likely to have problems.

One nurse had a patient who had trouble with her heart and needed an EKG done right away. The nurse had been given an hour-long class on how to do EKGs. She knew where to put the leads, but she didn't know how to work the machine. There was an aide on the floor who had been to a class, and she didn't know where to put the leads, but she knew how to work the machine. So together they were able to do it.

We got a memo that a manager from the hospital had sent out, saying that all the leads were being put on wrong, and that some of the EKGs were coming out wrong, and the doctors were all upset. We sent all this information to our licensing and regulation agency here in the state. We told them that the nurses had only gotten two hours of training, and in response our state agency did nothing.

The conditions you're describing are bad for the nurses, but even worse for the patients.

Oh, yes! What we're saying now is, we've got to start organizing the patients too.

We had a woman call here not long ago, her grandfather had been in hospital, he went in with a broken hip. And she said her family had stayed with him around the clock because they had heard that you couldn't get help in the hospital. After four or five days, he ended up with pneumonia, and after that, he died. And so I asked her, Did they come in and turn him every couple of hours? Because with the elderly, you have to turn them or they'll get pneumonia. And she said no.

But she also told me that he couldn't get an extra pillow. He had only one, and the nurses had told the family that there was a shortage of pillows. We have a record that the nurses had been complaining about the desperate lack of pillows. Now you see, when you turn a patient who has a broken hip, you need at least four or five pillows to do that--so when she said he was not being turned, she was right. So he developed pneumonia. I asked her if they had come in to cough and deep breathe him after he had developed pneumonia. And she said no.

So we think this man died, not from a broken hip, he died from lack of care. And it's not that the nurses didn't care--I know that floor, those nurses are dropping like flies, they're leaving because they can't do all the work. And the hospital wants the more senior nurses to leave anyway, because they're more expensive. A lot of patients go two or three days without baths. And you know, the fourth leading killer in the U.S. is hospital-acquired infections--more people die from that than from auto accidents and homicides put together. But these hospitals do not have to publish their infection rates, their mortality and morbidity rates, they don't have to publish their staffing ratios. And we believe there is a direct correlation between the infection rate and the staffing ratio.

What do you think is at the root of all this? What's wrong with the system?

The problem is, the hospital's main goal is to make a profit. And that's exactly what this company is all about. They don't care about anything but the bottom line.

I think the healthcare system is going to bankrupt this country. I believe they are the biggest thieves in terms of the way they bill. And it's not just Columbia. The other hospitals in this town do the same thing. And the patients aren't getting the care that they deserve.

Our Medicaid and Medicare money is going to these hospitals that are ripping off the system. One of our nurses who works in labor and delivery told us that when patients come in who are considered "high risk" they are automatically charged a higher rate--even if they don't actually get the extra care. We believe that the hospital charges the patient according to what the doctor orders, not according to what they actually get. For instance, if the doctor says the patient can have a sleeping pill every night, but the patient says they don't want it, they can still be charged for it.

How do you think the healthcare system should be organized?

We advocate a single-payer healthcare plan. Managed care is the worst. They talk about government medicine--well, this is much worse than government medicine.

What is happening now in your organizing campaign at Audubon?

We're still fighting over the election we had in 1994. We lost the election, but the judge ruled that the violations by Columbia were so egregious that the only remedy was for them to come to the bargaining table. But now the hospital is filing for exceptions.

What was so egregious?

Well, right before the election, a couple of Columbia's top executives spent several days at the hospital, going from floor to floor. What they would do is call the union nurses out to the nurses' station, away from patient care. They would call the other employees to gather around. And then they would engage the union nurses in a conversation, and eventually they'd tell people that their only choice, if the union was voted in, would be to go on strike or quit, because Columbia would not negotiate. Or they'd even sell the hospital. They scared people to death.

Then, the evening before the election, the top executives of Columbia, the mayor, the governor, our county legislators, and our senators, all did a press conference where Columbia made this huge announcement that they were going to bring their headquarters to Louisville. And oh my, this was all over the news, big headlines--they agreed to build their headquarters, and they would get all these tax breaks. So a lot of people, including our officials, thought these were great people. It wasn't a month later, Columbia said, "We didn't say that!" Their only reason for making that announcement was to break the union.

Reprinted from the September 1997 Labor Party Press. Memberships to the Labor Party come with a subscription to The Labor Party Press. To join, send $20 to Labor Party, P.O. Box 53177, Washington, DC 20009.