Saint Vincent Hospital Respectfully Engages with Lawmakers
Response letter shared to continue to be transparent with the community

Saint Vincent Hospital released a response from the Board of Directors of its parent company, Tenet Healthcare, to the May 5 letter from Senators Elizabeth Warren and Edward Markey and Representatives James McGovern and Lori Trahan. This response is being released to provide transparency to the community served by Saint Vincent Hospital.

Tenet respectfully responded to concerns regarding the ongoing strike expressed by Senators Elizabeth Warren and Edward Markey and Representatives James McGovern and Lori Trahan. The letter, a copy of which is included, also reiterated the hospital’s ongoing commitment to quality care. Additionally, the letter contained a copy of a May 7 message to hospital team members sent by Carolyn Jackson, CEO of Saint Vincent Hospital, that provided further information on the talks with the Massachusetts Nursing Association (MNA).

There continues to be ongoing and respectful engagement between Saint Vincent Hospital and the delegation. Communication channels have been open since before the strike and remain open.

Tenet remains supportive of Saint Vincent Hospital’s commitment to caring for the Worcester community and is following the Hospital’s lead to deliver upon that commitment.

From the desk of Ron Rittenmeyer letterhead

May 9, 2021

Elizabeth Warren, United States Senator
Edward J. Markey, United States Senator
James McGovern, Member of Congress
Lori Trahan, Member of Congress


Re: Delegation Letter to Tenet Board of Directors

Dear Senator Warren, Senator Markey, Congressman McGovern, and Congresswoman Trahan:

On behalf of the Tenet Board of Directors, I am writing to respond to your letter, dated May 5, 2021. We appreciate you reaching out, and we also share concerns about the protracted strike. We request your understanding of our position on this very difficult matter and our responsibility to the community, medical staff, and all of Saint Vincent Hospital’s employees. We remain committed to doing what is best for the hospital, which is inextricably tied to what is best for the community.

We value our nurses for their continued dedication for the past 127 years since the founding of Saint Vincent Hospital and of course their ongoing resilience during COVID-19. We also respect that our nurses chose to be members of unions, like many other employees at Saint Vincent Hospital. At the same time, we did not believe a strike was the right outcome – we worked earnestly to avoid it and have continued to provide thoughtful proposals to end it. As evidence of our commitment to working with our employees’ bargaining units, Saint Vincent Hospital was able to settle with UFCW during the middle of this nursing strike, with a collaborative process and fair offer. Twenty-six additional collective bargaining agreements were successfully reached with various labor unions throughout our system since January 2020.

When it became clear that a strike was imminent, our pledge was that safe, high quality care would continue. We prepared and trained replacement nurses; we engaged with the Department of Public Health to ensure quality of care was maintained; and we increased support to Saint Vincent Hospital from across the Tenet Enterprise as needed. The community continues to choose the hospital for care: in the last 60 days, Saint Vincent has cared for an average of 210 inpatients per day and over 950 outpatients per day. In addition, Saint Vincent has provided over 75,000 COVID-19 vaccinations since mid-February.

We have taken all claims by the MNA seriously, despite the repeated attacks on the integrity of our hospital and harassment of our employees, patients and even visitors. We methodically investigated each claim and have been transparent with the nurses and the public about the findings:

  • On safety, we conducted a review that revealed that hospital mortality rates have decreased 9% and hospital-acquired infection rates have decreased over 30% since 2019. These remarkable results are due to an unwavering commitment to quality.

  • On staffing and allegations of inadequate coverage with ratios worse than 1 nurse to 5 patients, we conducted a two-year audit, validated by a reputable, independent third-party firm. This showed that the hospital staffed med-surg units that treat patients with a wide range of illnesses and disorders at an average of 1 nurse to 4.4 patients from Jan 2019 to Feb 2020. Throughout COVID-19, despite a national nursing shortage, the hospital staffed those same units at an average of 1 nurse to 4.7 patients, and each med-surg unit remained within the collective bargaining agreement’s contractual guidelines. These safe and more than adequate staffing levels were achieved while also having a resource nurse, without a patient assignment, available in most units who could assist in patient care as needed, which is a feature not available in many Massachusetts hospitals.

  • On staffing compared to other local hospitals, we conducted a comparative analysis of staffing that was supported by the Massachusetts Health & Hospital Association’s well regarded PatientCareLink database. In 2019, all of Saint Vincent’s med-surg units were at or above median of other comparable Massachusetts hospitals. On average, the 7 med-surg units at the hospital provide more generous direct nursing care per patient day than 74% of comparable Massachusetts hospitals.

    Despite a complete absence of evidence of patient safety or staffing issues as claimed by the MNA at Saint Vincent Hospital, we continue to negotiate in good faith with the MNA so we can end this impasse. We have made several meaningful proposals, each with successive and significant concessions and each of which have been met with quick rejection by the MNA’s bargaining committee.

    March 1, 2021: In hopes of averting a strike, we maintained the generous economic proposal we had provided as well as earlier proposed staffing concessions, and we made two additional concessions: 1) Addition of COVID-19 staffing guidelines for patient care units; 2) Reclassification of two additional nursing units to 1:4 nurse to patient staffing, in recognition of the patient acuity on those floors. The MNA responded with no changes to its demand for mandated 1:4 nurse to patient staffing ratios, along with other staffing demands in various departments (including a request to add 86 more staff in the ER which only needs the 70 full time staff it has today) and proceeded to strike.

    April 26, 2021: After almost two months of a strike, despite no movement by the MNA on staffing demands, the Hospital maintained all prospective portions of its economic proposal and added to its staffing proposal: 1) Addition of a quarterly audit committee with a third-party reviewer, as we discussed with some of you; 2) Adoption of an expedited arbitration process, taken directly from the MNA staffing proposal. The MNA publicly rejected the proposal through a press release, engaging in no direct discussion with the hospital.

    May 1, 2021: On April 30, we proactively requested, through the federal mediator, that the MNA return to the table to discuss a new proposal from Saint Vincent Hospital. The Hospital maintained all prospective portions of the economic proposal and presented a bold alternative on staffing. Based upon MNA’s repeated praise of UMass staffing, the hospital’s proposal adopted all of the UMass/MNA contract language related to on-call status, resource nurse staffing, floating, flexing, and staffing provisions, including language from the UMass contract that specifically provides for a “mixture of 4:1 and 5:1” staffing on medical surgical floors. The proposal also increased per diem rates for nurses, in most cases by over 13%. We were hopeful, given even the MNA’s comments that this was a substantial move on the hospital’s part.

    May 5, 2021 (morning): The MNA rejected the May 1st proposal and presented a counter that cherry-picked portions of the UMass contract, the existing Saint Vincent Hospital contract, and added a variety of additional terms resulting in a document that was even more restrictive than their prior proposals. Included in these terms were an increased demand in the wage proposal and a demand for a new pension plan that it had never discussed in detail at any negotiation session. We were quite shocked the MNA would reject an offer to wholly restructure our staffing model to match UMass which they had held out publicly as the “safer and better” gold standard.

    May 5, 2021 (evening): In the spirit of trying one more time to find a middle ground, Saint Vincent Hospital, within four hours, offered concessions on eight additional items, including five staffing requests in the MNA’s most recent counterproposal. The hospital also extended the same health benefits cost-share to all nurses working 24 hours or more each week and further retroactive pay increases for per diem nurses. The MNA rejected the hospital’s proposal and sent us substantially the same proposal from earlier in the day, demonstrating no desire to work towards a compromise.

We have continued to make sincere and reasonable adjustments and have done so repeatedly. Agreeing to a mandated 4:1 staffing ratio, a defined pension plan, and other unreasonable asks from the MNA will potentially permanently damage Saint Vincent Hospital and its ability to continue to provide the services it has today as we may lack the capability under these onerous and unnecessary rules to have the staffing demanded. It may result in multiple service closures, significant job loss for our employees and vendors, and redirect resources away from necessary investments to improve care for the community, which we believe we have clearly shown with facts is unnecessary.

Our negotiation has prioritized very generous wage and benefits packages to improve recruitment and retention of nurses at Saint Vincent and address staffing – all in the name of bringing our nurses back to our patients. Unfortunately, the MNA bargaining unit continues to be unwilling to compromise, and it is clear this impasse is not truly about staffing. The federal mediator has requested that they offer our latest proposal to their members for a vote, which the MNA bargaining committee has rejected. Rather than stand with the MNA bargaining committee, many nurses have left for other jobs, and over 140 have crossed the picket line. I have attached, for your information, the correspondence our St Vincent’s CEO, Carolyn Jackson, provided to our Saint Vincent nurses on Friday evening, May 7th to summarize our current position and efforts. Successful closure requires both parties to operate in good faith. I am hopeful this response will assist you in determining that Saint Vincent’s is making a sincere and meaningful effort to resolve this in everyone’s best interest.

Based on the MNA’s actions earlier this week, we can only disappointedly conclude that continued negotiating with the bargaining committee may be futile at this point. Our priority is to ensure we take the actions to secure the future of Saint Vincent Hospital to continue to serve the community. We would sincerely request, as you have noted in your letter to us, to please urge the MNA to review their negotiating position. We have reviewed our position repeatedly and made many material concessions and respectfully request the same from MNA.

Sincerely,

Ron Rittenmeyer Signature

CC:
J. Robert Kerrey, Lead Director, Tenet Healthcare James L. Bierman, Board Member, Tenet Healthcare Richard Fisher, Board Member, Tenet Healthcare
Meghan M. FitzGerald, DrPH, Board Member, Tenet Healthcare Cecil D. Haney, Board Member, Tenet Healthcare
Chris Lynch, Board Member, Tenet Healthcare Richard Mark, Board Member, Tenet Healthcare Tammy Romo, Board Member, Tenet Healthcare
Dr. Saum Sutaria, President and COO, Tenet Healthcare Dr. Nadja West, Board Member, Tenet Healthcare

Saint Vincent Logo

To: The Saint Vincent Team
From: Carolyn Jackson, CEO
Date: May 7th, 2021

Although I have shared consistent updates on the strike and the status of negotiations, tonight I wanted to share a recap of our offers since March 1st and where things stand today. We have negotiated in good faith with the MNA to end this impasse, and we have made several meaningful proposals, each with successive and significant concessions. Unfortunately, each proposal was quickly rejected by the MNA’s bargaining committee.

March 1, 2021: In hopes of averting a strike, we maintained the generous economic proposal we had provided as well as earlier proposed staffing concessions, and we made two additional concessions: 1) Addition of COVID-19 staffing guidelines for patient care units; 2) Reclassification of 23S and 24N to 1:4 nurse to patient staffing, in recognition of the patient acuity on those floors. The MNA responded with no changes to its demand for mandated 1:4 nurse to patient staffing ratios, along with other staffing demands in various departments (including a request to add 86 more staff in the ED which only needs the 70 full time staff it has today) and proceeded to strike.

April 26, 2021: After almost two months of a strike, despite no movement by the MNA on staffing demands, the hospital maintained all prospective portions of its economic proposal and added to its staffing proposal: 1) Addition of a quarterly audit committee with a third-party reviewer; 2) Adoption of an expedited arbitration process, taken directly from the MNA staffing proposal. The MNA publicly rejected the proposal through a press release, engaging in no direct discussion with the hospital.

May 1, 2021: On April 30, we proactively requested, through the federal mediator, that the MNA return to the table to discuss a new proposal from Saint Vincent Hospital. The hospital maintained all prospective portions of the economic proposal and presented a bold alternative on staffing. Based upon MNA’s repeated praise of UMass staffing, the hospital’s proposal adopted all of the UMass/MNA contract language related to on-call status, resource nurse staffing, floating, flexing, and staffing provisions, including language from the UMass contract that specifically provides for a “mixture of 4:1 and 5:1” staffing on medical surgical floors. The proposal also increased per diem rates for nurses, in most cases by over 13%.

May 5, 2021 (morning): The MNA rejected the May 1st proposal and presented a counter that cherry- picked portions of the UMass contract, the existing Saint Vincent Hospital contract, and added a variety of additional terms resulting in a document that was even more restrictive than their prior proposals. Among these terms were an increased demand in the wage proposal and a demand for a new pension plan that it has never been discussed in detail at any negotiation session. We were shocked the MNA would reject an offer to wholly restructure our staffing model to match UMass, which they have held out publicly as the “safer and better” gold standard.

May 5, 2021 (evening): In the spirit of trying one more time to find a middle ground, Saint Vincent Hospital, within four hours, offered concessions on eight additional items, including five staffing requests in the MNA’s most recent counterproposal. The hospital also extended the same health benefits cost-share to all nurses working 24 hours or more each week and further retroactive pay increases for per diem nurses. The MNA rejected the hospital’s proposal and sent us virtually the same proposal from earlier in the day, demonstrating no desire to work towards a compromise.

In summary, we offered a proposal that focused on wages and benefits and included staffing concessions. That was rejected. We offered a proposal that had an expedited arbitration process that was suggested by the MNA to ensure we were staffing to the guidelines. That was rejected. We offered the same staffing language as UMass despite having a case mix index that has averaged 20% lower than that of UMass over the last 4 years. That was rejected. We enhanced that UMass staffing language even more by making 5 additional staffing concessions and 3 additional concessions on Wednesday. That was rejected by the bargaining committee as well. We requested via the federal mediator that our latest proposal be presented to the membership for a vote, but we have not received formal word whether they are willing to do that.

We have tried many different ways to reach resolution with multiple generous proposals. We did decline negotiating today, because there is no reason to talk further at this point. We welcome the MNA coming back to the table with a more reasonable proposal that closely approximates our May 1st or May 5th proposal, as that will help us reach resolution.

Thank you for your continued dedication to patient care during this challenging time.
Carolyn Jackson Signature

Carolyn Jackson
Chief Executive Officer
Saint Vincent Hospital & Massachusetts Market 123 Summer Street
Worcester, MA 01608
Phone: (508) 363-6504
Cell: (267)597-1153