Doctors Prescribe AFSCME
AFSCME Helps Physicians Fight Against Corporate Medicine
Tucson, Arizona
Why have some of America's best-educated, most highly respected professionals joined AFSCME?
"It's not about money," says Dr. Robert Osborne. "We organized because our patients' care was compromised by a bunch of bean counters who wouldn't know good medicine from beeswax -- and could care less."
That's what Osborne tells anyone interested in knowing why he led a certification drive by physicians at the Thomas-Davis Medical Centers here. In January, they voted 93 to 32 to join the Federation of Physicians and Dentists (FPD), an affiliate of the National Union of Hospital and Health Care Employees (NUHHCE)/AFSCME Local 1199.
These newly unionized doctors have an unusual commitment to organize every other worker in the medical centers, from janitors to nurses, lab technicians to clerical support staff, "to change the whole nature of health care here," in the words of Osborne.
NUHHCE Pres. Henry Nicholas, an International vice president, sees the action as part of labor's commitment of "returning the practice of medicine and the role of the patient advocate to the physicians."
Dr. Keith Shelman, who was elected chairperson of the new unit, emphasizes that it's about "returning to a work environment where once again we can be good doctors."
FPD Exec. Director Jack Seddon says the health business puts profits before patients and "is leading physicians and other professionals to question many of the decisions taking place at their facilities."
"You bet," concurs Osborne.
For all that, the Thomas-Davis battle clearly is one that never should have happened. After all, for 77 years it functioned as a very profitable, doctor-owned entity, with deep roots throughout the Tucson area.
Routinely piling up record earnings all those years, the doctor/owners still made time to operate an indigent health care clinic at St. Elizabeth of Hungary in the suburbs, and volunteered to work with medical students just starting out.
All that changed in 1994 after they sold Thomas-Davis for $720 million to Foundation Health Corp., a California medical services investment company. The 90 or so owner/physicians split the profits from the sale. Some retired to easy street, but most continued to work at their old jobs at Thomas-Davis.
"That's when the trouble started," says Osborne.
In no time, the new owners eliminated support staff, summarily dismissed valued nurses, curtailed routine diagnostic services, and even forbade the doctors to continue their unpaid volunteering at St. Elizabeth's clinic.
Then last summer Foundation Health sold Thomas-Davis to FPA Medical Management Corp. of San Diego. They fired 17 physicians for no cause, terminated 50 support staff, changed malpractice insurance coverage, dropped medical record staff, while jacking up patient load by over 1,000.
"Never mind the mean-spiritedness of this kind of stuff," cautions Osborne. "What really concerned us was the professional conflict it created.
"We are charged," he continues, "solemnly charged by our oath to serve the needs of our patients. Certainly traditional organized medicine is not exempt from criticism, but every doctor I know has a deep commitment, almost a spiritual thing, about serving the patient. To ease the suffering, to make whole again.
"It's not about money," Osborne quietly allows. "We are healers and comforters, and we must be allowed to do our jobs."
And it didn't make it any easier that as previous owners, the doctors knew the financial workings of the six-facility operation. It was clear that profits were running "over 30 percent," according to their estimates, while working conditions deteriorated and patient care suffered.
"I guess the last straw was when the hospital told one of our retired doctors he couldn't volunteer at St. Elizabeth's any more," Osborne recalls.
"It's hard to imagine a more selfish act," he says.
Things happened quickly after that. Last summer Shelman and Osborne and five other physicians met to plan on starting a union. After a series of phone calls, they got in touch with FPD and soon a cadre of organizing help arrived, followed quickly by successful petitioning and then the organizing election.
In February, United Health Care Employees, another NUHHCE-AFSCME branch, won the right to represent 480 non-professional workers at Thomas-Davis.
"The way we see it today," says Osborne, "is that the health care business is stacked against reform. We think the only real tool we have is the National Labor Relations Act. We're going to try to use it to restore doctors to their traditional roles of healer and helper."
Like many of the doctors at Thomas- Davis, Osborne characterizes health care as "a system out of control. There's no balance, no way for doctors or patients to make fundamental changes for the better."
The deck is stacked, he says, because health insurance is exempt from anti-trust laws, the so-called McCarran-Ferguson Act. That means the insurance industry can set health care standards all by itself because most Americans can't afford to pay out-of-pocket for all their health needs.
At the same time, managed care operators are exempt from any type of control because of the 1974 ERISA Act, the Employee Retirement Income Security Act. It prevents states from regulating pensions, but the federal government further exempted any type of benefits from state control.
That's why last October Congress voted and the White House signed the measure allowing pregnant women to spend two days in the hospital after birthing, Osborne explains.
"It's absurd," he hotly allows, "a system out of control.
"And the American people are supposed to rely on the insurance industry and health care providers to help us -- one that's exempt from anti-trust, the other exempt from state regulation!
"We've all got to get together to fix this darn thing," Osborne concludes, "whether we're rich or poor."
By Ray Lane
