Twenty fired doctors, nurses and therapists marched into the Whittier Street Health Center on June 20 to reclaim their jobs and join their co-workers in an historic “Union Yes” vote. Outside the clinic in Boston’s Roxbury neighborhood, a militant crowd cheered to show union, community and patient support.
With that vote, WSHC became the first community health center in New England where the professional staff is union strong. It was a stunning defeat of union busting and a historic victory against an orchestrated corporate attack on community health workers.
The victory was powered by a broad union-community mobilization, led by Service Employees Union Local 1199 organizers under the banner “Health Care Is a Human Right.” (tinyurl.com/y84dw6d7)
A week earlier, on June 14, WSHC human resource managers and hired security agents had seized the credentials of these frontline health care workers. Management violated patient safety and confidentiality by entering exam rooms and labs unannounced during clinical sessions. They then forcibly “escorted” workers out of the building.
WSHC’s top-paid executives justified the firings as driven by the health center’s funding woes. But the Roxbury community, where many of WSHC’s patients live, expressed immediate outrage in the streets.
WSHC is an important resource for affordable or no-cost care for thousands of poor and oppressed people, many uninsured or without adequate insurance. The clinic also provides culturally competent and trauma-informed behavioral health services.
Community outrage quickly became a crisis for the city’s ruling class.
An overnight mobilization brought hundreds of community members, labor activists and health care advocates to a mass rally outside WSHC’s door.
The truth behind the firings was exposed: The fired doctors, nurse practitioners, registered nurses, nutritionists, behavior health counselors, dentists, optometrists and ophthalmologists were all involved in leading a union campaign to organize WSHC’s workers — a federally protected activity. The illegal firings were timed to impact a June 20 union vote.
Facing immense pressure from the community and the progressive labor movement, Boston Mayor Marty Walsh reportedly intervened to pull WSHC back and soften its anti-union tactics. The WSHC board and CEO waffled for 48 hours and then caved in as voting day and more mass protests loomed.
Exposing health care ‘speed-up’ conditions
Workers World talked with Dr. Sherar Andalcio, who explained he was fired by WSHC for “objecting to management’s impossible productivity demands.” Dr. Andalcio continued to organize for the union victory while unemployed.
Dr. Andalcio described conditions at the center as “like a speed-up on a manufacturing assembly line ” — oppressive working conditions, constant wage theft and intolerable management demands on workers to increase WSHC revenue. He backed up his assertions with a wealth of internal WSHC documents, emails, painstaking research and personal notes.
Management’s ramp up of “billable patients” an hour over the last two years has caused 90 percent turnover of primary care and family medicine providers and 150 percent turnover of nurses. Clinical staff now have to see patients at a rate of 30 a day — with a strictly enforced maximum of 15 minutes with each patient to examine, treat and and write a chart note about their clinical plan!
Management pressure leaves health workers in a terrible triple bind: treating patients with complex diagnoses and co-morbidities, while also meeting strict productivity requirements and without making a mistake that would cause harm to a patient and/or jeopardize their own clinical license to practice in their field.
Like many health centers based in historically Black communities, WSHC serves patients coping with stark health disparities, rooted in the stresses of racism and poverty. Many WSHC patients suffer from, or are at increased risk for, diseases like asthma and chronic obstructive pulmonary diseases, HIV, hepatitis, nutritional deficiency, depression and anxiety, substance use disorders, and many other poverty- and minority-stress-related conditions.
The profit-driven speed-ups at WSHC that forced providers to quit have negatively affected patients, leading to constant cancellations, re-appointments with new care teams and inconsistent care. Dr. Andalcio noted: “We are encouraged not to give longer visits because [WSHC] can only bill $150, so we tell [patients] to come back. Just give me an hour with this patient instead of a disjointed 15-minute session.”
Profits for the ‘nonprofit’ health company
Dr. Andalcio researched WSHC’s “nonprofit” tax filings with the Internal Revenue Service and found that WSHC’s management methods generated $1 to $2 million in profits annually from 2008 to 2016.
This surplus was not used to benefit patients or the community. Instead the WSHC CEO’s salary and benefits were doubled over the eight-year period. Executive management also separately reported $600,000 in investment interest income in its 2017 annual report. When this same management illegally fired union organizers, it used the pretense of “funding shortfalls.” Meanwhile, staff have gone without raises for years.
After the June 20 union win, the strategy for SEIU organizers, explained Dr. Andalcio, is next to organize all WSHC janitorial, secretarial and administrative staff. United contract negotiation is the goal.
Gery Armsby, a health administration worker at another Boston community health center, spoke with Workers World about the significance of the victory: “Hospitals, insurance companies and health centers are increasingly operated and motivated by Wall Street interests. This means a demand for increased profit, which comes in the form of rapid technology upgrades to cut labor and a big surge in the price tag for specialized care and drugs.”
Armsby noted: “The average length of patient hospital stays has been forcibly reduced by management in recent years. As a result, many small, urgent care and primary care centers — some community ‘non-profits,’ others run by huge companies like CVS — are opening, drawing large numbers of health workers into smaller, unorganized workplaces.”
Health care workers organize
SEIU Local 1199 is investing resources in other union drives similar to that at WSHC. It started with early victories at NYC’s Callen-Lorde Community Health Center, which services the LGBTQ community, and Chase Brexton Health Care, which began as a gay men’s health center in the Baltimore area and now has five centers serving all generations in their communities as well as maintaining diversity. Now there are hopeful indications of a wave of successful union organizing.
Armsby observed: “A struggle-oriented approach inspires active worker-organizers in relatively small shops, like the 80 new members of SEIU at Whittier Street Health Center. Doctors and other traditionally nonunion professionals are clamoring to be organized alongside RNs, medical assistants, and janitorial, administrative and dining hall workers. This is a momentous shift in consciousness that needs to be supported and nurtured.”
“This level of solidarity reflects a desire, despite the atomization of the ‘gig’ economy workplace, to fight together against dead-end capitalism,” concluded Armsby. “Small shops should no longer be considered insignificant to this struggle, but rather seen as strategic to the goals of union justice for all health care workers and for health care as a human right for the people.”