In Los Angeles Hospital Strike, Nurses Say Staffing Is Issue No. 1

Sandi Marques doesn’t need anyone to tell her how critical St. Francis Medical Center is to the Lynwood area of Los Angeles. Marques grew up in Lynwood and nearby South Gate, and she is in her 36th year as a registered nurse at St. Francis. Though she now commutes from Anaheim Hills, she knows this area.

“The community needs this hospital. The whole area needs it,” Marques said Tuesday, standing just outside the medical center. On the street behind her, cars blew past, many blaring horns in support of her and her fellow nurses, and megaphones in the distance sounded the beginning of a rally. It was day two of a five-day union-led strike at St. Francis.
 

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It is because Marques understands the significance of St. Francis to this part of L.A. that what has happened over the past several years so troubles her. Staffing issues, she said, have become chronic — an everyday component of the nurses’ working lives. Supplies sometimes run short, including personal protective equipment (PPE) during the COVID-19 pandemic. Nurse-to-patient ratios regularly violate state-mandated levels. And contract talks with the hospital’s owner, Prime Healthcare Services, have gone nowhere.

So Marques, one of the nurses’ chief negotiators, walks a picket line. It is, she said, what’s left to try.

“I was here before there was even a union,” Marques said. “And we’ve never had to go on strike. We’ve come close — but until now, never have we had to do this.”

The five-day strike involves four Prime Healthcare-owned hospitals in the region and 600 nurses represented by the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UCHP). It also includes 900 health care workers represented by Service Employees International Union-United Healthcare Workers West, among them nursing and medical assistants, emergency room technicians and respiratory therapists. (Disclosure: SEIU and UNAC are financial supporters of Capital & Main.)

A spokesperson for Prime Healthcare did not respond to multiple requests for comment by Capital & Main. In a prepared statement delivered to media earlier in the week, the company said, “Every health system across the nation is facing challenges due to the national nursing and healthcare worker shortage,” adding that it would bargain “in good faith” with the unions.

“Proposals have been delivered to the unions that would increase wages and provide comprehensive benefit programs, including healthcare, that is among the best in the nation at little to no cost to employees,” the statement said. “We believe the current proposal benefits all our employees and hope to reach an agreement so we can continue our mission of providing compassionate, quality care to patients.”

The unions, whose contracts with Prime Healthcare expired in August, want higher wages — after three years of freezes — that they argue will reduce worker turnover, especially among nurses. But they’re also pressing Prime for more worker and patient safety measures. Those include commitments to increase staff and honor the state-mandated nurse-to-patient ratios, as well as to train new nurses before they’re assigned to intensive care or emergency departments, not after.

That could be a tough sell. Prime Healthcare has not agreed to contractually address staffing issues or job flight, and more than 6,000 nurse-to-patient ratio complaints filed with the state by St. Francis unions have not resulted in change.

Union members have said that working conditions began going downhill at St. Francis as soon as Prime Healthcare took over in 2020. That’s hardly a shock, considering the Ontario-based company’s business model of buying financially distressed hospitals and slashing costs — and, often, services — while boosting profits.

Prime Healthcare operates 45 hospitals in 14 states. In 2020, it acquired St. Francis for roughly $350 million from Verity Health System, a nonprofit arm of the Catholic Church that was in bankruptcy. The deal was accepted in part because the U.S. Bankruptcy Court determined that Prime had submitted the only qualifying bid. St. Francis is no longer a Catholic hospital, and Prime Healthcare runs it as a for-profit business.

Union leaders say the new owner promptly laid off 20% of the most experienced nursing staff, cut wages by 12% and instituted a three-year wage freeze. Coming in the midst of the COVID-19 pandemic, during which St. Francis nurses said they often had to bring their own PPE to work, the result was a dramatic increase in turnover — and a profit margin that the union said grew and has now reached 20%.

“Our nursing turnover rate has gone from 21% to more than 50% since they took over,” Marques said. “We’re the lowest paid facility in the area — and [company representatives] acknowledged that during negotiations.”

To Marques, the stakes feel enormous. St. Francis has one of the busiest emergency departments in Los Angeles County, and it is the only Level II trauma, stroke and STEMI (myocardial) center for many miles around. It’s also the only hospital available to thousands of locals, many of them on Medicare or Medi-Cal, who don’t own cars and cannot drive elsewhere.

For Prime Healthcare, though, this is closer to business as usual. After taking over the struggling Centinela Hospital Medical Center in Inglewood in 2007, the company closed departments, laid off 13% of its 1,700 staff members and canceled private insurance contracts, according to the Los Angeles Times.

This summer, Prime Healthcare announced that it would close Centinela’s maternity ward altogether following the death of a mother during delivery, for which it faces a lawsuit. State investigators later found that the hospital’s violations of federal safety requirements had put patients in “immediate jeopardy” situations that could result in serious harm or death.

St. Francis is now expected to shoulder much of the maternity caseload that used to go to Centinela. Said Marques, “We want protective (contract) language to ensure that our patients will be safe.” It is, she said, one more reason to walk the picket line.

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