How Forming a Union Helps Residents to Advocate for Patients
Organized residents have a long history of advocacy for their patients. With a strong united voice CIR members have influenced public policy and internal hospital decisions, established patient care funds and improved ancillary staffing. Some examples from recent CIR history:
1. Public and Political Advocacy
Given the heavy demands on residents' time, it is extremely difficult for individuals to maintain a consistent presence in public debates over the delivery and funding of health care. But experience shows that when resident physicians speak out elected officials, the press and the public listen. Through CIR, we have numerous examples of the power of organized residents:
n L.A. County / Harbor UCLA (CA)
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When lack of funding threatened to close a number of L.A. County's ERs and Trauma Centers in late 2002, the residents of Harbor UCLA's CIR chapter launched a campaign to pass "Measure B," a ballot initiative designed to increase funding by $168 million for L.A.'s public trauma care system through an increase in property taxes. Residents met with elected officials, appeared in local media, spoke at public hearings, and phone banked voters before the referendum. The measure passed by an overwhelming 73%, the first time that California voters had raised their own taxes in twenty five years.
n New York City (Multiple Hospitals) (NY)
In 2005, Governor Pataki of New York threatened to cut billions from the state budget for Medicaid. The move would have devastated safety net hospitals in New York City, so residents from CIR participated in a "Stop the Cuts" campaign with other unionized workers and the New York Hospital Association to restore funding. Residents testified at public hearings, started a postcard drive and lobbied politicians in Albany. In the end, nearly all of the cuts were restored.
n Alameda County Medical Center/Highland Hospital (CA)
In 2004, weak public financing of health care in Alameda County threatened to close the struggling safety-net Alameda County Medical Center (ACMC). CIR residents led the campaign to pass Measure A, a ballot initiative that increased health care funding through a 1/2 cent sales tax increase. Residents held press conferences, lobbied politicians, canvassed voters, raised money and spoke to the media. The measure passed by 71%.
n UMDNJ and Robert Wood Johnson University Hospital
In late 2005, administrators at UMDNJ (University of Medicine and Dentistry of New Jersey) and Robert Wood Johnson University Hospital announced that they intended to close the Family Medicine program and its
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n New York State (Various Hospitals) (NY)
Currently, in New York, a closed-to-the-public commission of financial service executives appointed by the governor is meeting to decide which hospitals will close statewide. In response, CIR has built a coalition of health care unions, community groups, religious organizations and health care advocates to demand an open process and to mobilize to stop any closing that will disproportionately effect access for the poor. The Save Our Safety Net Coalition is pushing legislation that would make the commission's report non-binding.
2. Involvement in Internal Decision Making
Residents' position as the frontline providers of care in the hospital allows special insight into potential patient care improvements and problems. CIR contracts guarantee resident involvement in hospital decisions. In L.A. County, residents sit on a public health committee with local health officials. In New York City, residents from public hospital such as Bellevue/NYU meet with HHC administrators on a regular basis and have helped craft initiatives such as improved language translation services and patient safety. All CIR contracts establish local Labor-Management committees that routinely address patient care issues.
3. Patient Care Funds
Most CIR contracts include Patient Care Funds, hospital funding set aside to be allocated for special patient care needs that the residents identify. Residents present requests to a resident-run committee, which decides how to allocate the funds. Past purchases have included: portable ultrasound machines, specialized digital microscopes, access to online clinical services, books and entertainment for Pediatric patients, clothes and exercise equipment for Psychiatric patients and advanced clinical dummies for training purposes.
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LA County Hospitals: $2.2 Million
Boston Medical Center: $20,000
Cambridge Hospital: $35,000
St. Luke's-Roosevelt, NYC: $100,000
HHC Hospitals (Includes Bellevue/NYU): $400,000
4. Ancillary Staffing Guarantees
Throughout the years, residents have won contract language through collective bargaining that guarantees the basic amount of ancillary staffing that their patients need and they need to do their jobs properly. Here are some examples:
n Childrens' National Hospital (DC)
CIR contract provides for full time "patient care coordinators" to follow resident rounds and carry out such tasks as scheduling, tracking consults, running lab studies and procedures, and overseeing patient discharge and follow up.
n Boston Medical Center
Extensive language contains such specifics as 24/7 transport of patients and records (response time not to exceed 30 min); seven daily rounds of phlebotomy; 24/7 EKG service; IV service 16 hours per day and medical interpreters 24/7. The contract also stipulates that residents should not be regularly assigned to perform "out-of-title" work like blood draws, phlebotomy, transport and clerical services.
n Cambridge Hospital
Phlebotomy and IV service provided on all Medicine wards 24/7.
For more information on how CIR members are standing up for their patients, visit the CIR website at www.cirseiu.org.