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Tenet Healthcare
The Nursing Disputes

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The nurses are the first to be aware of poor care and bear the brunt of corporate cost cutting and de-skilling. The nurses organised themselves and were involved in ongoing bitter battles with Tenet. They aggressively exposed Tenet's practices in 2002

"This is pretty fantastic," said Julie Pinkham, director of the labor program for the association, as nurses cheered behind her at the Dubliner. "They went ahead and agreed to all of our demands. Sen. Kennedy and Rep. (James P.) McGovern told them, 'These nurses are right on this issue.' " Nurses, Tenet reach tentative deal :: Overtime issue finally resolved Worcester Telegram & Gazette May 12, 2000

The nurses have been the first to see failures in care from Tenet's cost cutting. Small individual protests at corporate hospitals have all too often resulted in a punitive response. An excuse is found to terminate those who protest. As a consequence the nurses have been driven into unions. The disputes with the unions have been bitter and protracted.

While poor pay has been an important issue, working conditions, staffing levels, excessive overtime and the safety for patients and staff have been leading issues. While self interest is clearly a powerful stimulant corporate responses dismissing the issues because they are self serving is disingenuous. The nurses have been consistently on target and the community knows this. As a consequence the nurses have received considerable public support and Tenet bad publicity.

The nurses and the unions have been active in drawing attention to
failures in care at Tenet hospitals and have strongly attacked the gouging of the uninsured.

I have some information about three major disputes, the strikes at Tarzana in California in 1998, the bitter dispute in Worcester Massachusetts in 2000, and the angry dispute in California where Tenet's headquarters and the majority of Tenet hospitals are situated in 2002.


Tarzana, California 1998

This dispute related to safety issues for staff and patients consequent on Tenet's claimed penny pinching. I have limited information. Of interest is Tenet's aggressive response to one day strikes - with longer lock outs.

In response the nurses researched Tenet's background and NME's conduct and published a paper " Risky Business: The Tenet Story". Tenet is the new name for National Medical Enterprises (NME). This critically examined NME's shady past and the continuation of the same management team. They also examined Barbakow's highly praised market strategies, when he saved MGM from financial disaster, more critically in regard to the sort of person he was and asked whether he was a suitable person to lead a health care company. The nurses seemed to share
my concerns about Focht. I do not know what the final outcome of this strike was.

Over 275 Registered Nurses and other professionals at Tarzana Medical Center have overwhelmingly voted to conduct a second one-day strike on Friday, October 23. On September 15, the Tarzana professionals conducted a one-day strike and were subsequently locked out for two more days Nurses Vote to Strike Again at Tarzana PR Newswire October 15, 1998

The nurses, represented by the American Federation of Nurses, SEIU Local 535 have conducted two recent strikes against the Tenet owned medical center over short staffing, health and safety issues, and wages. Each strike was followed by a longer lockout by Tenet
The Union will distribute a research document called "Risky Business: The Tenet Story,'' linking most of Tenet's top operation management to National Medical Enterprises, it's pre-1995 merger name
"These N.M.E. holdovers, like C.E.O. Jeffrey Barbakow and C.O.O. Michael Focht continue to oversee unethical behavior, like Tarzana management locking out the nurses at a risk to patient care,'' said Union Representative Bob McCloskey. "It's also unethical to take money from nurses and give yourself huge raises. Barbakow received over $2.8 million in compensation in 1998, a 17% increase from 1997."
Tarzana Nurses Target C.E.O. PRNewswire November 6, 1998

Risky Business: The Tenet Story*

Quality health care is based on trust. Patients trust their doctors to have the knowledge and skills to heal. Doctors trust nurses to carry out their care prescriptions and monitor their patients' recovery. And localities trust local hospital boards to put community health above hospital profits.

The second largest for-profit hospital company in America, Tenet Healthcare Corporation (Tenet) understands the nexus of public trust and its business. Visit Tenet's World Wide Web Site ( and you'll find a portrayal of a gentle and honest corporation, with "Garfield the Cat" as the corporate mascot.1 At the Web site, Tenet proudly declares, "We hold integrity and honesty as our most important principles and perform at all times at the highest ethical standards."

But for good reason, the web site does not provide a full history of the company, nor does it provide background on its CEO, Jeffrey Barbakow. Because if it did it would face the contradiction of asking for trust in a hospital company which:
  • within the last five years, paid enormous fines for violating federal laws;
  • had affiliated doctors and members of management convicted of criminal offenses;
  • was accused of holding patients against their will;
  • closed a community's only hospital;
  • relies on junk bond financing for expansion; and
  • is run by an investment banker, and not a healthcare professional.

As this report on Tenet's history and top leadership shows, trusting Tenet may be "Risky Business". Risky Business: The Tenet Story* SEIU (Nurses Union) Research document Jan 1999

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Worcester, Massachusetts 2000

St Vincent's hospital was purchased by Tenet from a nonprofit Roman Catholic group in 1997. Tenet made a number of undertakings including a staffing commitment. They undertook to build a new medical centre. The change from the caring but struggling catholic hospital to the ruthlessly mercenary but successful Tenet must have been a culture shock. It probably drove the nurses to join the union and they were soon in conflict

In 2000 Tenet had embarked on its new business policy and cost cutting was a central component of this. The nurses opposition to this was a major problem for them. The fact that Tenet endured such a long strike and were prepared to risk so much adverse publicity before they finally gave way and acceded to the nurses legitimate concerns, is testimony to the threat to profits which the demands posed as a national precedent.

The nurses had been negotiating for 2 years and had hit a brick wall. Tenet insisted on an unrestricted right to force nurses to work mandatory overtime of up to two shifts (16 hours) continuously without the nurses having any right of refusal. Nurses thought this was a threat to patients and intolerably unfair - especially for those with small children.

The nurses had now experienced Tenet for some years and were no longer gullible. They believed that this was simply a ploy so that Tenet could under-staff the hospital. These nurses from a non-profit background had probably never been in commercial conflict but reluctantly came out on strike. This was prolonged and bitter.

One of the striking features of this strike was the extent of the support the union received not only from fellow unions but from the whole community, and from city, state and federal politicians. The matter was discussed at a hearing by the Legislature's joint Committee on Health Care. The nurses plight caused the city council to look critically at the way Tenet had fulfilled its agreement about staffing. They were sufficiently alarmed by this to
open a review with a view to taking steps to remove tax exemptions which had been granted to Tenet during the takeover.

Federal Senator Edward Kennedy visited the strikers. He eventually organised a meeting in his office in Washington. The nurses say that he forcefully told Tenet that the nurses were right. Tenet capitulated and the nurses walked out with almost everything they had asked for.

"It became very clear (yesterday) that Tenet plans to staff the hospital by forcing nurses to work double shifts, rather than hiring the appropriate number," Mrs. Ellis said. "This is a practice that is very dangerous to nurses, and extremely dangerous to patients, and it's a practice we cannot accept." Talks fail to avert nurses' strike :: Replacement workers due tomorrow Worcester Telegram & Gazette March 30, 2000

The key issue dividing the two sides is the hospital's demand that it retain the right to require nurses to work overtime. Hospital officials say such a right is required to guarantee enough nurses during busy times. The nurses say the hospital wants to require overtime rather than hire enough nurses to adequately staff the new medical center. Mandatory overtime a major issue in negotiations :: Strike takes effect for St. Vincent nurses Worcester Telegram & Gazette March 31, 2000

The hospital's proposed policy on mandatory overtime could have an adverse impact on patient care, Dr. Sema said.

"That's wrong," he said. "Patients always come first. This whole thing out here is about the patient."
David L. Shildmeier, spokesman for the Massachusetts Nurses Association, said widespread community support for the nurses' strike had given a morale boost to those on the picket lines.

"This strike seems to have struck a chord not only among the nursing community statewide, but it has galvanized public support," Mr. Shildmeier said.

The countermeasures of Tenet and St. Vincent "don't weaken us; they strengthen us," he said. "That just tells us how unconscionable this corporation is in its behavior, and that doesn't make us want to give in to them."
TENET HEALTHCARE STRIKE IN MASSACHUSETTS Worcester Telegram & Gazette April 2, 2000

"The only reason this strike will continue for a long time is because it is being orchestrated by a for-profit corporation in Santa Barbara that is worried about the precedent it would set for their other hospitals across America," said Massachusetts Nurses Association spokesman David J. Schildmeier.
Here, however, he said, Tenet is trying to force mandatory overtime on its nursing staff without similar limitations and despite the nursing union's clear opposition.
Outcome of strike may set a national precedent Worcester Telegram & Gazette April 9, 2000

Nurses were energized Friday when Sen. Edward M. Kennedy visited. The same day, an estimated 1,500 members of the Massachusetts Teachers Association left their annual convention to march in front of the medical center in support of the nurses.
"I am here to help you make sure that no hospital, whether Tenet or anyone else, forces you to work double shifts. I stand behind you, and I'll tell you why the whole community is standing solidly behind you. They understand you want the very best patient care," Mr. McGovern said. "I promise I will stand with you for as long as it takes." (U.S. Rep. James P. McGovern, D-Worcester)
Nurses Day celebrated on picket line :: Nation's nurses support pickets Worcester Telegram & Gazette May 8, 2000

Doctors and nurses, while marking the 180th anniversary of Florence Nightingale's birth, bemoaned the condition of nursing yesterday during a Statehouse news conference.

While the 11 speakers made general references to understaffed hospitals and overworked nurses, most were specific in criticizing Tenet Healthcare Corp. and in praising the nurses striking at Worcester Medical Center, which is owned by Tenet.
Tenet criticized at Boston confab Worcester Telegram & Gazette May 11, 2000

Worcester Medical Center nurses and hospital officials yesterday emerged from five hours of negotiations in the Washington, D.C., office of Sen. Edward M. Kennedy to announce that they had reached a tentative agreement to end the nurses' 42-day-old strike.

Under the settlement, which must be ratified by the union, nurses can be asked to work up to four hours of overtime per shift no more than twice each quarter, or eight times per year. The agreement also allows nurses to refuse overtime because of illness or fatigue.

Union officials were euphoric. From our standpoint, it's a total slam-dunk," said David J. Schildmeier, spokesman for the Massachusetts Nurses Association, which represents the nurses. "They said they would never, ever agree to a contract with less than 16-hour shifts. Well, never, ever has arrived. This is extremely strong language."
"This is pretty fantastic," said Julie Pinkham, director of the labor program for the association, as nurses cheered behind her at the Dubliner. "They went ahead and agreed to all of our demands. Sen. Kennedy and Rep. (James P.) McGovern told them, 'These nurses are right on this issue.' "
Nurses, Tenet reach tentative deal :: Overtime issue finally resolved Worcester Telegram & Gazette May 12, 2000

"We were going up against a corporate giant," said Elizabeth Joyce, a nurse for 23 years at St. Vincent Hospital. "We got more than we ever could have hoped for."

Kirstin Labby, mother of three, an intensive care unit nurse with 22 years at St. Vincent, said the unity of the picket line and the community support sustained her through the strike.

"They gave us what we offered," she said. "I don't know why they didn't do it sooner."
Elation over end of strike is tempered by bitterness Worcester Telegram & Gazette May 12, 2000

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The Nursing Dispute in 2002

Tenet's ongoing disputes with the nurses about staffing levels and patient safety backfired in late 2002 when the scandal broke. The two unions Service Employees International Union. (SEIU), and the California Nurses Association (CAN) seized the opportunity to press their concerns and their interests in the corridors of power. I have already discussed their research paper and the alleged problems in staffing.

Tenet eventually did a sweetheart deal with the SEIU, freezing out the CNA and giving SEIU registered nurses increased payment and also a role in setting standards. The CNA were angry about this and cried foul.

CNA did not take this lying down and mounted a blistering attack on Tenet and the care it provided. Tenet eventually settled generously with the CNA too. The silence from the nurses since then is deafening.

It seems a sad reflection on the union movement that they have such intense rivalry that they will break ranks when one union is cynically offered an advantage by Tenet. Does the silence of the unions and their members after the settlement speaks for the power of self interest and the ability of large corporations to buy off critics. We must remember that they live in a competitive marketplace and any form of leverage is acceptable.

"Nurses and other union members employed by Tenet Healthcare Corp. showed up at the company's annual shareholders meetings and lit into Tenet's executive-compensation practices, specifically the $111 million that Chairman Jeffrey C. Barbakow received after exercising stock options earlier this year," the Wall Street Journal reports.

The paper quotes the President of SEIU Local 121RN, Luisa Blue, asking: "Does it make any sense that one person takes in $111 million last year on his Tenet stock options, when the company spends only half that amount on pay and benefits for all the people who work at their Garfield Medical Center near here?"
SEIU leader challenges Tenet executive pay excess (from SEIU web site)Wall Street Journal October 10, 2002

The union, in complaints filed with the NLRB (National Labor Relations Board), also accused St. Mary's owner, Tenet Healthcare Corp., of failing to honor the union contract as it promised when buying the hospital in 2000.
NLRB to hear complaints against Fla. hospital Modern Healthcare October 14, 2002

Added May 2007
In addition to the concerns about the Medicare issue and the Redding investigation, the company is facing a nurses' strike in San Francisco - - - .
Executives Leave Beleaguered Santa Barbara, Calif.-Based Tenet Healthcare. Ventura County Star November 8, 2002

A labor union that has been locked in contentious organizing efforts with hospital chain Tenet Healthcare Corp. succeeded Tuesday in getting time to air its concerns about the company at the next meeting of the California Public Employees' Retirement System in December.
Union Seeks CalPERS Review of Tenet LA Times November 20, 2002

Tenet said it has reached an agreement with the Service Employees International Union and a branch of the American Federation of State, County and Municipal Employees covering Tenet's 41 California hospitals and two Florida hospitals.
Tenet negotiates broad agreement with two unions Modern Healthcare May 2, 2003

Tenet Healthcare Corp. has agreed to pay up to 29 percent in wage increases over a four-year period if a nurse decides to join one of two unions at a Tenet hospital in California.
"It's been a long time coming for something like this to happen," said McDaniel, reflecting on the three decades she has worked at Tarzana Hospital. "For-profit hospitals have been detrimental to patient care where management thinks the bottom line is more important."

McDaniel doesn't believe the contract will remedy what ails the hospital and its employees, "but it's a step in the right direction. You just have to remember, it's Tenet and I've seen them talk out of the side of their mouth before," she said.
McDaniel's colleague, Karen Pelone, said she believes Tenet decided to form an alliance with the unions because "they were looking for some support. They're more of a watchdog now," Pelone said. "And the contract will make it easier for us to deal with Tenet during our negotiations. Maybe it will even help the current nursing shortage."
Tenet enters pact with two unions LA Daily News May 02, 2003

The California Nurses Association said Monday it has filed charges with the National Labor Relations Board seeking to overturn an agreement reached between Tenet Healthcare Corp. and two labor unions.
California nurses union files labor complaint against Tenet AP Newswires May 6, 2003

Added May 2007
Nurses from the union picketed outside the (Annual) meeting and nearly monopolized the question-and-answer session inside, saying quality would not improve until the company hired more nurses and paid them better.

Calling Tenet's new quality initiatives "lip service to sound good to the shareholders," Sherri Stoddard, a nurse at Sierra Vista Regional Medical Center in San Luis Obispo, Calif., said: "The place to start is at the bedside. We have been so unable to provide quality of care because we are told `We have budget constraints, we have budget constraints.' "
Tenet Vows Improvements in Patient Care New York Times July 24, 2003

Added May 2007
The meeting at the Skirball Center in the Sepulveda Pass area was packed by nurses and supporters of the California Nurses Assn., the state's largest nurses union. Nurses said the Santa Barbara-based company is cutting corners on patient care.

"We are running short staffed, trying to cover 20 patients with four registered nurses. How can you do that effectively when you don't have the staff?" asked Tenet nurse Edie Rosario, who works at Doctors Hospital Center in Modesto.
Nurses, Investors Assail Tenet at Its Annual Meeting LA Times July 24, 2003

Added May 2007
That nurse is among many represented by CNA, a powerful union that ranks as one of Tenet's harshest critics. In a direct snub to CNA, Fetter forged agreements with two competing unions that angered CNA but nevertheless pleased the market.
Tenet's Mr. Outside Has Inside Game Too The Street.Com (Melissa Davis) September 2, 2003

Added May 2007
Tenet Healthcare Corp. said on Wednesday it has entered an agreement with the California Nurses Association that includes a no-strike provision until January 1, 2010, and provides for arbitration to resolve disputes.

The agreement was announced the day after the No. 2 U.S. hospital chain reached a labor agreement that ended a 13-month strike by the union's nurses at Doctors Medical Center-San Pablo.
The California Nurses Association agreed to limit its organizing of registered nurses at Tenet hospitals inside California and settle nearly all existing grievances, complaints and unfair labor practice charges between the union and Tenet.

Tenet, California Nurses Sign Broad Labor Accord Reuters Dec 17, 2003

Added May 2007
The CNA, which has come out on top in nine elections so far this year at Tenet Healthcare medical centers in Southern California, has added more than 2,000 nurses at 10 hospitals in 2004. It now represents more than 57,000 nurses statewide, including more than 2,600 R.N.s at 13 Tenet facilities and more than 8,500 in 21 CHW hospitals.

CNA wins two more San Francisco Business Journal Apr 5, 2004

An interesting account describes the way the company changed its ethics training program after its 5 year corporate integrity agreement imposed after its criminal plea in 1994 expired in 1999. The consequences are apparent.

Added May 2007
"We have to attend ethics classes every year and the company is dirty," said Elida Huerta, a nurse at Tenet's Doctors Medical Center in San Pablo, where nurses have been on strike since November. "Where was the board of directors? Did they not attend their ethics classes?"
Nurses, Investors Assail Tenet at Its Annual Meeting LA Times July 24, 2003

Added May 2007
In July of 1999, the month after Tenet's corporate integrity agreement expired and its aggressive business strategies apparently kicked in, more than 100 Tenet hospital CEOs sat mesmerized through a presentation by ethics guru Quint Studer. By early 2000, Studer -- who made a name for himself by turning a Florida hospital around -- had branched out on his own and landed Tenet as his first big client. He helped fashion Tenet's "Target 100" program, seeking 100% patient satisfaction, that the company still touts today. And within two years, he was already declaring the program a resounding success.
"I took on Tenet Healthcare as my first client and rolled out the Nine Principles of Service Excellence to Tenet's 110 hospitals nationwide to successfully create a world-class service culture for this multibillion-dollar company," he told the magazine. "Tenet's work with Studer Group helped drive quarterly earnings on Wall Street to an all-time high."

In reality, aggressive Medicare billing -- based on price hikes now viewed as unethical or even illegal -- was fueling much of that growth. And Tenet nurses, a large and crucial segment of the company's staff, weren't nearly as happy as Studer's training was supposed to make them. Nurses have long complained that Tenet regularly places corporate profits ahead of patient care. Those complaints, supporting claims of unnecessary surgeries and lax infection control, continue to flood in even today.

"The greatest new policy is this: 'All patient call lights will be answered promptly by all hospital employees," said a veteran nurse, who works in the neonatal intensive care unit at Tenet's Sierra Vista Regional Medical Center in California. "This means the janitor will go into your room and ask you what you need. 'Gee, can he get me off the bedpan?' The maintenance man can assist with 'personal needs.' And it's all in the name of 'patient satisfaction.'"
Tenet's Mr. Outside Has Inside Game Too The Street.Com (Melissa Davis) September 2, 2003

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Web Page History
This page created July 2003 by
Michael Wynne
Updated and revised July 2007