BRATTLEBORO — Drivers honked their horns Monday afternoon as they drove down Linden Street past the Brattleboro Retreat. Employees and members of United Nurses & Allied Professionals (UNAP), waved to the motorists, sharing a moment of agreement.
The purpose of the day's rally - described as an “informational action” - was to demonstrate to the administration and community, “that the CEO can't get excellence and innovation for free,” said Jack Callaci, UNAP's director of collective bargaining and organizing, referencing Retreat CEO Robert E. Simpson Jr..
The union has engaged in 12 futile negotiation sessions over six weeks with management of the Retreat, a nonprofit mental health and addictions treatment hospital, providing in-patient and outpatient services.
Members of UNAP Local 5086 at the Retreat held the first of two planned informational actions this week. The second is planned for Nov. 16.
The Retreat, founded in 1834 through a $10,000 bequest from Anna Hunt Marsh, is one of Windham County's largest employers. The inpatient units are staffed around the clock across three shifts.
According to its website, the United Nurses & Allied Professionals represents about 6,200 registered nurses, technologists, therapists, support staff, and other health care workers. Its 15 locals serve Connecticut, Rhode Island, and Vermont.
Callaci, who is based in Rhode Island, called the Retreat's contract demands “radical” and “the most destructive to employees we've ever seen” since Local 5086 formed at the Retreat in 1990.
“After decades of decline, including program closings, repeated layoffs, benefit reductions, and wage freezes, the employees were heartened by the expansion of programs and the Retreat's return to fiscal health in 2010 and 2011,” the union stated in a press release.
“Having responded to a fiscal crisis three years ago by agreeing to sacrifice wage increases and retirement benefits, the union looked forward to these negotiations to share in the success [its members] have all helped to bring about,” the press release said.
According to UNAP, however, the Retreat has made an unsatisfactory set of demands:
• Reductions in direct patient care staff.
• “Severe” cuts in the retirement program, including not guaranteeing any retirement contributions for the next three years.
• Reductions in shift differentials (the difference in pay rates from shift to shift).
• No wage increases over the next three years unless the hospital shows a profit.
• Halving job protections for employees on medical leave.
Callaci added that the Retreat has claimed that employees are asking for a 20-percent raise.
That's not completely accurate, he said, adding that employees' salaries lag behind those of their peers because of previous wage freezes. Given those concessions, what the union has requested would bring salaries to a reasonable level, he said.
According to Callaci, the Retreat turned a profit of about $2 million in 2010, and about $1.7 million in 2011.
While Callaci said that the union supports the Retreat investing in repairing its aging buildings, it does not support the hospital earning millions without meeting its “obligation” to share with employees.
Callaci said that the Retreat has asked to cut $2.25 an hour from the shift differential for employees working night shift. For a full-time employee, said Callaci, that represents a cut in pay of $4,800.
The cut would save the Retreat about $700,000 a year, said Callaci.
Management has told the union it could work in pay raises from that $700,000 in savings. Callaci responded that management is asking employees to “take from one set of colleagues and give to another.”
The Retreat also wants to drastically change how it funds employees' health insurance, said Callaci.
The plan would boil down to giving employees a “lump sum” and letting them work out how they pay medical expenses, he said. This change represents a 14 percent increase in health care costs.
Finally, said Callaci, the administration is looking to cut staff. This measure he views as dangerous given the increase in the complexity of the problems affecting Retreat patients.
Complex care
Instead of coming to the Retreat with one diagnosis, like depression, patients are now arriving with multiple diagnoses, like depression and a substance addiction.
To add to the diagnosis bundle, new patients, especially in the case of substance abuse, sometimes arrive with physical health issues.
The hospital has justified staffing cuts through comparing the Retreat's staffing to general hospitals that also have psychiatric units, Callaci said.
Beth Kiendl, nurse and union member, said the comparison to general hospitals doesn't wash because the Retreat's services had a higher degree of specialization.
When a person is hurt in Brattleboro, Kiendl said, he or she goes to Brattleboro Memorial Hospital (BMH). If the injury is more than BMH can handle, the person is airlifted to Dartmouth-Hitchcock Medical Center in Lebanon, N.H..
In the case of mental-health issues, the Retreat is “the place people get airlifted to” for treatment, she said. “That's fine, as long as we're given the resources to do the job.”
Because the acuity, and aggression, of patients has increased, said Kiendl, so has the number of injuries to staff. Some of this is a function of the world, she said, but some of this increase in violence is due to the Retreat accepting “the most seriously ill patients.”
The staff love the work they do, said Kiendl.
“Staffing is not a gift to us,” said Kiendl. “This is what we need to do the work safely.”
To Kiendl, it seemed management had a “pool of money” it's willing to move around, but that it expected staff to fund any expansion out of what it already receives.
The negotiations started with the staff and management far apart, said Kiendl. The Retreat has accused employees of not moving on their demands. But she said that is hard to do when staff have had nowhere to move to.
“It all feels unreasonable and really sad,” she said.
Edward Dowd, a nurse, stopped to speak with Callaci and Kiendl.
Dowd started working at the Retreat in 1984. For him, the informational picket and the Union's demands were about “fairness.”
Working in mental health is a demanding job, he said.
Many Retreat staff live “pay check to paycheck,” said Unit 1 Union President Bonnie Chase, who said that pay cuts could force qualified staff to move elsewhere.
“This is hard work,” she said. “It takes a certain character to do the job.”
John Moran of Wardsboro, a per-diem employee, union member, and licensed drug and alcohol councilor, held a sign and waved to drivers.
“I'm optimistic,” he said. “I think things will work out.”
Moran helped organize a UNAP local when he worked at Health Care and Rehabilitation Services (HCRS) before taking a position at the Retreat. He said quality working conditions are important, like equitable pay. Strengthening the collective bargaining process is a plus, he added.
Unions are about ensuring fairness, safety, and decent salary for all working Vermonters, said Moran.
Paid sick leave and other benefits to workers are big-picture issues for Vermont, said Moran, who also serves as state representative for the Windham-Bennington district.
Staying sustainable: the Retreat offers its perspective
In a second-floor conference room overlooking the portion of sidewalk where union members stood, Retreat spokesperson and Senior Vice President Peter Albert, LICSW, explained the hospital's current position.
The union started negotiations asking for a 20-percent pay raise and 12 percent employer pension contributions, both over three years, he said.
“Economically, that's not viable,” said Albert, who has worked at the Retreat since 1978. “We've got to look at the numbers, and the numbers aren't pretty.”
Over the past three or four years, the number of patients coming to the hospital each year has increased from approximately 1,900 to approximately 3,000. And this was before the state became involved, he said.
The state moved some of its patients and mental-health programs to the Retreat after Tropical Storm Irene flooded the state hospital in Waterbury last year.
The increased need has also prompted the Retreat to expand its outpatient programs.
Despite the expansion, the organization still turns away approximately 2,000 people a year, said Albert.
According to Albert, the Retreat has called in a federal mediator, who he expects will remain through negotiations.
Albert said the Retreat now faces this question: How does it sustain itself and compensate its staff?
The “sustainable” part of the question must be answered first, he said, noting that nationally, pay raises have averaged less than 2-percent through the industry.
Albert said the Retreat has offered a pay raise of 4.5 percent, and a 7 percent pension contribution over three years contingent on its earnings.
The Retreat spent a decade losing money, he said.
One year everyone agreed, across the board, to no pay raises, said Albert.
“It bought us some time,” he said.
Only in the past few years has the facility made a 1.5-percent to 2-percent profit.
After the addition of 52 direct-care staff, the margin becomes smaller, he said.
“As a nonprofit, we can't over-promise and dig ourselves into a hole again,” Albert said.
According to him, when the Retreat showed profits in 2010 and 2011, it gave the employees 4-percent raises for those two years. Albert thinks that due to budgeting cycles, the raises went into effect in 2011 and 2012.
In response to questions about monies received from the state when it moved some programs to the Retreat, Albert said those monies were earmarked from the start for establishing an acute-care unit in Tyler 4.
Money for other repairs to the hospital's infrastructure, like roofs, came from a bank bond based on the Retreat's 2010 and 2011 earnings, said Albert.
“[It's an] untouchable, different set of monies that we hope will make the working environment safer,” said Albert. The trend in health care is toward facilities doing more with less, he said. Mental health sits, still, on the fringes of the broader discussion of how to finance health care. Insurance companies compensating providers with hard-and-fast rules and fixed rates that don't compensate for more staff.
In response to the union's concern that management wants to cut staff, Albert said that adding staff does not automatically create a safer environment.
The Retreat uses a staffing grid, said Albert. The grid helps managers decide which employees - like mental health workers, nurses, or social workers - need to work, and how many of each, for each shift.
But given patients' shift toward more complex diagnoses, the current staffing grid might no longer prove the best.
Regarding employee health care, Albert said, the Retreat is trying to create choices for people absent health-care reform. No organization in Vermont deals well with the cost of health insurance, and that's what has prompted state and federal efforts toward health-care reform, he said.
There's a sense of a mental-health crisis in Vermont, Albert said. Emergency rooms are “backed up” with people needing mental health support, he said, adding that the fallout from Irene still affects people's mental health.
The Retreat has responded with enhanced staffing patterns, more training, debriefing sessions with staff after incidents, and creating low-stimuli areas on the units for patients, said Albert.
The hospital has also formed a consumer advisory group composed of former patients and representatives from Disability Rights Vermont and Vermont Psychiatric Survivors.
Albert closed the interview by saying he had worked with many of the union members picketing outside for 30 years.
“The people here do a great job,” he said.