MIDDLEBURY — Porter Medical Center (PMC) officials on Tuesday confirmed the organization’s workforce will be trimmed by 17.5 full-time equivalent positions, as opposed to the nine jobs originally disclosed this past Friday.
Officials said the updated, higher number reflects an additional 8.5 Registered Nurse positions that PMC could not publicly divulge on Friday due to the collective bargaining process that management and the nurses’ union follow when considering a reduction in force.
It was on Jan. 29 that Porter announced what it called “a series of staff changes and management restructuring” that eliminated a total of nine non-union employees — mostly in the 12 physician practices owned and operated by the medical center.
But on Tuesday PMC spokesman Ron Hallman confirmed the addition of another 8.5 full-time equivalent RN positions to the list of job casualties. Those affected RN jobs are also related to the organization’s physician practices, he said.
Porter officials said the staff changes are intended to cut at least $1 million in the medical center’s expenses over the next year.
“Because we are bound by our collective bargaining agreement with the nurses’ union, there is a certain prescribed way that we have to announce any actions that affect our Registered Nurses, which includes notifying the union first,” Hallman said. “Our goal was then to have face-to-face, respectful conversations with the nurses (on Feb. 1) to give them more information.”
An anonymous party connected to the nurses’ union emailed the Addison Independent a list of the affected RN positions this past weekend. This in part prompted Porter management to expedite its timetable for speaking publicly about the 8.5 full-time equivalent (FTE) nursing jobs on the chopping block, according to Hallman.
Alice Leo, president of Porter Federation of Nurses and Health Professionals, was candid in her assessment of the RN layoffs.
“This does not promote safe patient care,” Leo said during a phone interview on Tuesday. “It’s a sad time for Porter and a sad time for the community.”
In a press release issued by the union on Wednesday, Leo said, “We believe that changes that the Porter administration is making to doctors’ contracts, and the layoff of RNs, will lead to doctors having less time with their patients. We are asking the Porter administration re-focus on quality patient care and rescind the layoffs.”
Peter Igneri is vice president of Porter Medical Group (formerly known as Porter Practice Management), which oversees the 12 physician practices affected by the layoffs. Those practices are sprinkled across Middlebury, Bristol and Vergennes.
Here is a breakdown of the anticipated RN reductions at each of the affected physicians’ practices:
•  Addison Associates OBS/GYN: 1.4 FTE.
•  Addison Family Medicine: 0.9 FTE.
•  Bristol Internal Medicine: 1 FTE.
•  Champlain Valley Orthopedics: 0.6 FTE.
•  Little City Family Practice: 2.7 FTE.
•  Middlebury Pediatric & Adolescent Medicine: 1.21 FTE.
•  Porter Internal Medicine: 0.85 FTE.
NO GUARANTEES
Plans now call for Porter management and nurses’ union representatives to talk about the proposed RN cuts and determine which specific people they will affect.
Hallman said the cuts are part of Porter’s effort to right its financial ship, which — like many other small medical centers throughout the state — has been listing in some rough financial waters.
But he said affected employees are being encouraged to apply for what were, as of Tuesday, 21 RN vacancies and a combined total of 62 overall job openings throughout Porter Medical Center, which encompasses Porter Hospital, Helen Porter Healthcare and Rehabilitation nursing home and the 12 physician practices. All told, PMC employs 780 people.
Leo said the union has asked that PMC guarantee that affected nurses will be able to transition into other RN vacancies for which they are qualified. She said Porter management has declined to offer such a guarantee and will instead merely encourage nurses to compete for RN vacancies.
“If a (laid-off) nurse chooses to remain at Porter, we want them to be offered a position similar to the one they lost,” Leo said.
Hallman countered that “guaranteeing” placement for laid-off nurses would imply “that we will not ensure that the nurse has the appropriate skill level for the particular position for which they are applying — and obviously we will be sure that every applicant has the right experience for the particular job … but we hope that 100 percent of the affected nurses remain with Porter in one of the 21 RN positions currently posted.”
Union officials said PMC management, during face-to-face discussions, has talked about hiring Medical Assistants, or MAs, to potentially replace some of the RNs that are being let go. Leo said MAs are less costly personnel that are not as well trained as nurses.
“Replacing RNs with MAs is unsafe patient care,” Leo said.
Anza Armstrong, an RN and 38-year Porter employee who now works at Bristol Internal Medicine, echoed her sentiment.
“We are deeply concerned that replacing experienced, educated, licensed RNs with unlicensed Medical Assistants will have a negative impact on patient care,” Armstrong stated in a press release. “We need an experienced RN in every office every day. It’s unclear who will cover the RN’s responsibilities when the RN is not there.”
Hallman acknowledged that plans call for the hiring of some MAs, but said they would not serve in nurses’ roles.
“Medical Assistants work appropriately in medical practices throughout the United States in roles that are fully consistent with their education, training and skill level,” Hallman said. “Practices will continue to have Registered Nurses and other clinical staff in appropriate roles based on the size and nature of the practice.”
Union officials said the newly announced layoffs come on the heels of five Licensed Practical Nurse (LPN) positions trimmed from various departments within the hospital last December.
Hallman acknowledged those cuts and said all but one of the affected staff accepted jobs at Helen Porter.
Meanwhile, union officials and Porter Medical Center management continue to discuss severance benefits for those affected by the most recent layoffs.
“(Morale) has not been good,” Leo said of the esprit de corps within the PMC nursing community. “There have been a lot of rumors flying around. People have been nervous, anxious. There has been a lot of anxiety. It’s safe to say that since Friday, a lot of these nurses have been in a state of shock.”
‘UNSUSTAINABLE’
PMC President Lynn Boggs, during an interview on Tuesday, said Porter had no choice but to trim staff given the fiscal realities of the health care industry. She noted Porter Medical Center has generated an $11 million cumulative operating loss since the 2012 fiscal year, as well projecting a budgeted operating loss this year. There is a $3 million to $4 million gap between PMC’s current financial performance versus where management believes the organization should be, officials said.
“That amount of loss is unsustainable for a little hospital like Porter,” Boggs said. “There’s no way to make up that difference.”
In considering cuts, PMC leaders took a particularly close look at the physicians’ practices, which suffered a combined loss of $7.36 million last year — “twice the expected norm,” according to a fact sheet released by Porter officials.
“Many other health care organizations of various sizes are encountering the same thing,” Igneri said of losses in the affiliated physicians’ offices.
He added the “long-term interest of the organization’s sustainability required us to make those adjustments that most organizations have made a long time ago, including some of our neighbors.”
Looking at the “big picture,” Boggs said Porter Medical Center and other community hospitals are having to substantially change the way they do business in the era of the federal Affordable Care Act, which among other things stresses cost containment. Health care providers are now being given incentives to keep people well and out of the hospital, Boggs noted.
“It’s a whole different mindset,” Boggs said. “It really is all about cost containment.”
PMC has been operating in a negative margin since 2011, according to Boggs.
“We’ve been fortunate, in that we have had non-operating revenue coming in in the form of 340B,” she said.
The 340B program, Boggs explained, is a federal offering to provide lower-cost drugs to patients of limited means. Large pharmaceutical companies fund it. Hospitals like Porter also benefit financially from the discounted drugs. That 340B revenue has helped PMC’s bottom line, but Boggs warned that it’s a benefit that could be eliminated at any time. Big pharmaceutical companies have been lobbying federal lawmakers to ditch 340B.
“We have seen incremental bites off the apple,” Boggs said. “We lost $100,000 to $150,000 this year due to a change in legislation.”
Boggs added she has seen the first draft of a new master facilities plan for PMC that suggests around $30 million in key capital improvements to the campus infrastructure during the next several years.
“We don’t have that money right now,”’ Boggs said.
Asked if additional layoffs are in the offing, Boggs replied: “I’ve learned a long time ago never to say ‘always,’ or ‘never’; those are not good words in our vocabulary. But we don’t have anything on the horizon at all that would be additional layoffs.”
Reporter John Flowers is at [email protected].