Porter nurses take grievances public
MIDDLEBURY — The Porter Federation of Nurses and Health Professionals (PFNHP) fired a salvo at the Porter Medical Center administration last week, in the form of a flier circulated at Middlebury town meeting alleging that recent cuts and layoffs at the local hospital are jeopardizing the quality of patient care.
“The CEO of Porter Medical Center has turned a less than ideal situation into a disaster,” reads the pink, single-page flier distributed by members of the nurses’ union just prior to Middlebury’s annual meeting held in the municipal gym on Feb. 29.
“The administration should immediately halt its short-sighted decisions and work with employees and the community to build a solidly financed, patient-centered PMC,” the flier, titled “Put Patients First at Porter Medical Center,” states.
Meanwhile, Porter officials are disputing allegations made in the union’s flier, the release of which came as a surprise, according to Porter spokesman Ron Hallman.
The “short-sighted decisions” alleged in the union’s flier include:
• Defunding of primary care by $1 million.
• The laying off of primary care nurses.
• A demand that “doctors work more for less pay.”
• An environment that “has created 50-percent turnover of RNs in six months on the medical-surgical unit.”
“We believe that members of our community deserve to have high-quality health care available right here in Addison County,” PFNHP President Alice Leo said through a written statement provided to the Independent at Middlebury’s town meeting. “We came to town meeting tonight because the people of Middlebury need to know what’s happening at their health care facility. Laying off nurses and pressuring providers to see more patients and to increase revenue is not keeping with PMC’s mission of patient-centered care.”
Assertions made in the flier come around a month after the announced elimination of 17.5 full-time equivalent positions — including 8.5 nursing posts — at Porter Medical Center, mostly within the 12 physician practices owned and operated by the health care organization. PMC also includes Porter Hospital and Helen Porter Healthcare & Rehabilitation Center (nursing home). All told, PMC employs 780 people.
Porter administrators said the staff changes were intended to cut at least $1 million in the medical center’s expenses over the next year. They are part of PMC’s effort to right its financial ship, which — like many other small medical centers throughout the state — has been negotiating some choppy financial waters. The affected employees are being encouraged to apply for what were, as of a month ago, 21 RN vacancies and a combined total of 62 overall job openings throughout Porter Medical Center, according to Hallman.
The union’s flier asks area residents to call Porter CEO Lynn Boggs and PMC board Chairwoman Maureen McLaughlin to “ask for a return to patient-centered care.”
The PFNHP followed up its town meeting flier with a press release on March 2 announcing that it had filed Unfair Labor Practice charges with the National Labor Relations Board alleging discrimination for union activity and failure to provide relevant information needed to process grievances and for bargaining. The release also stated the union had voted to take five grievances to arbitration.
Porter officials said on Friday that the union on March 3 decided to withdraw the five unfair labor practice charges that were referenced in the press release. Hallman said PMC administration has heard the union will be re-filing two grievances. As of Friday morning, he said, nothing had been filed.
“We have not withdrawn the Unfair Labor Practices,” Leo countered. “We have re-filed them to make them clearer.”
PORTER COUNTERS CLAIMS
Hallman took issue with the claims the PFNHP made in its flier.
On the allegation that primary care had been defunded by $1 million:
“Porter Medical Center is in the midst of implementing a number of short-term initiatives to reduce expenses and increase revenue during our current fiscal year with a goal of improving our financial performance by $1 million to $1.5 million,” Hallman said. “In addition to restructuring staffing in our practices and introducing productivity benchmarks in provider contracts, we have reduced overtime, improved our group purchasing arrangements, enhanced our revenue cycle performance on the expense side, and on the revenue side we have introduced a new Infusion Center, added new cardiology testing and established a new centralized appointment and referral center for many outpatient services.”
On the assertion that, as a result of layoffs, Porter Medical Center physicians’ offices will not have an RN present at all times:
“We have been restructuring our staffing to ensure that we have the correct number of providers, nurses, medical assistants and other clinical and non-clinical staff members to meet the needs of every individual practice based on the services they provide and the number of patients seen,” Hallman said. “It is untrue to say that ‘offices frequently will not have an RN present’ … RN’s remain essential members of the team at every practice.”
NURSING CARE STUDY
Hallman pointed to a Department of Health study that showed Porter Medical Center provides 12 hours of nursing care per patient per day in its medical/surgical unit, which is the highest rate among all of the hospitals in the state (http://healthvermont.gov/hc/hospitalreportcard/nurse_staffing.aspx). As a comparison with nearby hospitals, UVM Medical Center provides nine hours and Rutland Regional Medical Center provides 11 hours, according to the study. Of those hours, RN’s provide seven hours per patient per day at both Porter and UVM, and six hours at RRMC.
The study reflected data through March 2015. Hallman said the nursing care hours per patient per day at Porter had gone up since then.
“During the past six months, that has actually increased to 16,” he said.
On the assertion that doctors are working more for less pay:
“We have restructured our provider contracts to include performance benchmarks for productivity, patient satisfaction and quality metrics — this is a standard contract format throughout Vermont and the U.S.,” he said. “It is new to Porter, but a long-standing and common format for provider contracts.”
Hallman explained that rather than the providers being paid a fixed amount on an annual basis, the new contracts are based on state and regional benchmarks that tie provider compensation to productivity, quality of care and patient satisfaction measures.
Porter administrators talked to PMC providers — consisting of physicians, nurse practitioners and midwives — about these new compensation benchmarks last fall, according to Hallman. Thirty-three PMC providers were presented new contracts (based on those benchmarks) around three weeks ago, Hallman said. Providers are now deciding whether to sign their new contracts, which take effect in May.
“Some are still considering it,” Hallman said.
Leo alleges there is “widespread discontent” among providers regarding what has been a paradigm shift in the manner in which providers are paid.
On the claim that PMC was actually under budget by $2.1 million in 2015:
“Porter actually lost $1.6 million in our most recently completed fiscal year,” he said, “and $11 million since 2012. We have been sharing that openly for many months now to provide our community context for why it is essential for our organization to improve our financial performance through a strategic combination of expense reductions and revenue enhancements to bring our expenses in line with our revenue.”
On the contention that PMC administration has created an environment that has resulted in 50 percent turnover of RNs in six months on the medical/surgical unit:
“That is an erroneous statistic and statement and lumps together staff who have transferred to other parts of our organization, and people who have moved for family or other personal and professional reasons,” Hallman said.
Leo said she has numbers indicating that two-thirds of the nurses who have left PMC’s medical-surgical unit have left PMC, while the remaining third have stayed.
Hallman said it is his hope that the nurses’ union and PMC administration will quickly sort out their differences.
“I think it is really important for providers and all employees to know that we encourage open dialogues; we want to hear constructive feedback,” Hallman said. “The only way we are going to move forward is together. The only real important issue is our patients and the care we provide to the community. These other issues can, and should, be resolved internally, because what is really important is that the community continue to have confidence in the truly incredible care that is provided daily by our doctors and nurses.
“The greatest tragedy would be if that confidence were ever harmed or shaken by some of the information that is out in the community,” he concluded.
Reporter John Flowers is at [email protected].