Eight months after clearing what was supposed to be its biggest hurdle, a merger between Boston City Hospital and the adjacent Boston University Medical Center is caught in a triangle of union, management and City Council conflicts that are delaying final authorization.
And the clock is ticking. The target date to merge the city-owned public hospital and the university-sponsored teaching facility is July 1, but the Boston City Council has yet to vote on a proposal to transfer control of the city hospital to a new not-for-profit organization called Boston Medical Center.
July 1 also is the expiration date for all existing union contracts, bringing workers uniformly under the control of the organization's new management. Boston Medical Center will encompass the two hospitals plus a city-owned rehabilitation hospital, Boston University Medical School and a partnership with eight community health centers called Boston HealthNet.
But union contract negotiations have become the focus of the merger preparations. Hospital managers are holding off on substantive consolidation and work-force decisions until after the July 1 transfer, while union leaders are campaigning to include all the work rules and benefit terms they can in a new collective bargaining agreement set to carry into the new era.
The result has been pressure on City Council members from union constituents to kill the merger unless a variety of union demands are met. Meanwhile, Mayor Thomas Menino, who has pushed for the merger, is pressuring council members for approval.
The merger proposal materialized out of a mayoral commission's recommendation for keeping Boston City Hospital financially viable, and it cleared a crucial barrier in October 1995 when the Massachusetts Legislature passed a measure allowing the public facility to convert to not-for-profit status.
The Legislature called for the conversion to take place by July 1, but it delegated final action to the City Council, which listens to union constituents, said Peter Nessen, chief merger negotiator for the city. "The last stronghold of the unions is the city," he said.
In Boston, where municipal workers have to live within the city limits, the union vote can be as much as 35% because of low overall voter turnout, he said.
After weeks of high-profile wrangling that appeared to be tilting in the unions' favor, Nessen said the mayor's office now has the seven votes needed on the council to pass the transfer plan, which would put pressure on the unions to settle.
But major labor issues still are not resolved, ranging from the status of pension plans to the gaps that need to be bridged between the two workplaces, said Enid Eckstein, negotiator for the local Service Employees International Union, which represents nurses at Boston City Hospital.
For example, nurses at the city hospital make $8,000 to $14,000 less than their counterparts at the university hospital, Eckstein said. Unless that wage differential is addressed, those nurses could be working side by side and getting far different pay for doing the same duties, she said.
That's just one example in which the failure to address work issues will be "setting up inequities that are going to affect this merger," she said.
The SEIU last week proposed extending existing union contracts until Oct. 1, but Nessen said the issues have been debated enough and the existing contracts had work terms that would burden the management of the new organization.
The merger's official status granted by the Legislature is a "public service hospital," which allows it to continue to receive favorable funding treatment even though it is a private hospital.
The proposed city budget, which also must be approved by July 1 to allow the merger, allocates between $12 million and $14 million for each of the next five years to help finance Boston Medical Center, Nessen said.
The medical center also will continue to draw the lion's share of funding from a state uncompensated-care pool, although the current $100 million funding level is projected to fall to $60 million by the fifth year, for a total loss of $90 million over the five-year period compared with current levels, he said.