In a move reflecting the growing aggressiveness of labor unions that have targeted healthcare, the Service Employees International Union is accusing a Nevada hospital operated by Columbia/HCA Healthcare Corp. of fixing an accreditation survey administered by the Joint Commission on Accreditation of Healthcare Organizations.
The allegation strikes at the heart of the chain's national marketing campaign, which touts the high accreditation marks received by its hospitals.
Executives of 688-bed Columbia Sunrise Hospital and Medical Center in Las Vegas, the state's largest hospital, say the charges are ludicrous and a desperate attempt by the SEIU to try to unionize workers there, an effort that's failed for well over a year.
Mitch Mitchell, the hospital's president and chief executive officer, responded heatedly: "The SEIU does not represent any employees at Columbia Sunrise Hospital. . . . It is absurd for the SEIU to raise these unfounded, groundless allegations. It's another attempt by the SEIU to discredit the quality of care that Columbia Sunrise employees deliver every day."
The SEIU says Columbia Sunrise is trying to "mislead the JCAHO and distort the accreditation process." JCAHO surveyors were at the hospital last week to conduct their regularly scheduled triannual accreditation survey.
The union, which has been trying to organize 2,000 of the hospital's 2,400 employees since early 1995, contends administrators have issued instructions intended to sway the survey results.
The SEIU sent MODERN HEALTHCARE*copies of internal memos that ask employees to remove patient names from bulletin boards during survey week; minimize use of restraints and document those restraints in use; supply missing documentation in human resources files; and memorize crib sheets telling them how they should answer if questioned by the survey team.
The SEIU also sent a questionnaire to hospital employees. The results, it said, show that patient care has been compromised by staffing reductions.
The SEIU has sent letters and copies of the internal memos to HHS' inspector general's office and HCFA asking the agencies to investigate the hospital's alleged manipulation of the accreditation survey. Hospitals that are accredited by the JCAHO automatically qualify for Medicare.
Tom Snyder, a local SEIU organizer, took on Columbia's marketing strategy by commenting that it "touts its JCAHO commendations as a Good Housekeeping Seal of Approval. We know from our own experience here that the process itself is deeply flawed. The hospital manipulates information. The outcome of a JCAHO review should not give confidence to the public about the quality of what goes on inside this hospital."
Nearly every hospital facing an accreditation survey does some preparation prior to a visit from JCAHO investigators. But some have gone too far, prompting the JCAHO in 1992 to adopt a policy against hospitals rewriting patient records in preparation for a visit from accreditors.
Richard J. Croteau, M.D., vice president for accreditation services at the JCAHO, based in Oakbrook Terrace, Ill., said it's not uncommon for hospitals to tidy up records and drill employees before scheduled accreditation survey visits.
"When you were in college, and you had a test coming up, you'd prepare for it. The survey is a test," Croteau said. Nevertheless, "compliance with the standards is not something you can accomplish in the few weeks prior to the survey," he added. The survey team looks at performance in the year prior to the visit. Having a list of right answers to possible questions "isn't going to add much to the outcome."
This is the first time the SEIU has tried to document an "attempt to mislead the JCAHO," union organizer Steve Askin said. "We haven't done quite what we've done here anywhere else. Workers are up in arms as a result of terrible things that have happened due to understaffing and problems with supplies and equipment."
Snyder said the union is collecting signature cards and will present them directly to the hospital administration to seek recognition without holding an election supervised by the National Labor Relations Board.
"Where there have been elections at Columbia-owned hospitals," Snyder said, "they have poured huge sums of money into litigation, causing several years' delay in counting votes of an election, let alone getting to a contract. They have bottomless resources and will use them ad nauseum to frustrate the desires of their work force."
Mitchell said he strongly believed employees "have the right to vote" in an NLRB election.
But when asked if the hospital would then recognize the union if its workers voted for one, Mitchell declined to answer, saying only, "There has not been a vote."