The California Nurses Association is spending little time mourning last month's loss of a state ballot initiative campaign to reform HMOs.
Instead, the 45,000-member labor union is spearheading a new coalition that's challenging the merger of University of California San Francisco Medical Center and Stanford (Calif.) Health Services.
The University of California Board of Regents and Stanford University trustees voted Nov. 15 to approve the merger. A deal is expected to be completed by July 1997. The facilities include UCSF and Mount Zion medical centers in San Francisco, Stanford University Hospital in Stanford and Lucile Salter Packard Children's Hospital in Palo Alto, Calif.
They would be operated by UCSF Stanford Health Care, owned jointly by the University of California and Stanford University. The entity, to be governed by a 17-member board that includes six University of California regents, is expected to save tens of millions of dollars a year through cost cutting and the securing of more managed-care contracts while still financially supporting the academic missions of the hospitals.
The CNA is working in concert with several other unions that represent employees at the two hospitals, including the American Federation of State, County and Municipal Employees; the University Interns and Residents Association; the Communication Workers of America; and University Professional and Technical Employees.
Calling themselves the Coalition to Stop the Sale of the UC Med Centers, the unions have taken out full-page ads in the Western edition of the New York Times and the San Francisco Bay Guardian, accusing the regents of "giving away" UCSF Medical Center and insinuating HMOs will be calling the shots on care delivery. The ads are anchored by photos and quotes of UCSF professors critical of the deal.
Both UCSF and Stanford officials declined comment on the matter.
"An acceptable alternative is to put this deal on hold. The alternatives have not been presented or discussed, and the viable alternative for the state is not to privatize because UCSF is not in trouble financially," said Carl Bloice, spokesman for the coalition. "For those reasons it's not acceptable to give away public assets."
However, California Gov. Pete Wilson is a UC regent and voted to approve the deal. Therefore, observers, who include Stanford and UCSF officials, agree it's unlikely that California Attorney General Dan Lungren, a fellow Republican, would shoot it down after review.
Others say the CNA's concern over protecting public assets masks its true intent: protecting jobs.
"The unions are beside themselves and are using the occasion to act out their worst fantasies," said Wanda Jones, president of the New Century Healthcare Institute, a San Francisco-based hospital management consulting firm. "This is just a smoke screen for their concern as to how their jobs will be affected."
Jones is not involved in the merger.
Although both Stanford and UCSF have promised to offer 95% of current employees jobs at the onset of the merger, Jones noted that there was a large disparity between the number of Stanford and UCSF nonphysician employees: 6,100 vs. 4,900.
"Both of them are overemployed, and a very obvious, unstated situation is that jobs are being artificially protected," she said. "Inevitably, there are going to be jobs lost."
However, literature distributed by UCSF Medical Center asserts that more jobs would be created in the long term after the merger is completed.
Nonetheless, UCSF and Stanford have been criticized for leaving labor out of discussions surrounding the yearlong courtship.
"This is a union town, and you can't ignore them," said Steve Cera, president of International Medical Management, another San Francisco-based consulting firm. "I think that's why it would have been a good idea to have had a broader dialogue on the front end."
Indeed, UCSF and Stanford have already lost a couple of initial legal skirmishes with the unions.
On Nov. 14-one day before the regents approved the merger-San Francisco County Superior Court Judge William Cahill demanded that Stanford and UCSF turn over proprietary documents such as business plans and financial projections, so he can determine whether they should be made public.
In September, California's Public Employment Relations Board ruled that the regents intentionally withheld information regarding the merger. That ruling could eventually block the merger, assuming it survives review by administrative law and Superior Court judges.
Meanwhile, the CNA and its fellow unions vow they will file a lawsuit to block the merger, but there are doubts as to whether they can match the hospitals' deep pockets.
"It seems that the hospitals would have a lot more money," Jones said.
"We've about run out of money," the CNA's Bloice confirmed.