Four Massachusetts Democratic lawmakers are demanding that Tenet Healthcare disclose how it spent COVID-19 relief funds, accusing the health system of enriching its executives and shareholders instead of supporting its providers and communities.
Sen. Elizabeth Warren, Sen. Edward Markey, Rep. Jim McGovern and Rep. Lori Trahan blast the company for accepting federal money while shortchanging its workers, including nurses at St. Vincent Hospital in Worcester, Massachusetts, who currently are on strike.
"The apparent greed of Tenet Healthcare during an unprecedented public health emergency and economic crisis is astounding, particularly in light of the billions in taxpayer assistance received by your company, and the ongoing failure to address the concerns of its frontline health care workers," the lawmakers wrote in a letter sent to Tenet CEO Ron Rittenmeyer on Tuesday.
The legislators gave the Dallas-based hospital chain until July 13 respond to detailed questions about its use of Provider Relief Fund (PRF) grants and other state and federal assistance during the pandemic.
The St. Vincent Hospital strike, now in its fourth month, is evidence that Tenet is not meeting the needs of its employees and patients during the crisis, Warren, Markey, McGovern and Trahan wrote.
The Massachusetts Nurses Association (MNA) this week rejected the hospital's latest offer because it didn't meet what the union says are "desperately needed" staffing increases.
MNA sent a counter proposal to the hospital through a mediator, but hasn't yet gotten a response, said Marlena Pellegrino, a registered nurse at St. Vincent and co-chair of the union's St. Vincent bargaining unit.
"We hope that they will take our offer meaningfully and get this strike settled," Pellegrino said.
Tenet's nurse staffing is better than 75% of comparable hospitals in Massachusetts, spokesperson Lesley Bogdanow said in a statement. Every St. Vincent nurse who went on furlough during the pandemic did so by choice, she said. Tenet's contract offer included higher wages, enhanced benefits, increased staffing and tighter hospital security, she said.
Tenet spent $936 million in Provider Relief Fund grants through March 31.
In their letter, the lawmakers took issue with Tenet's more than $3 billion in earnings before income, taxes, depreciation and amortization in 2020.
Unlike its more profitable peers, however, Tenet would have posted a sizable net loss in 2020 if not for PRF grants. Tenet's full-year net income was $399 million, including the grants. The company generated $17.6 billion in operating revenue.
HCA Healthcare, by contrast, posted almost $4 billion in net income and $51.5 billion in revenue in 2020. Multiple unions have called out the Nashville-based hospital chain during the pandemic, alleging a lack of investment in adequate staffing and safety measures. HCA returned all $1.6 billion in PRF grants it received from the federal government.
Warren and her colleagues aren't the first to demand accountability for PRF grant spending. Democratic Reps. Katie Porter (Calif.) and Rosa Delauro (Conn.) wrote to HHS Secretary Xavier Becerra and then-acting Federal Trade Commission Chairperson Rebecca Slaughter in May.
The lawmakers expressed concern that health systems, including Tenet, were using the money to fund acquisitions. Tenet announced plans in December to spend $1.1 billion to buy up to 45 ambulatory surgery centers, and it intends to further expand that portfolio throughout the year.
St. Vincent Hospital nurses filed more than 710 "unsafe staffing" reports since the beginning of 2020, which warn of conditions that jeopardize patient safety, Warren and the others wrote in their letter. At the same time, they assert that Tenet has aggressively cut costs, including slashing hospital spending by 11% between April and June 2020.
In addition to a list of all pandemic-related assistance Tenet received, the lawmakers request an accounting of how Tenet spent the money and whether it has any unspent grant money received before June 30, 2020. June 30, 2021 was the deadline to return any unspent PRF dollars received before June 30, 2020, despite hospitals' pleas for more time to spend the funds.
The lawmakers also want an explanation of how Tenet transferred grant funding between its subsidiaries, a maneuver that allowed it to spend about $100 million of that money in the fourth quarter. Finally, they're asking for a complete account of Rittenmeyer's total compensation.
Tenet doesn't agree with many of the statements and characterizations in the lawmakers' letter, but "will of course respond appropriately," Bodangow said.
The MNA, which represents 800 nurses at the hospital, said in a statement that nurses on St. Vincent's medical-surgical floors and telemetry floors have been assigned five patients at a time over the past two years, which it said is dangerous. In the emergency department, MHA said it's not uncommon for nurses to be assigned five and six patients simultaneously.
The union is seeking a limit of four patients at once, allowing for five only when it is warranted. They also demand the hospital staff more emergency department nurses. The nurses also want a "resource nurse" on every floor who manages patient flow, responds to unexpected patient increases and assists wherever necessary.
"This would provide the nurses the needed flexibility to assure the assignment matches the patient's needs and the ability for the nurse to meet those needs safely and effectively," MHA said in a statement.