June 2012 NURSE California ratio law

June 2012NationalNURSE

T H E V O I C E O F N AT I O N A L N U R S E S U N I T E D

UNFRIENDLY FIRESEIU local teams up withhospitals to undermine

California ratio law

WE HAVE ARRIVEDKansas City RNs settle landmark first contract

RNs take bus tour to spread the word about the only real healthcare solution: Medicare for all

GettingAmerica on Board

NATIONAL NURSE,™ (ISSN 2153-0386

print/ISSN 2153-0394 online) The

Voice of National Nurses United,

June 2012 Volume 108/4 is

published by National Nurses United,

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Please contact us withyour story ideasThey can be about practice or manage-

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EXECUTIVE EDITOR RoseAnn DeMoro

EDITOR Lucia Hwang

GRAPHIC DESIGN Jonathan Wieder

COMMUNICATIONS DIRECTOR Charles Idelson

CONTRIBUTORS Gerard Brogan, RN,

Hedy Dumpel, RN, JD, Jan Rabbers, Donna Smith,

David Schildmeier,Ann Kettering Sincox

PHOTOGRAPHYJaclyn Higgs, Tad Keyes,

Erin FitzGerald

as registered nurses, we allknow just how important andlifesaving RN-to-patientstaffing ratios are. Currently,only one state in our greatunion, California, has mandat-ed safe staffing ratios, thoughNNU nurses across the coun-try are determined to winthem state by state, or better,nationally. Since the lawpassed in 1999 and ratios wereimplemented in 2004, ratios

have attracted RNs back to the bedside, motivated people tobecome RNs, and been shown in solid studies to save lives.

So imagine our shock and disgust when, this June, thepresident of a local of the Service Employees InternationalUnion partnered up with the California Hospital Associa-tion, the hospital industry’s lobbying group that has timeand time again tried to kill the ratios, to argue that ratiosshould be suspended during meals and breaks for twoyears. Their reasoning? That RNs should help the hospitalssave money because of the state budget deficit. Say what? Ifyou couldn’t make any sense out of that argument, don’tworry, because we couldn’t, either, and that’s because it wasall just lies. Their attack on the ratios has failed, for now,though we guess we should thank them because they’ve putthe entire organization on high alert to protect and defendthis groundbreaking law. To get the full story and all thegory details, please read the article in the news section andalso NNU Executive Director RoseAnn DeMoro’s columnin this issue.

Also on our minds this past month has been healthcarereform and the ongoing campaign to improve Medicare andextend it to everyone in this country, regardless of age. TheU.S. Supreme Court decision upholding the Affordable CareAct, also known as Obamacare, was hailed by some as mon-umental, but we nurses know better. The law still leavesinsurance companies in charge, even providing a captivecustomer base for them, and patients will still be deniedaccess to healthcare as they have been. California RNs tooka road trip this summer on a “Medicare for all” bus to edu-cate the public about what still needs to be done to fixhealthcare in this country and heard the most amazing,heartbreaking stories.

Finally, there will be more of us than ever fighting thegood fight on behalf of our patients and our profession:More than 850 RNs from the St. Louis, Mo. area voted tojoin NNU in June! Congratulations to these brave RNs fortaking this step. We are proud to have you with us.

Deborah Burger, RN | Karen Higgins, RN | Jean Ross, RNNational Nurses United Council of Presidents

Letter from the Council of Presidents

Stay connectedFACEBOOK: www.facebook.com/NationalNursesFLICKR: www.flickr.com/nationalnursesunitedTWITTER: @RNmagazine, @NationalNursesYOUTUBE: www.youtube.com/NationalNursesUnited

TOC_CAL 7/24/12 12:37 PM Page 2

4 News Briefs SEIU local teams up with hospitals to attack ratios

5 | Baystate RNs win victories, go back to bar -gaining table 6 | Minnesota Nurses Associationadopts Member Action Team model 7 | Sutter RNsstrike fourth and fifth time 8 | Kansas City RNs winfirst contract; RNs at two St. Louis hospitals winunionizing elections 9 | Michigan RNs key to voteon protecting collective bargaining; 10 | Two CNARNs appointed to California Board of RegisteredNursing; NNU leaders take inspiration from Haitirelief project; RNs help launch campaign to passRobin Hood Tax on Wall Street; NNU-VA nursessettle their contract, fight mandatory overtime, and receive training on bargaining rights

11 Ratios at Risk The hospital industry is finding lackeys in labor to

attack California’s safe staffing ratios. By RoseAnn DeMoro

12 Next Steps Are you wondering what the U.S. Supreme Court

decision on the Affordable Care Act means forpatients? Learn what the law does and doesn’t do,and how improving and expanding Medicare for allis the only solution that works. By Charles Idelson

18 Still SiCKO Five years after release of the seminal documentary,

the film’s subjects reunite to discuss how little haschanged. By Donna Smith

12

Contents

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J U N E 2 0 1 2 W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 3

ON THE COVER: Registered nurse volun-teers with the Medicare for all bus at itsJune 26 stop in Modesto, Calif. RNs gavefree health screenings and then hosted a town hall meeting on Obamacare’s short-comings and the benefits of Medicare for all. Photo by Erin FitzGerald.

TOC_CAL 7/24/12 12:37 PM Page 3

CALIFORNIA

It’s not enough to win and havesomething. You have to fight like hell toprotect and defend it.

California RNs got a startlingreminder of that truism in June when

the president of another healthcare unionteamed up with the California HospitalAssociation (CHA), the hospital industry’slobbying group, in a surprise attack toundermine the state’s landmark safe staffinglaw which sets maximum RN-to-patientratios. Their goal was to suspend the ratiolaw during meals and breaks for RNs,which, as any RN understands, essentiallyguts the law.

On June 14, Dave Regan, president ofSEIU-United Healthcare Workers asked theCalifornia Labor Federation, an importantumbrella group for many of the state’sunions, to “go neutral” on any proposedlegislation to suspend the ratio law duringmeals and breaks for two years. He also had

some of SEIU-UHW’s local members payvisits to legislators to seek backing for such abill. Regan essentially argued on behalf ofthe hospital association that nurses neededto sacrifice their meals and breaks and thesafety of their patients to help hospitals save$400 million because the state was in abudget crisis. Yet most hospitals in Califor-nia are privately owned and state recordsshow they collectively posted $4.4 billion inprofits in 2010 alone.

The labor federation voted 60-2 to defeatRegan’s proposal, but registered nursesacross the country went on high alert whennews about Regan’s maneuverings wentpublic because they know that any effort toweaken the law is the first step towarddismantling it entirely. The California Nurs-es Association, the NNU affiliate whichsponsored the law, has repeatedly had toward off attacks by the hospital industry andstate officials to undermine the law since itwas passed in 1999 and implemented in2004. In 2004, just before ratios went intoeffect, the state hospital association filed a

lawsuit targeting the law’s requirement thathospitals needed to be in compliance withratios at all times, specifically during nurses’breaks. The association lost that suit, withthe judge writing in her opinion that any“other interpretation would make the nurse-to-patient ratios meaningless.” Later thatyear, at the bidding of the hospital associa-tion, Gov. Arnold Schwarzenegger issued anemergency order to roll back key portions ofthe ratio law. In response, California nurseshounded Schwarzenegger with more than100 protests and also filed suit against hisactions. He both backed down and lost thesuit, with a court finding that he had actedillegally in issuing the executive order.

“California RNs, with the support ofpatients, have fought long and hard toimplement and defend this vital law againstrepeated attacks by hospitals all too ready toabandon patient safety for their bottomline,” said RoseAnn DeMoro, executivedirector of National Nurses United and theCalifornia Nurses Association. “This latest,unprincipled attack, will also fail.”

When CNA and NNU sent out thenational call to RNs asking them to takeaction to defend the ratio law, many wroteback stressing the importance of ratios andthat they be in effect around the clock, with-out exceptions. Lifting ratio requirementsduring meals and breaks effectively meansthat nurses will unsafely have their patientloads doubled, as supervisors ask them to“buddy up” with a coworker. Since manydedicated RNs are unwilling to risk the safe-ty of their patients, this means that they willforego their meals and breaks entirely and,consequently, the time to regroup that theyneed to stay sharp, fed, and rested on thejob.

One of the comments to a HuffingtonPost article about the attack, by a nurse in astate without mandated staffing ratios, saidthat when she is forced to double up onassignments when a colleague goes onbreak, she is so scared. “I find myself PRAY-ING for the nurse I am covering to return; itis UNSAFE to have 10+ patients to beresponsible for, for even a short time,” shewrote.

To sign the petition to defend California’sratio law and for more information, pleasevisit www.nationalnursesunited.org/page/speakout/reject-the-attack-on-california-rn-ratios. —Staff report

4 N AT I O N A L N U R S E W W W. N AT I O N A L N U R S E S U N I T E D . O R G J U N E 2 0 1 2

NEWS BRIEFS

SEIU Local Teams Up withHospital Industry to AttackCalifornia’s Ratio Law

RRRRAAAAATTTTTAAAA IOSIOSIOSIOSIOSIOSIOS

NewsBriefs_June_June 2012 7/24/12 12:34 PM Page 4

MASSACHUSETTS

The national Labor RelationsBoard (NLRB) has sided with theMassachusetts Nurses Associa-tion/National Nurses United infinding that the Baystate Visiting

Nurse Association and Hospice (BVNAH)unlawfully declared impasse and imple-mented its so-called “final offer” on Feb. 16,2012. After a lengthy investigation, theNLRB concluded that the unfair labor prac-tice charge that the union filed againstBaystate had merit by finding probablecause that Baystate violated the NationalLabor Relations Act.

The NLRB decision coincides with anoverwhelming vote by the delegates at the2012 Massachusetts State DemocraticConvention to pass a resolution condemningBaystate Health for its blatantly anti-unionactivities and calling on it to respect theunionized nurses and return to the table andbargain in good faith.

In January, after a year of negotiations,BVNAH had unilaterally declared thatimpasse had been reached and therefore ithad the right to implement its last offer,which it subsequently did.

Rather than going forward to a lengthyformal hearing process, MNA and Baystate

have agreed to a settlement that gives thenurses a clear victory.

“We couldn’t be happier,” said bargainingunit committee member Chris Clark, RN.“The NLRB investigated and found that theagency clearly violated NLRB laws. Whenthey declared the end to negotiations andimplemented their last offer it was an insultto each and every member. Baystate’s intentwas to scare the members. It has notworked. The committee and the membersare anxious to get back to the table andnegotiate an equitable contract.”

The immediate result is that a formalNLRB settlement agreement will be postedin the facility and sent to each bargainingunit employee. It states in part that theBVNAH will not declare impasse prior toproviding information requested by theMNA relevant for negotiations, and that theagency will not announce or implement anyterms of its “last best and final offer” prior toreaching a lawful impasse in negotiations.

Among the issues still in contention whenBaystate illegally declared impasse is a propos-al by Baystate to implement an attendancepolicy that would be extremely unsafe to bothnurses and patients by forcing nurses to workeven if they are ill. Baystate is also proposingthat the nurses should accept a second-yearwage package solely determined by manage-ment. In the near future, a date will be set to

continue negotiations. This means that theagency will not be able to unilaterally imposeits attendance policy (or any other part of itsfinal offer) and will have to return to thebargaining table upon request by the union toconclude the negotiating process.

At the 2012 Democratic Convention inearly June, the nurses and their supportersneeded to get 50 delegate signatures fortheir resolution against Baystate to be votedon. After only a few hours of signature gath-ering, the nurses had more than 650 dele-gates signed on. Among those who signedthe petition were several state legislatorsand numerous local elected officials. Whenthe resolution came to the floor of theconvention, it passed on a voice vote withalmost no dissent.

Members of the Massachusetts NursesAssociation/National Nurses United whowork at BVNAH in Springfield and BaystateFranklin Medical Center (BFMC) in Green-field were highlighting Baystate’s ongoingattempts to undercut their fundamentalright to bargain over such basic issues aswages and health insurance. Both units havebeen in prolonged contract negotiations.

“We are very gratified by the overwhelm-ing support of the thousands of delegates tothe Democratic Party Convention. Now isthe time to get back to the table andcomplete a fair settlement so we can contin-ue to deliver excellent care to our patients inthe Pioneer Valley,” said Baystate FranklinMedical Center bargaining unit co-chairDonna Stern, RN.

The successfully passed resolution citedin part Baystate’s “documented history ofanti-union behavior” and “has been found bythe National Labor Relations Board to haveviolated federal labor law, and has consis-tently opposed workers’ right to organize.”

According to BVNAH negotiatingcommittee member, Chris Clark RN, theconvention was an important part of thenurse’s campaign to educate the community.“We were able to speak with hundreds ofdelegates and the support was tremendous,”Clark said. “Many of the delegates alreadyknew Baystate’s anti-union history, and manymore were educated about that history andthe present situation. To get such an over-whelming vote from those thousands of dele-gates will only make us stronger and deepenour commitment to keep the campaignmoving forward.” —David Schildmeier


Baystate RNs Win NLRB and Political Victories



MINNESOTA

Whom can nurses trustto advocate for them sothat they can advocate fortheir patients?

The answer is simple:one another. By creating Member ActionTeams (MAT), groups of RNs trained andready to take action on an issue, nurses havea foundation of connection, resources, andtrust to push back against a well-funded andhighly coordinated onslaught of corporateinterests determined to deskill and demoral-ize the nursing profession.

The Minnesota Nurses Association is usingthe MAT model to equip its RNs with the toolsand tactics they need to rely on one another.

“We need something like this in place all thetime,” said MNA RN Eric Tronnes. “This typeof training and engagement doesn’t need to be

something that only pops up every three yearswhen we have to negotiate a new contract.”

By connecting with one another throughMember Action Teams, MNA RNs arebreaking through the isolation, talking witheach other and building trust among them-selves in order to neutralize corporateattacks on nursing values.

“Going through the Member ActionTeam training here at MNA, you realize howimportant it is to have a plan in place,” saidMNA RN Margaret Blissenbach. “It’s morepeople involved, and it’s not asking toomuch of each individual nurse. MAT is agood deal for RNs because it is definite—‘This is your responsibility, and that’s it.’You’re not being asked to call a millionpeople. Instead, you’re a part of this organi-zation and this is your little piece of what weneed you to contribute. And if you are will-ing to do your small part, it ends up beingincredibly valuable for the rest of us.”

Nationally, hospitals are workingtogether to pass legislation and create poli-cies that will ensure they can pay peopleless money to do more work. The attemptsto pass a National Nurse LicensureCompact and right-to-work laws are part ofa very intentional manipulation. Now addto this the specter of mergers and acquisi-tions leading to conglomerate healthcarerun by the numbers.

At MNA, Member Action Teams aredesigned to connect nurses in purpose,message, and strategies. MATs are meant tofoster two-way communication, keep every-one aware and engaged, and provide aconsistent network of trusted individualsand information.

“You don’t want people on high alert atall times, but you do want to keep everyoneinformed of what’s going on statewide,”Tronnes said. “We want to let nurses knowthat this negative employer behavior that isgoing on inside your bargaining unit isn’tisolated. That it’s a statewide, or evennationwide issue.”

Against the boatloads of money floatedby their employers, Minnesota RNs havealready done some amazing things via the

Member Action Team model. For instance, the network

helped organize and initiatehundreds of e-mails, phonecalls, and face-to-face visitsfrom MNA RNs to state

legislators during the 2012 session, helpingprevent an onerous and unsafe NationalNurse Licensure bill from passing.

Make no mistake, however. The moneywill keep coming, and it is essential thatnurses build on their successes for the sakeof their patients and their profession.

Through Member Action Teams, MNAnurses will be nimble and responsive. Thetwo-way communication helps them shareinformation faster and learn quickly aboutissues at the bedside. As MNA increasesmember awareness, nurse leaders cancount on more powerful member engage-ment throughout the year and throughouteach facility.

“I have to say, the MAT training really gotme moving,” Blissenbach said. “I left therethinking, ‘I’ve got to get my facility movingon this.’ Because I think once you see what itcan do, you realize just how important it is.”

—John Nemo and Jan Rabbers

NEWS BRIEFS

Member Action Teams KeepMinnesota RNs Ready for Anything


CALIFORNIA

To ratchet up pressure on anemployer that is refusing tobargain reasonably and fairly,about 3,500 registered nurses aswell as respiratory and radiology

technicians working for Sutter Healthhospitals in the San Francisco Bay Areawent on two one-day strikes June 13 andJuly 3. As a punitive measure, Sutter lockedout nurses for an additional four days. Butwith more than 100 takeaways on the tableat various facilities, some as basic as paidsick leave, nurses are more determined thanever to win a contract that upholds theirnursing practice and economic standards.

“I woke up today with this awesome feel-ing and I was wondering what that feelingwas,” said Rochelle Pardue-Okimoto, a NICURN at Alta Bates Summit Medical Center inBerkeley. “I realized it’s the feeling of notgiving up. Divide and conquer. That was[Sutter’s] plan. If you look out here today,they failed. All they did was piss us off.”

It was the fourth and fifth time thatSutter RNs had gone on strike within theyear in response to outrageous concessions

demanded by the hospital chain duringcontract negotiations that have lasted nearlya year and a half. In addition to eliminatingpaid sick leave, Sutter has proposed take-aways such as floating RNs to units forwhich they have no experience or training,huge out-of-pocket increases in costs for

health coverage, forcing RNs to work over-time, eliminating retiree health coverage,and cutting health benefits from RNs whowork fewer than 30 hours per week—amonga host of other proposals.

Sutter Health is supposed to be anonprofit hospital corporation, but has post-ed profits of nearly $4.2 billion since 2005and pays its CEO, Pat Fry, an annualcompensation package worth more than$4.5 million. To achieve these numbers,RNs charge that Sutter is not only takingadvantage of the poor economy to under-mine RN contract standards but alsosystematically cutting services that it deemsnot profitable and shutting down hospitals.Sutter across Northern California has closedlabor and delivery, pediatrics, skilled nurs-ing, and psychiatric units, as well as cuttingoff services such as mammogram screeningsand bone marrow transplants.

Entire hospitals are on Sutter’s choppingblock, too. Sutter has wanted to close St.Luke’s Hospital in San Francisco, though itis the only private-sector hospital servingthe southern half of the city, and has slatedSan Leandro Hospital across the bay, whichtreats more than 27,000 emergency roompatients every year, for closure as well.

The day before the July 3 strike, a scandalerupted in San Francisco over the deal Suttermade with Mayor Ed Lee to build its new,massive Cathedral Hill medical complex.Sutter documents leaked to the press showedthat it was entertaining financial scenariosthat called for a variety of cost-cutting meas-ures it had promised the city it would notundertake, such as massive layoffs of existinghospital staff in San Francisco, providing lesscharity care than projected, and eventuallyshutting down St. Luke’s Hospital eventhough the city and community memberswant it kept open. The revelations providedmore ammunition for Sutter nurses, whohave been charging all along that Sutter isdeceptive in its bargaining.

“It is absolutely wonderful to see all thesenurses here together in unity fighting forwhat is right and what we’ve worked allthese years for,” said Maryalice Martinez, amed-surg RN at Mills-Peninsula MedicalCenter. “Don’t give up the fight. Keep fight-ing and supporting each other, even whenthey play dirty tricks on us. Just hang inthere. We’ll come out the other side in goodshape.” —Staff report

Sutter RNs Step Up PressureWith Fourth and Fifth Strikes


From top: RNs at Sutter Health's Mills-PeninsulaHealth Services rally on the strike picket line;Rochelle Pardue-Okimoto, RN rallies the crowdat Alta Bates Summit Medical Center



NEWS BRIEFS

MISSOURI

Registered nurse Sarah Mitchwill be the first to say that she is“no spring chicken” and well pastretirement age. But at age 67 andan RN for more than 45 years,

she has stayed in her job as an IV therapynurse at Research Medical Center in KansasCity, Mo., largely because she has wanted tosee unionizing efforts come to fruition there.

That day came on June 19, when the 580registered nurses at RMC, owned by gianthospital chain HCA, proudly announced asettlement for a first contract that recognizesthe RN voice in patient care matters, improvesstaffing standards, and offers economic incen-tives that recruit and retain quality RNs.

“It sounds hokey or old fashioned, butwhat we really want is to be able to do thebest job we can,” said Mitch about the nurs-es’ reasons for organizing into a union. “It’sabout standing up and helping each other sothat we can help the patient. It works.”

The contract came on the heels of a secondvote in which RNs overwhelmingly reaffirmedtheir support for unionization with NationalNurses Organizing Committee-Missouri, anNNU affiliate. As Leslie Rogers, an RMC RN

leader and member of the negotiating team,described in a letter of appreciation to RNsafter the vote, nurses showed their dedicationto forming the union by going “above andbeyond the call of duty” in order to vote. Manyshowed up on their day off, often with babiesand children in tow. One RN drove 300 milesround trip in order to participate.

One week later, the RNs were able to turntheir wishes into reality by wrapping upcontract negotiations that began in December2010. RNs ratified the contract the next week.

“This contract addresses our most pressingconcerns about patient care standards andabout keeping our most experienced nurseshere at RMC,” said Rogers, an operating roomRN and member of the nurses negotiatingteam. “We have eliminated the wage cap onexperienced nurses—a key goal to retaining

our nurses. This helps ensure the best care wecan provide and builds a strong foundation for

new RMC nurses to rely upon.”The contract at RMC

comes after first contractsettlements by NNOC over the past seven months inother HCA-affiliated hospi-tals—10 in Florida and one in Las Vegas. HCA, based inNashville, Tenn. is the largest

for-profit hospital corporation in the world. In each of these HCA hospital contracts,

RNs successfully negotiated professional prac-tice committees (PPC), a committee composedof elected staff RNs charged with makingrecommendations to management on improv-ing patient care. Along with PPCs, thecontracts also include acuity-based RN-to-patient staffing levels established in policy andenforceable by a newly negotiated staffingcommittee. Staffing committees are a hallmarkof these HCA contracts, where bedside RNswill work with management to review staffingissues in the hospital, ensure compliance withstaffing matrices, and recommend changes.

“It took time,” Rogers said. “But in the end,we were able to reach a settlement that theRNs deserve and which provides our patientsin Kansas City with quality care.” —Staff report

RNs in Kansas City Win First Contract

MISSOURI

In june, Missouri RNs at two St. Louis-area hospitals voted to join the Nation-al Nurses Organizing Committee-Missouri and to become a part of thenational nurses movement led by

National Nurses United.On June 7, registered nurses at Saint Louis

University Hospital (SLUH) voted 305 to 99 tounionize with NNOC-Missouri, an affiliate ofNNU. The union will now represent more than600 RNs at Saint Louis University Hospital,which is part of the Tenet Healthcare system.

“We are so happy that we SLUH RNs willnow have a vehicle to negotiate for improvedpatient care, salaries, and benefits that canrecruit and retain the best nurses for the best

patients in St. Louis,” said Lesa Dustman, anintensive care unit RN at SLUH. “We have noillusions about the work ahead but, with unityand resolve, we look forward to a bright future.”

And just two weeks later on June 21, RNsat Des Peres Hospital in St. Louis also voted110 to 60 to join NNOC-Missouri. Theunion will represent about 250 RNs at DesPeres, which is also a part of Tenet.

“We are thrilled that Des Peres RNs andSLUH RNs both won our right to collective-ly bargain,” said Marilyn Strain, RN. “Work-ing together, we will negotiate for improved

patient care, salaries, and benefits that canrecruit and retain the best nurses for thebest patients in St. Louis.”

Overall, NNU affiliates now representnearly 5,000 RNs at 11 Tenet hospitals infour states: Florida, Texas, California, andMissouri. “We are excited to welcome fellowRNs from Saint Louis,” said Sherri Stod-dard, RN, chair of NNOC’s national TenetRN Bargaining Council. “We strive everyday to maintain patient care standardsacross the board in Tenet hospitals.”

NNU leaders said the elections will inspireother nurses in the region to organize. “It hasbeen a dream of mine to see nurses in St.Louis come together and form a united frontfor RN standards and patient safety,” saidNNU Executive Director RoseAnn DeMoro, aSt. Louis native. “Two down!” —Staff report

Meet Us in St. Louis

Mother-and-daughterRNs Leslieand LaraRemingtoncast theirvotes



MICHIGAN

Awhopping 684,286.

That’s how many signaturesMichigan Nurses Associationmembers and other workersfiled June 14, virtually guaran-

teeing that a plan to enshrine collectivebargaining rights in the state Constitutionwill appear on the November ballot.

The filing—of more than twice as manysignatures required—is a historic milestonein a fight that MNA nurses are leading onbehalf of themselves, their patients, andtheir communities.

With corporate money sweeping statelegislatures and a governor dancing aroundso-called “right to work” legislation, the fightmakes Michigan the new national battle-ground for survival of the working class.

“Corporate-backed politicians are out todestroy collective bargaining because theyunderstand that the right to organize is whatgives workers power,” said John Armelagos,an RN at the University of Michigan HealthSystem and treasurer of the Protect Our Jobscoalition, which is organizing the initiative.“The Michigan Legislature has passed oneanti-worker bill after another, attacking everyresident’s right to have a voice in the work-place. It’s a special threat to nurses becauseour very ability to advocate for our patients—the core of our profession—is at risk.”

With the support of NNU, MNA mobi-lized with other labor groups to protectcollective bargaining rights through thebroad-based Protect Our Jobs campaign.

MNA has been at the forefront of the

campaign since its launch in the spring, withnurses going out in their communitiescollecting signatures to put the measure onthe ballot.

Leadership from the nurses at theUniversity of Michigan was instrumental.Armelagos himself collected 1,100 signa-tures, a process he found inspiring. “Collec-tive bargaining gave birth to the middleclass in Michigan, and people here under-stand better than many that the middle classwill die without it,” Armelagos said. “Whilewe were collecting signatures, people wouldsay things like ‘My mom is in a union, andthat helped me go to college’ and ‘Thank youfor doing this.’”

Armelagos said Michigan residents arestarting to see the assault on collectivebargaining as part of a multi-faceted assaulton democracy. Michigan’s recent emergencymanager law enables the state to take overcities and school districts by replacing local-ly elected officials with corporate executiveswho can nullify collective bargaining agree-ments; Republicans are pushing some of themost egregious voter suppression laws; andMichigan has garnered global attention forattacks on women’s reproductive rights andthe silencing of a female legislator who usedthe word “vagina.”

Katie Oppenheim, a fellowRN at the University of Michi-gan, said the only good newsabout the oppressive climate inMichigan is that it is awakeningnurses and other workers totheir own power.

“Nurses see our patients andtheir families suffering at the

hands of these regressive laws, just like wehave seen suffering caused by the brokenpriorities of our federal government,”Oppenheim said. “NNU has been very influ-ential in getting more nurses to not only beincreasingly aware of the dilemmas ourpatients face—housing, health care, educa-tional costs, etc.—but to use our power to dosomething about it. We recognize that if wecannot maintain and grow the middle classin this country, what will become of realdemocracy?”

Oppenheim, who spoke on the “Coordi-nated Assault on Collective Bargaining”panel to hundreds of nurses at NNU’s 2012Staff Nurse Assembly in Chicago, under-stands the challenges ahead for thecampaign.

Those include deep-pocketed right-wingers and corporations hiding behindCitizens United, like those who helped ScottWalker prevail in Wisconsin.

She said she expects even more volun-teers from the labor, faith, and progressivecommunities to mobilize to ensure thepassage of the amendment. Right now, thatmeans passionately educating both unionmembers and non-union members aboutthe value of collective bargaining.

“MNA will remain leaders in the ProtectOur Jobs campaign, telling our stories asnurses to help the public understand what’sat stake,” Armelagos said. “One of ourmembers was even the official signer for thepetition on behalf of all Michigan workers.

We’re proud to helplead the fight toprotect collectivebargaining, becausewe refuse to letcorporations andpoliticians silenceour voices.”

—Dawn Kettinger

Michigan Nurses Key to Voteon Constitutional Amendment

To send a message ofsupport to Michigan Nurs-es Association membersfighting to protect collec-tive bargaining rights,visit their Facebook page:Facebook.com/ minurses.



Californiaexpanding the influence of the California Nurses Association over nursingstatewide, two CNA RN leaders wereappointed in May to the California Boardof Registered Nursing, the regulatory bodythat governs, administers, sets policy for,and oversees discipline for nursing licensesand practice. Trande Phillips, a KaiserPermanente pediatrics RN who serves as aCNA board member and NNU vice presi-dent, was named by Gov. Jerry Brown torepresent a direct patient care position onthe nine-member board. “This is the oppor-tunity of a lifetime to take my advocacy fornurses and patients to the highest level,”said Phillips. “We hold people to a veryhigh level of skill and knowledge in thisstate and set the standards for nurses allover the country.”

Michael Jackson, a University of SanDiego Medical Center emergency roomcharge RN and a nursing instructor atSouthwestern College, was named also by Brown to represent an educator position.“I’d like to leave the board better than wefound it,” said Jackson about what he hopesto accomplish during his four-year term. “Isee myself as a watchdog for the public andfor nurses’ practice.”

Internationalin april, Jean Ross, Minnesota RN and amember of the NNU Council of Presidents,along with Bonnie Castillo, director of theRegistered Nurse Response Network(RNRN) project, traveled to Haiti for aPublic Services International (PSI) confer-ence. While there, they had the chance totour various program sites run by J/PHRO, a relief organization cofounded byactor and activist Sean Penn that has estab-lished itself as a long-term resource forrebuilding the island nation, which wasdevastated by a 7.0 earthquake in 2010. Inaddition to coordinating removal of abouthalf of the country’s rubble, J/P HRO hasstarted and operated at least two health-care clinics that treat hundreds of people a

day, schools forHaitian children,and is nowbuilding homesfor the Haitianpeople. In short,the group iscommitted tohelping theHaitian peoplerebuild theirentire infrastruc-ture. “It was all

very impressive,” said Ross. “It’s amazinghow much they have accomplished.” Rosssaid RNRN and J/P HRO are also explor-ing opportunities for collaboration betweenAmerican and Haitian nurses. For moreinformation about J/P HRO and how todonate, visit www.jphro.org.

Nationalon june 19, National Nurses United andother supporting groups formally launchedthe U.S. campaign for a Robin Hood Tax byholding protests in 15 major cities acrossthe country in front of JPMorgan Chasefinancial institutions and unveiling the U.S.Robin Hood Tax website at RobinHood-Tax.org. Celebrities such as actor MarkRuffalo and Nobel Laureate economistJoseph Stiglitz are in favor of the financialtransaction tax, which would be a small taxof 50 cents for every $100 of Wall Streettrading. Experts estimate it could raise asmuch as $350 billion per year for health-care, education, the environment, and jobs.“This small sales tax on stock trades couldraise billions of dollars in the United Statesand help people on Main Street who arestruggling to have access to healthcare,good jobs, and affordable housing,” saidLucia Adams, an RN at Las PalmasMedical Center in El Paso, Texas. “As nurs-es, we see the pain felt in our communityand our patients, who share stories with usabout their everyday struggles and how theeconomy has devastated their lives. Todayis a chance for nurses to share our message

of the Robin Hood tax so that we can helpto turn the crisis around.”

Veterans Affairsnnu-va recently completed contractnegotiations for its first-ever nationalcontract covering VA nurses at the 22 facili-ties represented by NNU-VA. Nurses arenow in the process of ratifying the contractand the VA secretary approval process. Oncethis process is complete, RN leaders plan tohold trainings on the new contract for thenurses. See the next issue for a full report onthe new NNU-VA contract.

In other VA news, Lexington NNU-VADirector Barbara Devers, RN filed andprevailed on a grievance over mandatoryovertime, chalking up another win in theNNU column on the issue. A few monthsago, VA nurses in Buffalo also scored a winagainst mandatory overtime. “We will contin-ue to enforce the laws around mandatory OTfor the protection of our nurses and the veter-ans we serve,” said Irma Westmoreland, RNand president of the NNU-VA council.

Lastly, six NNU-VA RNs are currentlyproviding training at different sites aroundthe country about Title 38, Section 7422,which limits the collective bargainingrights of VA registered nurses. Sadie Hugh-es Young, RN will be training in Denver,Colo.; Ruby Rose Hutchinson, RN will betraining in Atlanta, Ga.; Rhonda Risner-Hanos, RN will be training in Chicago, Ill.;Jeanelle Foree, RN will be training inBronx, NY and Buffalo, NY; Odell Ander-son, RN will be training in Cincinnati,Ohio; and Eula Rouland, RN will be train-ing in Washington, D.C. These nurses,along with our NNU labor representatives,completed specialized training in this topicand will be sharing their knowledge withothers. The VA secretary has issued newguidance on the subject and these nurseswill be part of the teams that are trainingall leadership staff I in VA and the union.They are to be commended for their will-ingness to come forward and provide thistraining.—Staff report

WRAP-UP REPORT

NNU RNs helped launchthe U.S. campaign for aRobin Hood Tax on June19 by protesting in frontof JPMorgan Chasebranches in 15 citiesacross the nation. Fromleft: RNs in the Bay Area;RNs in Minnesota; RNs in Texas; RNs in Washington, D.C.


And now a message fromTexas nurses on the attemptby another union to destroyratios:

“We, the NNOC RNs of the Professional Practice

Committee at Cypress Fairbanks Hospital (Houston),

and the 300 registered nurses we represent in our

facility, strongly and vehemently oppose the current

attack on California’s safe patient ratio legislation.

“It is well known and documented that safe

nurse-to-patient ratios save lives and improve

patient outcomes. Suspending ratios while RNs

are having their meals and breaks will place

patients in harm’s way. RNs will have double the

number of patients in their care.

“Twice as many patients means less RNs at the

bedside, resulting in less monitoring of patients’

conditions, less pain control, and less ability to

protect seriously ill patients from deteriorating

further. Putting our patients at risk for the sake of

hospital profits is unacceptable and dangerous.

“Therefore, we stand in solidarity and fully

support our NNU sisters and brothers in California

on this critically important issue. Ratios must stand

to allow nurses to care for their patients safely!”

Nicely put. If there is one bedrock issue that unites

U.S. nurses from coast to coast, it is safestaffing for their patients.

So when a California union official, DaveRegan, president of SEIU/United Health-care Workers West, teamed up with the Cali-fornia Hospital Association on a scheme tosuspend a key portion of the California’shistoric ratio law, nurses were fighting mad.Nurses across the country, in fact.

Here’s what happened. In May, Regansigned a secret partnership agreement withCHA, the lobbying arm of the hospital industryin California and one of the biggest spenders inCalifornia politics which uses its influence tooppose nearly every effort to improve patientcare, workplace standards, or worker rights.

For example, CHA has successfully lobbiedfor years to delay state mandates for seismic

upgrades to prevent hospitals from fallingdown on patients and staff during a temblor inquake-prone California. The law was passed,and reinforced, after hospitals did in factcollapse in two Southern California earth-quakes, killing patients in some hospitals andcreating serious structural problems in others.

Opposing safe staffing has probably beenthe CHA’s number-one priority – and, forthe same reason it has opposed other safetystandards. Profits, not patient care, are theprime directive of the hospital executives itrepresents, who keep CHA afloat with theirdues. It’s also the reason why the hospitalindustry has fiercely fought ratio legislationin other states where nurses for years havesought to emulate the California experience.

In California, CHA opposed the ratio lawevery year before it was enacted, then triedto persuade state regulators to adopt mean-inglessly high ratios, then filed a lawsuit onthe eve of implementation to overturn therequirement that hospitals be in compliancewith the ratio law at all times, and specifical-ly during meal and rest breaks.

Rejecting CHA’s suit, Superior CourtJudge Gail Ohanesian ruled that maintain-ing the minimum ratios at all times, includ-ing meal and rest breaks was the onlyreasonable interpretation of the nurse-to-patient regulation, noting “[a]ny otherinterpretation would make the nurse-to-patient ratios meaningless.”

With failure after failure, CHA thenengaged in subversion, holding workshopsfor nurse managers on how to evade theletter and spirit of the law. The tacticsworked best in hospitals where the nursesdid not have a collective voice through theCalifornia Nurses Association.

Next, CHA persuaded the then weight-lifting Gov. Arnold Schwarzenegger tosuspend portions of the law. After 107nurse-led protests, a court ruling that hehad acted illegally, and a smack down in thepolls, Schwarzenegger backed down.

So CHA found another water carrier, in

this case Dave Regan. CHA and Regansigned a partnership pact in May. As part ofthe deal, Regan agreed to do the hospital’sbidding, starting with collaborating withCHA on its dream of overturning the ratiosby initially suspending them during mealand rest breaks. Their plan: to find a compli-ant legislator and then persuade other Cali-fornia unions to remain silent on the issue.

This plot failed as well. Nurses across thestate protested, and the California Labor Feder-ation refused to help Regan look good in theeyes of his new master, the hospital industry.

Within days, thousands of nurses fromcoast to coast had signed petitions and writ-ten letters and website messages to us oppos-ing the attack, along the way telling their ownstories about the often poor staffing and otherpatient care conditions in their hospital.

From a Nevada RN: “We have a ratio agreement with

the union in NV of 1:5 and that doesn’t include

breaks. So during a nurse’s break we are 1:10, and

sometimes even 1:11. Sometimes we are even down

two different hallways and when I mentioned that it

was unsafe for me to watch my five patients and the

nurse on break’s five down a different hallway, I was

questioned as to why it was unsafe by management!”

From a Missouri RN: (Our) rehabilitation

hospital assigns 7-8 pts or more per RN. They do not

use acuity, they only go by numbers. (We have) more

medical pts than rehab. Tube feedings IV antibiotics

in and out caths every 4 hours. Lucky if you get 30

min for lunch. Never a break. Phone goes off all the

time even at lunch with no one to take over for you.”

From a North Carolina RN: “I remember hear-

ing from my nurse manager, back when I worked

in a hospital, that it was important to ‘come in

under budget.’ Then from someone else I heard that

the managers who did got bonuses as incentives …

we were repeatedly told, despite our reasonable

requests for more staff, that we had enough nurses

according to the acuity numbers … The acuity

numbers needed to be tweaked to reflect the real

needs of the patients and staff, not the needs of the

company to serve the almighty dollar. When will

RoseAnn DeMoroExecutive Director, National Nurses United

Ratios at RiskThe hospital industry is finding lackeys in labor to destroy safe staffing ratios


(Continued on page 17)

RAD_June 2012 7/24/12 12:33 PM Page 11

NEXT STEPSThe U.S. Supreme Court has upheld the Affordable Care Act, but medical

care will still be out of reach for millions of Americans. Learn how the law leaves the private insurance system unchanged, and how expanding

Medicare for all is the only solution that works. BY CHARLES IDELSON


ACA_June 7/24/12 12:37 PM Page 12

Now that the United States Su -preme Court has upheld the 2010Affordable Care Act, it’s a good timeto revisit what the law does and doesnot do, and what’s next on the agen-da for advocates of more comprehen-sive healthcare reform.

At its best, the law will help somepeople who have been unable to gethealth coverage, primarily through theexpansion of Medicaid and some of

the insurance reforms, assist seniors to pay for prescription drugs, andprovides important financial help for community health programs.

But the law does little to control healthcare costs for families andindividuals, is not universal, leaves big loopholes in the insurancereforms, and is a huge windfall for insurance companies, hospitals,and pharmaceutical corporations.

Overall, the law reinforces, protects, and expands the reach of theprivate insurance system. Even its most progressive element, the

Medicaid expansion, was undermined by thecourt decision allowing individual states to optout, which could substantially reduce the law’spromise of expanded coverage.

As NNU Co-President Karen Higgins, RN,who was on the steps of the Supreme Courtwhen the decision was announced, said, “Nurs-

es experience thecrisis our patientscontinue to endureevery day. That’s thereason we will con-tinue to work forreform that is uni-versal, that doesn’tbankrupt families orleave patients in theoften cruel hands

of merciless insurance companies.” That reformis called an expanded and improved Medicarefor all.

There are several key provisions of the ACA,most of which are to be phased in by 2014.

Probably the most controversial part of thelaw so far has been the individual mandate,which means that those who currently have nohealth insurance, for example, through theiremployer or covered by a government-fundedprogram like Medicare, Medicaid, or the VA, willbe required to buy private insurance. Failure tocomply will result in a tax (as redefined by theSupreme Court) amounting to $695 a year or2.5 percent of an individual’s income, whicheveris greater. Subsidies are supposed to be providedfor people with incomes of up to 400 percentabove the poverty line to buy insurance. Newstate health insurance exchanges will be set upto offer choices.

The ACA also offers a few “benefits” that will add some more people tothe ranks of the insured. People with incomes up to 133 percent above thepoverty line will have access to Medicaid, a provision accounting for morethan half of the additional people who will now have health coverage.That Medicaid expansion comes with a big caveat, however. The courtallowed states opposed to the Medicaid expansion to opt out. A numberof states are threatening to do so. And young adults up to age 26 can nowremain on their parents’ health plans, a provision already in effect.

The law bars some of the most notorious insurance abuses,including denying coverage because of preexisting conditions, reci-sions (dropping coverage when you become sick), and annual andlifetime caps on coverage. Insurers are also supposed to providerebates to consumers if they spend more than 20 percent of theirrevenue on administrative costs. Insurance plans will also berequired to include preventative care (e.g. mammograms, vaccina-tions, colonoscopies, physicals) with no co-pay, by 2018. Medicarewill now include an annual physical and no co-pays for preventiveservices. And the law provides for significant increases in fundingfor community health centers, one of the best provisions of all,E

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Opposite page: Washing-ton, D.C.-area NNU nurseson the U.S. Supreme Courtsteps the morning its rul-ing upholding Obamacarewas announced. Thispage: RN Vickie Bryantchecks a San Luis Obispoman's blood pressure.

ACA_June 7/24/12 12:37 PM Page 13

which was added late in the Congressional debate at the insistenceof Sen. Bernie Sanders.

On prescription drug coverage for those on Medicare, the ACAhelps shrink the “donut hole” in coverage, but does not eliminate it.The Bush administration program of prescription drug coverage forMedicare recipients through a private supplemental program left ahuge coverage gap with large out-of-pocket costs for seniors. The ACAreduces the gap, by about 40 percent, which has produced importantsavings for millions of seniors, but does not solve the entire problem.

Finally, small businesses, which pay far more than big companiesif they offer health benefits, will get tax credits of up to 50 percent of

14 N AT I O N A L N U R S E

ACA_June 7/24/12 12:38 PM Page 14

the cost of premiums for offeringhealth insurance to their workers, aprovision already in effect.

But on many fundamental lev-els, the law falls woefully short andfails to rein in health insurers.

Insurance companies, drugcompanies, and hospitals will stilllargely be able to charge what theywant. Restrictions on premium rateincreases and out-of-pocket costsare limited and will likely be inef-fective. The probable result: a con-tinuation of bankruptcies linked to

high medical bills and many people, including those forced to buyinsurance, skipping needed care because of high out-of-pocket costs.

Furthermore, insurance companies will still be able to deny med-ical treatment, diagnostic procedures, and referrals, making excusesby citing such care as “experimental,” or “not medically justified.”They will be able to dictate the order of tests and course of treat-ment. Recourses for patients will remain weak. And you can betinsurance companies will spend a lot of money on lawyers andclaims adjustors who will be experts at finding loopholes in the new


“Medicare is far more effective than the broken private system in controlling costs and

the waste that goes to insurance paperwork and profits, and it is universally popular,

even among those who bitterly opposed the Obama law. Let’s open it up to everyone.

NO ONE SHOULD HAVE TO WAIT TO BE 65 TO BE GUARANTEED HEALTHCARE.”

Opposite page clockwise fromtop left: RN volunteers gave freescreenings in Santa Cruz; LACounty-USC Medical Center RNsin Glendale; a father and daugh-ter stop in at the Santa Cruzscreening; RNs chat with a par-ticipant in San Bernardino. Thispage from left: An RN in SantaMonica listens during a bloodpressure check; Diane Pittsley,like so many others RNs met, isuninsured.

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ACA_June 7/24/12 12:38 PM Page 15

crackdowns on insurance abuses. For example, insurers can createnew marketing techniques to cherry-pick whom they cover despitethe ban on denials for people with preexisting conditions. The lawalso permits insurers to charge more based on age and for those whofail “wellness” programs because they have diabetes, high bloodpressure, high cholesterol readings, or other medical conditions.Insurers will continue to be able to rescind coverage due to “fraud orintentional misrepresentation” - the main pretext they use now.

The law also simply fails to provide universal coverage. Before thecourt decision, the non-partisan Congressional Budget Office esti-mated up to 27 million people would be left without health coverageunder the ACA, mostly people who will still not be able to afford tobuy private insurance. However, the court decision permitting statesto reject the Medicaid expansion could cause the number left out tojump by as much as several million more. The principle of “all thehealthcare you can afford” remains in effect, as the insurance marketis divided into multiple risk pools and multiple plans offering differ-ent levels of coverage based on price.

For the first time, the law will tax health benefits beginning in2018. The main target is comprehensive coverage. The inevitable

result will be fewer employers offering good health benefits, and farmore people pushed into plans with reduced coverage and significant-ly higher co-pays, deductibles, and other large out-of-pocket costs.

For registered nurses, the law promotes IT systems in healthcare,many of which are wasteful and have been used by many employersto erode RN clinical judgment and promote dubious standardizedprotocols and other efficiency measures. Budget pressures will drivethese delivery system changes, under the guise of “improving quali-ty.” The law also encourages the use of dubious “patient satisfaction”schemes, such as scripting and rounding, that typically underminenursing practice by linking them to hospital reimbursements. Formore on what’s wrong with these schemes, see the October 2010issue of National Nurse.

Ultimately, what the ACA accomplishes is create a windfall forhealth corporations: Billions of dollars in additional profits forinsurance companies, through the individual mandate and taxpay-er-funded subsidies to buy private insurance; for drug companies,whose support for the ACA was negotiated by blocking the ability ofthe federal government to negotiate bulk purchasing discounts;and hospitals, which will get millions of new customers and higher


Many Already on BoardFor Medicare For AllOn Jan. 25, Carolyn Trovao knew she was having a heart attack.Yet the 61-year-old Fresno, Calif. woman lay on her living roomfloor with crushing chest pain, afraid to go to the emergency roombecause she knew that, because she had no health insurance, get-ting medical help would ruin her financially and potentially kickher unemployed son out on the streets.

“I actually stayed at home for 16 hours suffering chest pains,praying that I would die because I was afraid that my son would beleft homeless,” said Trovao. “I do have insurance to pay off mymortgage, so at least if I died, he would at least have a home.”

Passing in and out of consciousness, Trovao eventually couldn’tstand the pain anymore and her 23-year-old son, who lives withher, convinced her to go to the hospital.

Trovao is still alive today, but now saddled with a $135,000 hos-pital bill that she has no resources to pay. The reason she didn’thave insurance coverage in the first place after she retired from her15-year position with Aetna (yes, she used to work for a healthinsurer, advising brokers about Aetna policies no less) was becauseshe could not afford the $1,300 per month COBRA premiums.

“That’s what happens to people,” said Trovao. “I never thought thatI’d lay there and want to die, but I have to be honest with you, I’d haverather died than leave my son homeless.” She said the hospital recentlycalled about payment, but she has no idea how she will settle that debt.

Trovao’s situation is just one of the many distressing stories that NNUnurses and staff members heard and documented during their three-week bus tour across California this summer as part of NNU’s cam paignto expand and improve the Medicare system to cover everybody.

Dubbed the “Healthcare Express,”the bus left San Diego on June 19 andcrisscrossed the state, making stops inmore than 18 cities. At each stop, nurs-es offered basic health screenings to

the public, then hosted a town hall meeting toshare healthcare stories, discuss the shortcom-ings of the Affordable Care Act and, alternative-ly, how a Medicare for all system would work to

provide true universal healthcare, and explain how people can takeaction to pass such a reform. The town hall gatherings were oftenpacked, and community members instinctively understood the needfor Medicare to be expanded to cover everyone regardless of age.

Registered nurses met all kinds of patients, from those who havelost their jobs and insurance so can no longer afford their medications,to those who had not seen a doctor or nurse in more than a decade.

Many of the registered nurse volunteers had their own stories totell. One RN is supporting 10 relatives on just her salary. Only herimmediate family has health insurance. Another RN, Joan Potts,recently lost her insurance when she lost her job. Her husband, whois diabetic, depended on her coverage and is not able to get individ-ual insurance because of his preexisting condition, so is not able toseek medical care. Based on her previous year’s salary, they maketoo much money to qualify for Medicaid. They are now considering adivorce so that he can access some kind of government aid.

“He suffers every day and I know there is medical help for him, butit’s unattainable. We just can’t afford it,” said Potts. “I’ve come torealize that healthcare shouldn’t be a luxury. There’s good people outthere suffering needlessly and they’re dying needlessly. Unfortunate-ly, it took something like this to happen to me to make me realizethat this needs to stop. We need to have healthcare for everybody.”

Find out more about NNU’s Medicare for All campaign andwhat you can do to help at NursesHealAmerica.org. —Lucia Hwang

To see video interviewsfrom the Medicare for Allbus tour, please visityoutube.com/calnurses.

Carolyn Trovao told her story inFresno, Calif.

ACA_June 7/24/12 12:38 PM Page 16

hospital upper management get this? Perhaps if the CEO was a regis-

tered nurse, not a businessman with an MBA, things might be better.”

NNU members and staff across the country hear storieslike these every day. It’s the reason why NNU has sponsorednational legislation S. 992, introduced by California Sen. Barbara Boxer, and H.R. 2187 by Illinois Rep. Jan Schakowskyand state bills from Nevada to Florida.

It’s why nurses in California, with the solidarity and sup-port of nurses throughout the United States, will never accepta return to the days when California patients had to call 911from their hospital beds to get help and be silent in the face ofthe latest insidious threat to the hard-won law to protectpatients. And no joint venture of a corrupted labor leader withthe hospital industry can change that.

RoseAnn DeMoro is executive director of National Nurses United.

reimbursements. All of which will further strengthen a healthcaresystem already too focused on profits rather than patient need.

“Medicare is far more effective than the broken private system incontrolling costs and the waste that goes to insurance paperwork andprofits, and it is universally popular, even among those who bitterlyopposed the Obama law,” said Higgins. “Let’s open it up to everyone.No one should have to wait to be 65 to be guaranteed healthcare.”

NNU will continue to work at both the state and national levelsfor guaranteed healthcare through expanded Medicare. More than adozen states have active single-payer movements, and the ACA doesallow state waivers in 2017 to expand beyond the ACA; activists arepushing to move the waiver date up to 2014.

Nationally, nurses will work with a broad array of existing health-care and community activists to improve Medicare through suchsteps as ending the creeping privatization of administration andservices, increasing funding, and expanding Medicare as more peo-ple see a need to solve, once and for all, a patient care crisis that willnot end with the Supreme Court decision.

Charles Idelson is communications director of National Nurses United.


(Continued from page 11)

RATIOS AT RISK

ACA_June 7/24/12 12:38 PM Page 17

We were glad to be reunited, but it wasbittersweet.

Nine of the patients who were sub-jects in Michael Moore’s 2007 docu-mentary film SiCKO about the brokenU.S. healthcare system gathered inPhiladelphia on June 30 to reconnectand educate the public that, five yearslater, Americans’ access to healthcare

has not improved and, if anything, gotten worse. I was one ofthose patients.

This five-year reunion, themed “Still SiCKO After All TheseYears,” was all about the SiCKO patients and what has happened tous in the years since the movie hit the big screen and opened up theeyes of millions of people to the absurdity, greed, and malice ofhealth insurance corporations. The film was an instant sensation,and National Nurses United RNs were instrumental in promotingSiCKO and using it as a conversation starter about what’s wrongwith a healthcare system that is run for profits, not for patients. Inthe film, Moore contrasted our corporate-driven system to more effi-cient and effective government-run ones in other industrializedcountries throughout Europe, Asia, and North America.

Sharing the stage in Philadelphia were Reggie Cervantes, 9/11first responder; Dawnelle Keys, mother of baby daughter Mychellewho died when refused treatment in an out-of-network hospital;Julie Pierce and Tracy Pierce, Jr., wife and son of the late TracyPierce, who died when denied a bone marrow transplant; AdrianCampbell Montgomery, who slipped over the border into Canadawith her little daughter, Aurora, when she couldn’t secure cancer

care in Michigan; myself and my husband Larry, who went bank-rupt though we were insured as we fought for healthcare access; andLee Einer, the film’s healthcare industry whistle-blower. Billy Maher,another 9/11 first responder, also came to Philadelphia but wasunder the weather and couldn’t be on stage.

The evening’s events were emceed by Patricia Eakin, RN, of thePennsylvania Association of Staff Nurses and Allied Professionals(PASNAP) and Chuck Pennacchio, executive director of Health Care4 All Pennsylvania. The opening portion of the program featuredwelcoming remarks by Michael Lighty, director of public policy forNational Nurses United and the California Nurses Association, whoframed the evening’s proceedings by talking about the nurses’ tourback when SiCKO was released and the ongoing work NNU/CNA isdoing to bring improved Medicare for all, for life, toeveryone. Almost five years ago to the day of the reunion, nursestraveled down the East Coast in a shrink-wrapped SiCKO bus topromote the film as it opened in cities from New York to Philadel-phia and Washington, D.C., and then in Chicago.

What was most telling was how many of us (we call ourselvesAmerican “sickos”) struggled even to travel to the reunion and reliedon donated support to do so. Starting months before the Philadel-phia event, the SiCKO patients set up fundraising pages and sentemails seeking support. Director Michael Moore offered his help,and as the evening unfolded, the audience learned that these bravesouls who have already bared their struggles for the entire world tosee on the big screen were once again willing to push the agenda anddemand their voices be heard.

My fellow film subjects have continued to experience great trau-ma in their lives following the film’s release. Reggie finally has


Still SiCKO Five years after release of the seminal documentary, the film’s subjects reuniteto discuss how little has improved in our healthcare system. BY DONNA SMITH

Sicko_June 7/24/12 12:36 PM Page 18

Medicare coverage, but as a single mom who cannot work due to her9/11-related health issues, she is teetering on the brink of poverty.Dawnelle cares for her mother and works hard in her daily life tohelp families whose children have special needs. Adrian works forthe publication Labor Notes in Detroit and loves her post-SiCKOjob, but has had two more recurrences of cancer that have left herfinancially ruined at 30 years old, and she mourns over not beingable to have any more children. Julie and Tracy, Jr. recently lost thehome they shared as a family before Tracy, Sr., died, though Julietried so hard to work with the bank to save their home. But the bankpreferred foreclosure and auction to negotiating with the family. LeeEiner is working in his New Mexico community to support locallysustainable foods and he bakes at a local restaurant. I now work as alegislative advocate for NNU, but Larry and I still grapple with med-ical bills and the loss of personal relationships as I face a new cancerstruggle and Larry has had two more major health scares and sur-geries. Billy Maher lost both of his parents and continues to strugglewith the demons that have haunted him since 9/11.

Clearly, we sickos are still hurting and trying hard to rebuild ourlives, and the audience learned more as we recounted our mostrecent challenges and life updates. One by one, we outlined how dif-ficult it still is to access appropriate medical care when we need itand how the financial devastation has continued.

Einer then spoke about his role as an industry whistle-blower inSiCKO, and introduced Wendell Potter, a former vice president ofcorporate communications for the insurance giant CIGNA. WhenSiCKO was first released, Potter in his capacity for CIGNA posed asa moviegoer to spy on audiences during the film’s premier. His jobwas to gauge public response and help format the industry’s

methodical public relationscampaign to discredit bothMoore and the film. But in2008, just a year after the film’srelease, Potter underwent whathe terms a “crisis of conscience”and has since become one of thehealth insurance industry’s mostoutspoken whistle-blowers andcritics, authoring a book titledDeadly Spin about his careerworking for the industry. At thereunion in Philadelphia, Potterformally met Michael Moore forthe first time.

Then, together, we Americansickos introduced DirectorMichael Moore. Though he hadbeen sitting among the audiencemembers, as Moore made hisway to the stage, the crowdcheered. The Plays and PlayersTheater where the event washeld was packed to capacity.Since the air conditioning in thecentury-old building had failedearlier in the evening and theweather outside was nearly 100degrees, we all suffered terriblyin the heat. It reminded us all of

the day back in 2007 when the SiCKO bus first rolled up to Inde-pendence Plaza in Philadelphia.

Once Moore took the stage, he acknowledged all of those whoworked to put the reunion together. He discussed the making of themovie and the power of movies to persuade and change people’s minds.Moore related how he originally planned to make a movie about theplight of the uninsured, but that 90 percent of the letters that floodedhis email inbox when he asked for healthcare horror stories were fromthose with insurance coverage. He thanked us again for sharing our sto-ries with the world. “Your stories struck a real serious nerve with peoplebecause they knew that they weren’t alone,” said Moore, “that they, orpeople they know – people in their families, people in their neighbor-hoods, people at work – were going through the same thing.”

The audience then got into the act with a question-and-answer peri-od during which Moore was asked what he is working on now and hewas pushed to address so many issues of importance to working peopleand those who care about education, the environment, and beyond.

Finally, we American sickos closed out the evening by challeng-ing Moore and Potter both. One by one, the film subjects pointedout that what happened to them pre-SiCKO that made them perfectfodder for the film could and would still happen to them under theAffordable Care Act, the healthcare reform law passed by PresidentObama in 2010 that was just recently upheld by the U.S. SupremeCourt. “The problem isn’t fixed until that isn’t true anymore,” we toldthem. “The work’s not done until it’s done. We’re still SiCKO. Anduntil we say the system is fixed, the work remains ahead.”

Donna Smith was featured as a subject in the film SiCKO and is now a legislative

advocate for National Nurses United.JOE

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“Your stories struck a real serious nervewith people becausethey knew that theyweren’t alone: thatthey, or people theyknow—people in theirfamilies, people intheir neighborhoods,people at work—weregoing through thesame thing.”

—MICHAEL MOORE

Sicko_June 7/24/12 12:37 PM Page 19

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