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Those questions have burst from a bitter union battle at one of the nation's largest health care corporations – which happens to be Catholic.
The struggle at Catholic Healthcare West began a year ago, when the Service Employees Union International began signing up nurses, housekeepers and other workers at seven hospitals in the Sacramento area and three in Los Angeles.
Only in recent weeks, however, has the union gone public with allegations that the hospitals have harassed and intimidated pro-union employees with the help of an anti-union consulting firm.
"This is the biggest anti-union campaign we've ever seen. Columbia/HCA doesn't do a better job of attacking its workers," said Sal Roselli, president of Service Employees Local 250, which covers Sacramento. Columbia/HCA is a for-profit corporation, the largest in U.S. health care.
Referring to the nine orders of nuns that run the non-profit Catholic Healthcare West with lay management, Roselli added: "Clearly, the women religious are colluding with the suits, or this wouldn't be happening."
Officials there acknowledge they have retained the services of Management Science Associates, a firm with a reputation in union circles for "union busting." But they deny using heavy-handed tactics such as assigning security guards to follow around union supporters at work, and say the hospitals have merely provided information employees need in deciding whether to affiliate with a union.
"We support their right to make a choice" about unionization, said Cindy Holst, spokeswoman for Mercy Healthcare Sacramento, which is part of Catholic Healthcare West. But she said, "We have made it clear to our employees that it would not be in their best interests to vote in a union to represent them."
In a formal press statement, Catholic Healthcare West said, "We believe that the most constructive relationship between management and non-management employees is a direct one," without a union.
Nationally, labor has faced resistance in all hospital sectors, secular and religious, for-profit and nonprofit. Labor organizers say Catholic hospitals have been no exception and have typically sought out the expertise of firms that specialize in maintaining "union-free" workplaces.
But one difference with the campaigns at Catholic institutions is that union supporters can quote chapter and verse from Catholic social teachings in support of trade unions. Another difference is that, notwithstanding those teachings, Catholic hospitals can muster the moral and spiritual authority of their sponsoring religious communities in arguing against unions.
Eliseo Medina, a national Service Employees leader based in Los Angeles, accused Catholic Healthcare West of sending out the message that employees "have to make a choice between being good Catholics and being in the union."
Medina said, "I'm a Catholic, and I've always listened to what priests, nuns, and brothers tell me. But I don't think this is what Catholic social teaching is all about."
He cited, among other things, an alleged incident in which the chaplain of St. Francis Medical Center in Lynwood, Calif., near Los Angeles, is said to have asked in morning prayers at the hospital for God to lead workers on the right path and against the union.
But the chaplain, Brother Richard Hirbe, said it didn't happen. He said he offers prayers over the public address system at 8:00 a.m. every day and has "never once" mentioned the union in those prayers.
Medina of the Service Employees also cited a letter written to St. Francis employees by Brother Hirbe, whose formal title is Director of Spiritual Healthcare Services.
Noting that the hospital is dedicated to "building up the Kingdom of God," the letter stated: "No union can make claim to building God's Kingdom as it's mission, just as no union can make you a guarantee, only a shallow promise of a ‘better life.' "
The brother, in a telephone interview, said he wasn't making an anti-union statement. The purpose of the letter was simply to "inform the consciences" of employees about the Catholic healthcare mission, said Brother Hirbe, a member of Brothers for Christian Community, which he described as a contemporary community of religious men.
Like other hospitals, those belonging to Catholic Healthcare West are struggling to adapt to the competitive, cost-cutting environment of managed care.
Responding to market pressures, the hospital chain has raced ahead of the industry trend toward mergers and acquisitions. Founded in 1986 with eight hospitals and now with 37, it is the seventh largest hospital network in the nation, according to research by the Service Employees.
Pro-union employees and their supporters, including some "labor priests" in Los Angeles, say Catholic Healthcare West has become preoccupied with the bottom line. They contend – and the hospital denies -- that the quality of patient care has plummeted along with employee morale.
Key issues in the organizing campaign include a stronger voice by employees in decisions about staffing and services as well as health insurance for their children. Currently the benefits are only for employees, though hospital officials say the workers can pay a premium for coverage of dependents.
"At this time, it is economically unfeasible for us" to extend the coverage, said Holst of Mercy Healthcare Sacramento.
Still, Holst said the costs of doing business have little to do with why the hospitals are resisting the union. The stated reasons for doing so are broader than that and a bit philosophical.
"A union – an outside third party whose values greatly differ from ours – would drive a wedge in the relationship," three Daughters of Charity wrote in a "Dear Team Members" letter to employees of Robert F. Kennedy Medical Center, part of the Catholic chain, in Hawthorne, Ca.
Nearby, at St. Vincent Medical Center in Los Angeles, 10 Daughters of Charity wrote: "A union sets up an adversarial relationship within the hospital. It breaks down, even eliminates, direct communication with employees …" The letter said unions can do this "by their very nature."
The union is attempting to turn a critical spotlight on such roundly anti-union statements, against the ecclesiastical backdrop of pro-labor teachings. Union literature has cited Pope John Paul's statement that unions are "indispensable" in modern societies and "are indeed a mouthpiece for the struggle of social justice" (Laborem Exercens, 1981).
Hospital officials say they see no contradiction between their position and Catholic social teaching.
"Is it a mortal sin to believe that unions are not the best way of social justice?" said Brother Edward Smink, chaplain and manager of spiritual services at Robert F. Kennedy Medical Center. He added, "Employees have a right to unionize, but they clearly have a right not to unionize."
Some hospitals in the Catholic Healthcare West network are already unionized, partly due to acquisitions of community hospitals where unions have existed for decades.
It is within bounds of Catholic social teaching for employers to let workers know they prefer to stay non-union, officials say.
But critics such Father Stan Bosch, pastor of two parishes in Los Angeles, say the hospitals have been doing that and much more.
Father Bosch said he recently spent three hours talking to workers in the St. Francis Medical Center cafeteria, and came away convinced that the hospital is actively thwarting their right to organize.
The priest said pro-union workers complained of managers and supervisors telling them, "I'd hate to see you lose your job." He said they also spoke of one-on-one grilling sessions that they consider coercive, and other anti-union strategies.
Susan Whitten, spokeswoman for Catholic Healthcare West in Southern California, said management has used the meetings to convey unbiased information to employees. She said the charges of intimidation "are just not true."
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