Chapter 42: So Wonderful

July 23, 1990, McKinley, Ohio

"The nurses voted last night to decertify their union," Mary said when I arrived at the hospital on Monday morning.

"Bad move," I replied.

"Why?"

"According to Bobby Murphy, that means that their contracts are null and void, and they become 'at-will' employees. According to him, they have to circulate preference or 'authorization' cards. If more than half the proposed members sign cards, the new union is certified, but then it has to begin negotiating, and ALL the clocks reset. Even if they form the new union with the techs and orderlies, they won't be able to strike until they negotiate in good faith; otherwise, they risk termination, and they have no protection."

"That does put a different spin on it."

"It does, though it's short-term pain for potential long-term gain. Basically, once they negotiate a new contract, they'll be able to legally strike. But they also need to have the orderlies and tech decertify their union to join the new one. In my mind, that'll be the end of orderlies."

"Who'll do that work?"

"Nursing students and medical students," I replied. "At this point, the orderlies mostly do transpo, assist with changing bedding, and collect laundry. They're already phasing them out of transpo, which I'm sure you've noticed. For laundry, they'll just add laundry workers and have them collect the linens and scrubs rather than have orderlies deliver them."

"They're paid less, right? The laundry people, I mean?"

"I'm fairly certain that's the case. Fundamentally, it's all a trade-off, as is everything else."

"Higher taxes?"

"Basically, that's the only solution for a public hospital. We're not suffering the problems of the big-city hospitals in Chicago, New York, or LA, but we're starting to see costs rise faster than revenues. Private hospitals have a bit more leeway to raise prices and can be more selective about patients who are not covered by EMTALA. And guess what that does?"

"Increases the problems for public hospitals."

"Yep. Anyway, what's on the board?"

"Zilch. It was a very quiet Sunday night. One minor MVA, one non-STEMI, one rule-out appy diagnosed with constipation."

We went into the lounge, and I poured myself some coffee. It was a relatively quiet early morning, and just after 8:30am, Doctor Wernher asked to see me.

"We're going to offer to bring Doctor Gibbs back on August 1st," he said. "Her schedule and duties will be along the lines you proposed. How do you feel she'll react?"

"Positively," I replied. "You should expect her to push the limits you impose."

Doctor Wernher smiled, "I may have some experience with a doctor who does that regularly."

I chuckled, "I won't apologize."

"Nor would I expect you to! You have the innate ability to take things right to the line, but not a smidgen over. In any event, she'll technically be on probation, so we have a ninety-day evaluation period. I'm certain you'll hold our feet to the fire in fairly evaluating her work."

"I will, but I won't pull any punches, either. If Loretta can't handle it, or patient care is at risk, I'll say so."

"That's what I'm counting on. On another topic, I had a call from Leland Crowe a few minutes ago. After all the legal wrangling, you'll be required to make your procedure book available for examination. Mr. Crowe did have a protective order issued that only allows the attorneys to examine it here, in his presence, and not to make photocopies. He did warn that they might subpoena it as evidence, and in that case, he'll take it into custody as an officer of the court and keep it in his possession. If it needs to be entered as evidence, photocopies will be made and held under seal."

"I suppose that's the best we can hope for," I replied. "When?"

"He'd like you to bring him the book this morning."

"OK. It's about 80% filled, so I'm going to mark the next empty page at the end of the book. The pages are numbered, so nobody can play any games."

"Good. One final piece — the nurses voted to decertify their union late last night."

"Doctor Mary told me," I replied. "May I make a suggestion?"

"You may."

"Use the interim period to fire Karla Pearson. Any nurse who puts patients at risk by refusing an order from a doctor has no business working here."

Doctor Wernher raised an eyebrow, "That's extreme, coming from you! You're usually on the 'give them another chance' side; that's how you were with Melissa Bush."

"I'm going to assume Owen Roth spoke to you about that."

"He did. Risk management put the kibosh on it, not that Nels Anderson needed a reason. Was her only transgression that intemperate outburst about the suspected AIDS patient?"

"That was what led to everything else, yes. I felt Doctor Gibbs was mistaken with regard to how she handled it, but I was a First Year at the time, so my opinions weren't particularly relevant."

"How would you have handled that?"

"A visiting student assignment in an AIDS ward at a hospital in San Francisco," I replied.

"You don't think she'd have quit?"

"It's possible, but that would have been up to her, and it would have shown her true character. I think she's shown it now by taking the Match at ARH Harlan and serving that community for a year. The one thing nobody ever accused Melissa of was neglecting patient care. Doctor Gibbs assumed Melissa would, but had no evidence other than Melissa's intemperate response.

"What you have to consider is the combination of the times, the rarity of that diagnosis here, and Melissa's brainwashing by the cult that passes for a church. And I say that as a member of a church that is, in some ways, more cult-like than just about anything this side of the Sierra Nevadas!"

"An interesting admission."

"We're weird," I replied. "And do not conform to ANY Western notions of Christianity. From our perspective, Rome and her Protestant daughter churches are simply two different responses to the same error. But that's not the point here. The point is, anyone who puts patient care at risk has no business working in the ED, or in the hospital, for that matter.

"I think my case is made by the complaint to the arbitrator, who'll have to dismiss the complaint per the labor rules in the most recent contract. That said, he may not even have to rule because, according to Fireman-Paramedic Murphy, once they decertified the union, everything resets, and a new union has to start at square one with collective bargaining."

"That is what I've been told," Doctor Wernher confirmed. "Would you be satisfied if Nurse Pearson were transferred to Medicine?"

"It's not about me being satisfied," I replied. "It's about the patients. If you and Tim Baker agree she's not a risk to patients, then transfer her. But I cannot trust her."

"That's the key point, isn't it? If we don't trust each other, we can't properly treat patients. Let me ask this — do you trust Paul Lincoln?"

"Yes. He was caught out and unlucky. That could easily have been me, especially if we were slammed. Yes, I would have wanted an ultrasound; but it wasn't actually indicated, which is the key. The problem we're facing is that decisions as to what tests and what procedures are to be performed are being decided by risk management and the budget committee, not doctors. The only reason I can safely perform a speculative ultrasound is your order, backed by risk management. You know the accounting weenies object."

"You really should spend a year at a place like Cook County."

"No, I shouldn't, because, despite my passive nature, I might be the cause for an increase in GSWs on bureaucrats!"

Doctor Wernher laughed, "That sounds very similar to something Perry Nielson said when I first met him in Chicago when he was at Cook County, and I was at Rush-Pres."

"I didn't realize you knew each other."

"Acquaintances, only. I knew a number of other ED docs, including Al Barton and his protégée Jessica Adams, whom I believe you've met."

I nodded, "Yes, when she was one of Al Barton's med students at Indiana. She was supposed to be at the conference in Indy, but she ended up not being able to make it. Is there anything else?"

"No. I'll take what you've said under advisement. Be sure to get your procedure book to Leland Crowe."

"Will do. Thanks, Dutch."

"Irreverent 'til your last breath!"

"Indeed!"

I left his office, let Nate know I was going up to Legal, and made my way to Mr. Crowe's office. In his presence, I wrote 'End' in red marker on the first empty page, drew two lines under it, and wrote in the date.

"I'll make sure this is returned to you when this is over," he said.

"No hope of any settlement?"

"No. Despite my earlier hopes, they believe they have us bore-sighted and don't feel the need to negotiate a settlement."