Chapter 69: Tabloid Journalism

May 20, 1991, McKinley, Ohio

"Not again," I sighed.

"Unfortunately," Ghost replied. "The nurses have given notice of their intent to strike on June 1st."

"And this time, they're not an exclusive nurses' union," I observed.

"Not to mention they've been working without a contract for a year. Doctor Wernher wants to see you and me at lunch to discuss a strategy."

"Pay them what they're worth," I said sarcastically.

"I agree with you, and I suspect Doctor Wernher does as well, but it's not up to us. It's up to the County."

"The County should have the revenue from the tax receipts, both from our county and the three others."

"You would think, but you know politicians. Noon in Doctor Wernher's office. He'll have lunch brought in."

Technically, Kayla was Chief Resident for another two weeks, but I knew there was no way I could escape with that line of argument.

"I'll be there," I said.

It was not how I wanted to start my Monday morning, but there was little I could do about it. I opened the door to the lounge and asked Walt and Margie to get a chart and bring in our first patient of the day. We ended up seeing nine patients from the waiting room, and an EMS-transported rule-out MI who simply had gastric distress, before I went to Doctor Wernher's office for our meeting.

"Pay them what they deserve," I said as I sat down at the small conference table in Doctor Wernher's office, where a sub sandwich, chips, and grapefruit juice had been set out for me.

"You're leading with that?" Dutch asked.

"I had to say it, so I figured I'd say it first so as not to interrupt the practical discussion about dealing with the problem that we're facing."

Both he and Ghost laughed.

"As Doctor Saunders would opine," Ghost said, "that's a perfect Loucksian answer."

"I am nothing if not predictable," I chuckled. "How likely is a strike?"

"The negotiations are at an impasse and have been for the best part of the last six months. The county is pleading poor, and the nurses are pointing to the tax increase, as well as the tax revenue from the other counties. The issues run deeper than pay, as the nurses are angry about being forced back to work without a contract. The County Board believes the nurses engaged in unethical, underhanded dealings by decertifying their union and forming what amounts to a sham union, including techs and orderlies.

"Add in the fact that the few remaining orderlies are militant about not losing their jobs, and the techs all want a significant salary increase and what they call improved working conditions, combined with the nurses' demands, there is just no chance this is going to be resolved by May 30th, barring a miracle, and you know my take on miracles. So, here we are. We have to assume we'll have no nurses, no techs, and no orderlies."

"I'm not an expert," I said, "but I've read EMTALA as well as the memos from Legal and articles in medical journals. There are literally no exceptions to the triage and stabilization requirements. Anyone who presents here has to be evaluated and treated. Once we've done that, we could refer patients to the clinic or a 'doc-in-a-box', but we cannot force them to go to those facilities."

"That's my understanding as well," Dutch said. "If we assume no nurses, Residents are going to have to conduct triage, which exacerbates the problem. The Hospital Board is considering canceling all vacation and leave."

"No exceptions?" I asked.

"I wouldn't count on going to Vermont if I were you," Dutch replied.

"Given the only words I want to use are on the banned list, which includes translations, I'll simply scowl."

Both Dutch and Ghost laughed.

"I completely understand, and I've discouraged them from taking that action, but staffing is going to be a problem. All options are being considered, including hiring private duty nurses, but unless they have relevant ED experience, we can't really use them, and I do not believe we can count on any nurses crossing the picket lines."

"Not even surgical nurses?" Ghost asked.

"The union leadership has consistently implied a complete and total work stoppage," Dutch said.

"That's irresponsible and unprofessional in the extreme," I observed. "While I support the nurses' demands for a wage increase, refusing to supply nurses for emergency surgery is just beyond the pale. They'll lose public support. And we'll lose millions upon millions in the wrongful death suits that are sure to follow. Do I need to say it?"

"That it would be cheaper to give them their raises?" Dutch asked. "You would think, but the bean counters look at one-time costs versus ongoing operational costs."

And would, I was certain, lead to my wife excoriating the system once again, and this time, having a legitimate argument I wouldn't be able to counter.

"We can use Residents and medical students to perform most nursing tasks," Ghost observed. "Who is going to do the work of the techs in radiology and the lab?"

"That is a significant problem," Dutch replied, "as physicians have neither the training, experience, nor expertise to run the equipment. For lab tests, we can send them to an outside lab, but that could add hours to the time it takes to receive 'stat' labs. There are talks with Taft about graduate students in research who have experience with the equipment being hired, but it's unclear if they will cross the picket lines."

"Not to be 'that guy', but do we know if the departmental clerks will cross the picket lines?" Ghost asked. "They aren't in the union."

"We don't know," Dutch replied. "There is a rumor that the union is talking to them to get them to join, and if that happens..."

"It keeps getting better and better," I sighed.

"The plan is to supplement with MS2s," Dutch said, "though, as you know, they cannot touch patients. MS3s and MS4s will have longer shifts, as will Residents and Attendings. I know you just released the schedules for June, but you need to develop contingency schedules. For the moment, for any shifts shorter than twenty-four hours, add two hours to each shift. Mike, your Thursday seminars will be suspended, as the MS2s will be in the hospital."

In my mind, the disruption being caused and the risks associated with running the hospital without nurses were so great that they outweighed the cost of simply paying the nurses more, but nobody was asking me. I would, though, give Viktor an earful about it after work.

"We'll need to post the schedules," I suggested. "We can't really spring the extra hours on the Residents and Attendings with no warning."

"I agree," Dutch said. "I'll post a notice outlining the change. It'll be two hours at the end of each shift for all physicians."

"May I make a suggestion?" I inquired.

"I'm open to any ideas," Dutch replied.

"We establish some kind of system with Doctor Gibbs whereby people who voluntarily go to the clinic are given priority. She's permitted to turn away other walk-ins and refer them to their personal physician or another urgent care facility. We can do something similar with the outpatient clinic, though that would mean they would have to cancel all scheduled procedures, similar to what Surgery will do."

"I'll take that upstairs," Dutch said. "It's a good idea."

"The other thing is, we should have Mary Anderson down here full-time with her PGY1s. They won't have anything to do in Surgery, and we can use them here, and train them at the same time."

"Another good idea. I'll speak to Owen Roth about that."

"What about bringing in High School graduates as candy stripers?" Ghost suggested.

"When the High School discontinued the program, they allowed the Seniors who were working to continue, but that ends next week, and the County canceled the liability rider as of the end of the month."

"Well, isn't that special?" Ghost observed sarcastically.

"Doctors, I understand, but I need you both to assist in keeping up morale. It's going to be a challenging situation, but we need to do our best to ensure excellent patient care, even in the most difficult circumstances. I daresay you'd rather be here during a nursing strike than have been a doctor in a front-line field hospital in Korea or Vietnam. If there's nothing else, you're dismissed. Post the revised schedules on Friday."

"Will do," I replied.

"And me," Ghost added.

We left the office, and Ghost nodded towards the Attendings' office, so I followed him there, closing the door behind us.

"Do you think it would help if we had a word with Viktor Nikolay'ich?" Ghost asked.

I couldn't help but laugh.

"I'm not sure what's more frightening," I observed. "My sister-in-law teaching my daughters French, or you becoming Russian!"

Ghost laughed, "It's in the freaking water at home, with Oksana's family, and at church! You should know that!"

"True, though it was much, much stronger when I was growing up. Pretty much nobody under fifty speaks Russian regularly, while it was very common until I started High School. In any event, I don't think it can hurt, though the problem is the County Board, not the Hospital Board."