Montefiore Hospital and Medical Center

MONTEFIORE HOSPITAL AND MEDICAL CENTER Montefiore Hospital and Medical Center and New York State Federation of Physicians and Den- tists, Petitioner. Cases 2-RC-18594 and 2-RC- 18629 April 30, 1982 DECISION AND DIRECTION OF ELECTIONS BY CHAIRMAN VAN DE WATER AND MEMBERS FANNING, JENKINS, AND ZIMMERMAN Upon petitions duly filed under Section 9(c) of the National Labor Relations Act, as amended, a hearing was held before Paul Rickard, a hearing officer of the National Labor Relations Board. Fol- lowing the hearing and pursuant to Section 102.67 of the National Labor Relations Board Rules and Regulations and Statements of Procedure, Series 8, as amended, the Regional Director for Region 2 issued an order transferring these cases to the Board for decision. Thereafter, the Employer and the Petitioner filed briefs in support of their respec- tive positions. The Board has reviewed the Hearing Officer's rulings made at the hearing and finds that they are free from prejudicial error. They are hereby af- firmed. Upon the entire record in these cases, the Board finds: 1. The Employer, Montefiore Hospital and Medi- cal Center (herein referred to as the Medical Center or the Employer), is a New York not-for- profit corporation which operates Montefiore Hos- pital, located at 111 East 210th Street, Bronx, New York. The Medical Center is engaged in providing health care facilities located in and around the city of New York, most of which also are located in the Borough of the Bronx, New York. The Medi- cal Center is engaged in providing health care and related services to the sick and the infirm. In the course and conduct of its operations, the Medical Center annually derives gross revenues in excess of $500,000 from the performance of its services and it purchases supplies and materials valued in excess of $50,000 directly from suppliers located outside the State of New York. Based on the foregoing stipulated facts, we find that the Medical Center is engaged in commerce within the meaning of the Act and that it will effectuate the purposes of the Act to assert jurisdiction herein. 2. The Petitioner is a labor organization claiming to represent certain employees of the Medical Center. 3. A question affecting commerce exists concern- ing the representation of certain employees of the 261 NLRB No. 82 Medical Center within the meaning of Section 9(c)(1) and Section 2(6) and (7) of the Act. 4. The Medical Center provides its health care services at several geographic locations. It has two clinical campuses, referred to as West Campus and East Campus, on which a number of hospitals are located. t In addition it operates various ambulatory care centers and a health service for some of New York City's correctional institutions. The Petitioner seeks to represent staff physicians and dentists (herein referred to collectively as doc- tors) employed by the Medical Center. The parties are in some disagreement as to the scope and com- position of any unit which may be established,' but their basic disagreement concerns whether the doc- tors are protected by the Act. It is the Employer's position that the doctors are managerial because they participate in the formula- tion and implementation of policies concerning the operation of the Medical Center, and hence cannot be included in any certified unit. The Employer relies on the Supreme Court decisions in Bell 3 and Yeshiva4 dealing with the status of managerial em- ployees. In Bell, which involved buyers in the purchasing and procurement department of a researcher and developer in the industrial sector, the Court held that managerial employees are not entitled to the benefits of the Act, and sanctioned a definition of managerial persons as those who "formulate and effectuate management policies by expressing and making operative the decisions of their employer."5 In Yeshiva, which involved an academic institution, the Court found that certain faculty members were managerial. In this case we are required to apply the principles concerning managerial employees to a health care setting. We note, initially, that the staff doctors of the Medical Center are professional employees as de- fined in Section 2(12) of the Act, and we have rec- ognized that staff doctors may constitute an appro- priate bargaining unit separate from other profes- sional employees6 even though in the health care ' West Campus consists of Montellore Hospital, North Central Bronx Hospital, and Montefiore Medical Group. East Campus includes the Hos- pital of the Albert Einstein College of Medicine and Bronx Municipal Hospital Center composed of Jacobi and van Etten hospitals. 'I The Employer also contends that the health service it operates for the correctional institutions is controlled by, and intimately connected with, the city of New York, a political subdivision of the State of New York, and therefore the petition seeking a unit at this location should be dismissed. 'N.L RB. v. Bell Aerospace Ca, 416 U.S. 267 (1974). 'N.LR.B. v. Yeshiva University, 444 U.S. 672 (1980). Supra, 416 U.S. at 288. Montefiore Hospital and Medical Center, 235 NLRB 241 (1978); see also Mon Valley United Health Services, 238 NLRB 916, 924, fn. 17 (1978), and Ohio Valley Hospital Association, 230 NLRB 604 (1977). 569 DECISIONS OF NATIONAL LABOR RELATIONS BOARD industry the Board is required to avoid the frag- mentation of units.7 As professional employees, the doctors may also be managerial, but their manage- rial status may not be based on decisionmaking which is part of the routine discharge of profes- sional duties. Only if the activities of professional employees fall outside the scope of the duties rou- tinely performed by similarly situated professionals will they be found aligned with management.8 And in the health care context the Board must evaluate the facts of each case to determine whether deci- sions alleged to be managerial or supervisory are incidental to the professional's treatment of pa- tients. 9 Seeking to apply these principles, we consider the organization of the Medical Center and the role and responsibilities of the doctors, together with the Employer's contentions that the doctors' man- agerial status is shown by their participation in de- partmental operations, committee service, and the residents training program, and their employment on the faculty of a medical college. The Medical Center's administrative structure is highly centralized. It has a board of trustees which appoints a president of the Medical Center. Report- ing to the president is a director, who has five deputy directors responsible, respectively, for the following areas: administration, fiscal affairs, human resources, ambulatory care, and professional affairs. The director and the deputy directors con- stitute a senior management committee, which makes all policy for the Medical Center and all of its units. The Medical Center has a separate budget for each of its facilities, but ultimate control of fi- nancial and administrative matters pertaining to all employees rests with these deputy directors. The deputy director for human resources is responsible for setting and administering personnel and labor relations policies, including those relating to wage guidelines, overall percentages of wage increases, job titles, grievance handling, and employee bene- fits, for all doctors. The deputy director for ambu- latory care has final authority over all outpatient services provided by the Medical Center's doctors. Other professional services provided by these doc- tors fall within the jurisdiction and ultimate control of the deputy director for professional affairs. The basic professional grouping by which the Medical Center's doctors are organized is the de- partment. The record establishes that almost all ' See Mercy Hospital of Sacramentoa Inc., 217 NLRB 765, 766 (1975), for a discussion of the legislative history of the 1974 health care amend- ments to the Act. I See Sutter Community Hospitals of Sacramento. Inc., 227 NLRB 181, 193 (1976); Yeshiva, supra, 444 U.S. at 690. ' S. Rept. 93-766, 93d Cong., 2d sess., 6 (1974); Yeshiva, supra, 444 U.S. at fn. 30. doctors employed by the Medical Center are ap- pointed to one or more departments based on the areas of professional expertise in which they are qualified. Most of these departments, called nonuni- fied departments, encompass all of the facilities lo- cated on one campus. Some departments, however, including such large departments as surgery and medicine, encompass doctors at facilities on both campuses. These are called unified departments. °0 Both unified and nonunified departments also en- compass doctors at certain satellite facilities. Each department is headed by a chairman or di- rector who, subject to the approval of the deputy director for professional affairs, has the basic re- sponsibility for hiring doctors to practice in the de- partment. Appointments of individuals to more than one department are jointly agreed upon by the relevant department chairmen. The chairmen also evaluate department members; apportion their wage increases from an amount of money allocated by the Medical Center basically on a departmental basis; and decide how to allot employee time to the facilities within their jurisdiction. All institutionwide policy is formulated by cen- tral administrators, and institutionwide policies appear to pervade the Medical Center's day-to-day operations, thus limiting the managerial autonomy within each department, leaving a smaller area of autonomy than was vested within the individual schools comprising Yeshiva University. This con- striction of autonomy presents a significant distin- guishing factor. For the purpose of this Decision, however, the crucial difference is the manner in which the Medical Center departments, as contrast- ed with the individual schools of Yeshiva Universi- ty, are governed. The Supreme Court found the governance of the individual schools at Yeshiva to be largely a colle- gial matter, with the real authority for fundamental decisions regarding management policy vested in the faculty as a group: The controlling consideration in this case is that the faculty of Yeshiva University exercise authority which in any other context unques- tionably would be managerial. Their authority in academic matters is absolute. They decide what courses will be offered, when they will be scheduled, and to whom they will be taught. They debate and determine teaching methods, grading policies, and matriculation standards. They effectively decide which stu- dents will be admitted, retained, and gradu- ated. On occasion their views have determined "0 As of the time of the hearing, unification of the department of medi- cine was scheduled to be completed in 1980. 570 MONTEFIORE HOSPITAL AND MEDICAL CENTER the size of the student body, the tuition to be charged, and the location of a school. When one considers the function of a university, it is difficult to imagine decisions more managerial than these. To the extent the industrial analogy applies, the faculty determines within each school the product to be produced, the terms upon which it will be offered, and the custom- ers who will be served. Here, the medical and dental departments of the Medical Center are governed by the department chairmen or directors, and administered by them with the aid of subordinate supervisors called, var- iously, directors, chairmen, deputy chairmen, and chiefs of services. " In the words of the Medical Center's deputy di- rector for professional affairs, the department chairmen (or directors) are responsible for setting and implementing "the standards for professional care of patients, teaching [and] research in their de- partments . . . and to manage the activities" of their departments. Medical directors within the de- partments, or such other persons as serve directly under the chairmen, typically lay out schedules, assign and evaluate the doctors, and deal "with problems as they come up." In consultation with, or by authority of, the chairmen, they allocate among the doctors the total amount of money ap- propriated for wage increases.1 2 As a general proposition, the chairmen make every major administrative decision with respect to the operation of their departments that is not dic- tated from above. Staff doctors have some input, but this is only in the form of recommendations which, for the most part, the chairmen or their des- ignees evaluate. For example, unlike the faculty in some universities, the staff does not vote on hiring decisions. Search committees often help narrow the field of consideration, but the chairmen make the final selection subject to approval, usually pro forma, from the central administration. Medical procedures and policies are discussed and adopted at staff meetings, but the record does not show that these become management directives to any signifi- cant extent; rather what little the record offers tends to show that the policies adopted become general guidelines, implementation of which is, to a " There are approximately 95 stipulated supervisory positions among the approximately 500 staff doctors working half time or more for the Medical Center. These supervisors, some of whom may also be manageri- al employees, are exclusive of the various administrators serving depart- ments, constituent hospitals of the Medical Center, and the Medical Center itself. " Each department receives annually an amount representing a certain percentage of the total of salaries for the previous year. The increases are not necessarily distributed across the board. The chairmen have, and ex- ercise, the discretionary power to distribute these increments so as to best fulfill the needs of the department and the employees. large extent, the individual doctor's professional decision. While there is testimony concerning "medical boards" to which all the staff physicians, plus other professionals and administrators, belong, such boards neither make policy nor have any direct responsibility for the quality of patient care. There is also a faculty senate, but it functions only with respect to matters such as resident training, and not day-to-day practice in the departments.1 3 Department chairmen typically make the final se- lection of residents, although, in some departments, they "generally" follow the recommendations of a staff committee. In short, the department chairman makes the managerial decisions, delegating some to subordi- nate supervisors. He does not rubber-stamp the staff's recommendations. Rather, as one depart- mental supervisor testified: "[The chairman's] deci- sions take into account the will of the staff." The Employer nevertheless contends that its staff doctors are managerial employees, relying on the doctors' possession of faculty appointments to the Albert Einstein College of Medicine and on their asserted collegial participation in the formula- tion and implementation of "medical policy," " rel- ative to academic matters and hospital administra- tion. An important factor distinguishing the posi- tion of the doctors as faculty members here from the faculty members in Yeshiva is that the Yeshiva faculty members were full-time teaching or other- wise educationally related personnel whose colle- gial authority with respect to academic matters was deemed to be so closely connected with the "busi- ness" of the university that their decisions consti- tuted governance of the institution (444 U.S. at 688). Here, on the other hand, the staff doctors are, as a whole, primarily concerned with patient care rather than academic matters; each is primarily as- sociated with a hospital, which happens to be a teaching hospital, and only secondarily with an educational institution. ' Further, the Petitioner seeks to represent the doctors only in their employ- ment relationship with the Medical Center. The specific exercise of authority by staff doc- tors in academic matters which the Medical Center " The record does not show what the faculty senate actually does with respect to resident training. " By a coincidence without legal significance, the Albert Einstein Col- lege of Medicine is affiliated with Yeshiva University. The Yeskri Uni- versity case did not involve the medical college. " The record is silent as to whether there exis, either as part of the Medical Center's staff or as a separately employed group a corps of doc- tors whose primary function is teaching. Similarly, while there i some evidence regarding the staffs particiption in the training of interns and residents, there is virtually none with respect to their dealings with medi- cal students. The interns and residents number approximately 500, as do the staff doctors who work at the Medical Center at least half time. Thus, if each of these staff doctors participated in the training of the in- terns and residents, the teaching ratio would be I-to-1. 571 DECISIONS OF NATIONAL LABOR RELATIONS BOARD labels "managerial" consists, inter alia, of inter- viewing prospective interns and residents, evaluat- ing their performance, and participating in the for- mulation of their curriculum. But such functions are not necessarily managerial. Yeshiva, supra at 690-691, fn. 31.16 Moreover, while the Medical Center treats these functions as typical of the re- sponsibilities of all staff doctors, the record indi- cates that they are performed by committees or by unnamed individuals. It does not provide a basis for finding that all staff doctors perform such func- tions, or that any identifiable individuals perform them regularly. Further, as noted earlier, the aca- demic matters with which these activities deal do not constitute the basic "business" of the Medical Center, which is to provide health care. The Medical Center also relies on the staff's par- ticipation in interviewing candidates for permanent staff positions, recommendations as to the purchase of new equipment, a consensus decision within the department of medicine to "encourage affiliation" with another hospital, and the adoption of medical (or dental) policy at staff meetings. While these matters lie closer to the core of the Medical Cen- ter's operations, they do not necessarily fall outside the professional duties primarily incident to patient care. Moreover, there is insufficient evidence in the record with respect to most of these staff activities to attribute them either to the entire staff or to spe- cific individuals.1 7 Many of the staff's purported managerial functions are performed by various committees within the departments. Yet, not all staff doctors are on the committees which perform such functions. In addition, many doctors are not on any departmental committee. We cannot find, on the facts in this case, that the alleged managerial participation on which the Medical Center relies-if managerial and not pro- fessional-so aligns the staff doctors with manage- ment or places them sufficiently within the man- agerial structure as to warrant their exclusion. See Yeshiva, supra at 682-683. Scope of Unit This is the third Board proceeding in which the Medical Center and this Petitioner have litigated the appropriateness of bargaining units. In the earli- est proceeding, the Petitioner sought and the Board ' See also New York University, 221 NLRB 1145, 1156 (1975). " We recognize that, in Yeshiva, the Supreme Court resolved the un- certainty as to the possible nonmanagerial status of some faculty members by concluding that it would not draw the line between those who were managerial and those who were not, because "it is clear that the unit ap- proved by the Board was far too broad" (id at 691, fn. 31), and left this line drawing to the Board. However, we do not believe the Court intend- ed to preclude the Board from requiring the party seeking to exclude either a whole class of employees or particular individuals as managerial to come forward with the evidence necessary to establish such exclusion. found appropriate a unit limited to the doctors em- ployed at one of the Medical Center's satellite facilities, a neighborhood clinic called the Martin Luther King, Jr., Health Center.' 8 The Medical Center argued then that only a unit encompassing, with certain exceptions, all of its facilities, includ- ing the Martin Luther King, Jr., Health Center and other satellite ambulatory care facilities, was appro- priate. 9 In the second proceeding, before the Board's Region 2, the Petitioner sought a unit lim- ited to NCB. The Medical Center contended that the appropriate unit was an employerwide unit, in- cluding satellite ambulatory care facilities. The Re- gional Director, relying most heavily on the close ties between NCB and Montefiore Hospital, held that a unit confined to NCB was inappropriate and dismissed the petition.2 0 In the instant proceeding the Petitioner seeks a single unit comprising NCB and Montefiore Hospi- tal (the West Campus) plus certain satellite facili- ties,2' excluding the East Campus. The Petitioner is willing to proceed to an election, however, in any unit the Board finds appropriate. The Medical Center continues to argue that any appropriate unit must include both the West and East Campuses, but now contends that it would be inappropriate to include any of the satellite facilities. There may be valid reasons, of course, for par- ties to change their positions with respect to the appropriateness of units, and we attach no stigma to any seeming inconsistency. As is not uncommon, both parties have taken a pragmatic approach to the unit question. The question, of course, is to what extent each pragmatic solution is also a prin- cipled one. There is no history of bargaining for the employ- ees sought herein. The Medical Center has a col- lective-bargaining agreement with District 1199, National Union of Hospital and Health Care Em- ployees, RWDSU, AFL-CIO, which encompasses all of its employees at all its facilities in various units of service and maintenance, technical, and professional employees. The Medical Center also has contracts with the American Physical Thera- pist Association and a local of the Committee of Interns and Residents, which are Medical Center- wide in their coverage. In addition, the Medical Center has three contracts with the New York State Nurses Association: one covering the regis- "' Montefiore Hospital and Medical Center, 235 NLRB 241 (1978). That clinic is apparently no longer part of the Medical Center. 'o The Board did not find that such a unit would have been inappropri- ate. "Case 2-RC-18438 (1979) (unreported in Board volumes). " The parties agree on the exclusion of certain satellite facilities. One of them, Rikers Island Health Service, the subject of the consolidated Case 2-RC-18629, is discussed infra. 572 MONTEFIORE HOSPITAL AND MEDICAL CENTER tered nurses employed at NCB, one covering those at Rikers Island, and one encompassing the remain- der of the registered nurses employed by the Medi- cal Center. The contents and duration of the nurses' contracts are the same, and they are negoti- ated simultaneously. It appears that over 300 doctors are employed by the Medical Center on the West Campus. NCB is administered and staffed by the Medical Center pursuant to an "affiliation" contract with the city of New York. The Medical Center also operates the hospital of the Albert Einstein College of Medicine, at 1325 Eastchester Road, Bronx, New York, and supplies personnel to provide certain services at the Bronx Municipal Hospital Center lo- cated nearby, pursuant to agreements with Yeshiva University. These two facilities are situated about 4 miles from the West Campus and are referred to as the East Campus. In addition to the two main cam- puses, the Medical Center employs doctors at sev- eral smaller facilities, geographically separated from either campus, some of which are involved in these proceedings. As a result of the Medical Center's administra- tive centralization, all of the doctors in its employ are subject to the same labor relations and person- nel policies and benefits. Grievance handling and hiring procedures are virtually uniform regardless of the facility at which these individuals perform their duties, with one exception, doctors are paid from the same payroll. The exception is NCB, a municipal hospital, which has a separate payroll from which doctors are paid for the time spent working there. However, many doctors who re- ceive paychecks exclusively from the centralized payroll work a substantial amount of time at NCB, which reimburses the Medical Center for such services. Similarly, employees may receive NCB paychecks for time not spent at that facility be- cause job duties required their presence elsewhere, and NCB is appropriately reimbursed when this occurs. Each party argues for a unit which is neither em- ployerwide nor limited to a single location or fa- cility, but which is different from the unit the other party urges. Neither of the parties' primary unit configurations, however, is presumptively appro- priate. The Petitioner, as noted, is willing to pro- ceed to electionin any appropriate unit. It is desir- able to establish a base point from which to exam- ine the respective unit configurations urged by each. An employerwide unit is presumptively ap- propriate, 22 and such units are, in fact, the first " Libbey-Oens-Ford Glass Company, 169 NLRB 126, 127 (1968). ones delineated as appropriate in Section 9(b) of the Act, upon which the Board's authority to es- tablish collective-bargaining units rests.2 We deem it useful, therefore, to examine the respective units the parties contend are appropriate in relation to such a presumptively appropriate unit in order to gain perspective on the parties' contentions and on the ultimate issue of the appropriate unit here. 24 We examine first the validity of the Medical Center's contention that the satellite clinics the Pe- titioner seeks to include should be excluded from any unit contemplated here. At issue are two satel- lite clinics, the Comprehensive Health Care Center (CHCC) and the Neighborhood Family Care Center (NFCC), located approximately 7 and 5 miles, respectively, from Montefiore Hospital. Both operate under employerwide labor policies, includ- ing uniform salary guidelines. CHCC is a family care clinic funded partly from Federal sources and administered by the Medical Center under the ju- risdiction of its deputy director for ambulatory care.'Z CHCC has its own director on location. He is employed by the Medical Center and is a physi- cian as well as an administrator. There are approxi- mately eight other physicians (six pediatricians and two internists) and two dentists. The director se- lects physician candidates and recommends their hire to the Medical Center's deputy director for ambulatory care and, in the case of pediatric candi- dates, also to the chairman of the department of pe- diatrics at the Medical Center. These individuals interview the recommended candidates and regu- larly approve the hiring of those recommended by the CHCC director. The record does not show how CHCC dentists are hired. The CHCC director administers its day-to-day operations under the general supervision of the deputy director for am- bulatory care. A Medical Center associate director assists as a liaison between CHCC and the Medical Center and monitors the participation of the Medi- cal Center in the grants that help to fund CHCC. CHCC pediatricians regularly attend or conduct rounds at Montefiore Hospital. NFCC is a community mental health clinic, ad- ministered pursuant to a contract between the I Western Electric Company, Inc, 98 NLRB 1018, 1032 (1952). See also Mercy Hospital of Sacramento Inc, supra " This analytical method does not, of counre, signal an abandonment of the fundamental proposition that there may be more than one appropriate way of combining employees into groups for bargaining purposes. Here, we choose to analyze the unusual and perhap unique unit configuratons sought by the respective parties with the aid of a model. We choose the employerwide unit as a model because it is a basic unit recognized by the Board since its earliest days and because, as compared to the most likely alternative presumptively appropriate unit model, the single-location unit, it more closely resembles the respective units contended for here. " It is similar to the Martin Luther King, Jr., Health Center, the sub- ject of our 1978 decision, as the latter then existed. 573 DECISIONS OF NATIONAL LABOR RELATIONS BOARD Medical Center and the city of New York. Its medical staff consists of approximately eight psy- chiatrists who, technically, are part of the Monte- fiore Hospital department of psychiatry, and two pediatricians. The medical director of NFCC is a psychiatrist who is responsible to his department chairman, although the extent of the chairman's in- volvement in the NFCC program is unclear. Ad- ministrative responsibility for the NFCC lies in part with the Medical Center's administrator of the NCB affiliation, presumably reflecting some con- nection between the services rendered by the Medical Center at NCB and those rendered at the NFCC mental health clinic. Subject to whatever restraints these organizational ties connote, the NFCC medical director administers the clinic, making effective recommendations with respect to hiring and professional evaluations. We find it appropriate to include both of these satellite facilities in a unit encompassing other Medical Center facilities. The ties of CHCC to Montefiore Hospital give at least the CHCC pedia- tricians more than a sufficient community of inter- est with other Medical Center physicians to war- rant their inclusion. While the ties between the Medical Center doctors and the few remaining CHCC physicians and dentists are less clearly de- lineated, the latter work under the same labor poli- cies and salary guidelines, and do not appear to be so lacking in the shared community of interests as to warrant their being relegated to a separate, iso- lated bargaining unit. The record as to NFCC pre- sents a picture lacking somewhat in clarity and detail. The physicians there may have a separate community of interests that is at least as significant as any community of interests they share with other Medical Center physicians. However, like the CHCC doctors, they appear to be subject to the Medical Center's uniform labor and salary policies and, in the absence of anything persuasively negat- ing their shared community of interests, are, as the Petitioner urges, appropriately includable in a mul- tilocation unit of Medical Center doctors.26 Like the relationship between the West Campus and the satellite facilities, the relationship between the West Campus and the East Campus has ele- ments which pull both ways insofar as separateness " Cf. City Electric. Inc, 225 NLRB 325 (1976); Cardinal Timothy Man- nin& Roman Catholic Archbiop of the Archdiocese of Los Angele. a Car- poration Sol aet aL, 223 NLRB 1218, 1221 (1976); Kaiser Foundation Health Plea of Oregon, 225 NLRB 409 (1976). In Kaiser, a majority of the Board held that under the facts presented there, somewhat similar to those in the instant case, the outpatient mental health clinic did not con- stitute an appropriate unit separate from the employer's other facilities. While Members Fanning and Jenkins dissented in that case and would have found the petitioned-for separate unit appropriate, they did not find an overall unit inappropriate there and similarly do not in the instant cae. or integration of bargaining is indicated. Only here the question is not whether an integrated unit is ap- propriate but whether a unit excluding the East Campus, as the Petitioner seeks as its first choice, is inappropriate. Notwithstanding that there could be more than one appropriate unit, we find that the Petitioner's primary requested unit is inappropriate. As the Petitioner concedes, there is a sufficiently shared community of interests between the doctors on the two campuses to make an overall unit an appropriate unit, and we need not dwell on each of the factors justifying such a finding.2 7 Rather, we shall focus on the sufficiency of the factors favor- ing exclusion of the East Campus. The entire set of relationships is so multifaceted, however, that none of these factors can be evaluated singly; only by analyzing them within the framework of the total degree of interconnection among the Medical Cen- ter's facilities can the solution emerge. Thus, a moderate geographical separation of ap- proximately 4 miles, with an estimated driving time of 15-20 minutes, is, at first blush, a factor of some importance favoring separation. However, a shuttle service is provided, indicating at least the opportu- nity for convenient temporary interchange on a very short-term basis. The evidence of actual inter- change among the doctors defies generalization. There is a moderate amount of temporary inter- change-professional obligations on both campus- es-among doctors in the unified departments, as opposed to those in the nonunified departments, whose visits to the opposite campus are, on the average, much less frequent. However, even within the unified departments, notably in surgery, for which department the record is most complete, there is a great deal of variation among the doctors with respect to time-splitting between campuses, and somewhat less than half of the surgeons appear to have regular intercampus duties. In some of the unified departments regular meetings and other ac- tivities such as grand (i.e., conference or teaching) rounds include doctors from both campuses. In summary, interchange, while far from being a uni- form condition of employment, is a factor which affects a substantial number of the doctors. The existence of unified and nonunified depart- ments injects a complicating factor for, despite the centralization of authority with respect to overall administration of the Medical Center, including labor relations, to some degree the day-to-day policy is only departmentwide. Part of this policy "t They include, in varying degrees of persuasivenes, the presumptive appropriateness of an overall unit, centralized administration including labor-related matters, similarity of skills, employerwide bargaining history for other employees, and interchange as discussed below. See Mercy Has- pita/s of Sacramenta Inc, 217 NLRB 765 (1975). 574 MONTEFIORE HOSPITAL AND MEDICAL CENTER might be considered purely a matter of professional import. Yet, another part occupies ground near the border where professional and employee interests meet, and the degree of uniformity or nonunifor- mity as between the campuses has some signifi- cance. Here, because we treat the issue of whether all the West Campus doctors have a sufficient sepa- rate community of interest, the fact that a substan- tial number of them belong to unified departments in which day-to-day policy is predominantly inter- campus in scope diminishes the separateness of in- terests. Taking the record as a whole, it would be diffi- cult to say that the West Campus doctors have a closer community of interests with the doctors at satellite clinics CHCC and NFCC than they do with the East Campus doctors. The opposite seems more likely to be the case. Thus, the interests of the West Campus doctors and the satellite doctors are not "sufficiently distinct from those of other employees to warrant the establishment of a sepa- rate unit." Newton-Wellesley Hospital, 250 NLRB 409, 411 (1980).28 Such a unit configuration, en- compassing a selective combination of facilities, is, in this instance, inappropriate. Cf. Norrwock Shoe, Division of Scoa Industries, Inc., 209 NLRB 843 (1974); Marriott In-Flite Services, a Division of Mar- riott Corporation, 192 NLRB 379, 380 (1971). We find that the only appropriate unit encompassing more than one facility is one that includes all the facilities either party would include. That unit con- sists of the West and East Campuses, CFCC, and NFCC. Composition of Unit The Petitioner seeks to include, in any unit found appropriate in Case 2-RC-18594, all doctors em- ployed half time or more at facilities within the unit. Full-time employment ranges upward from 40 hours per week. The Medical Center would in- clude all doctors who are employed 19 hours or more per week. There is no evidence of the number of doctors, if any, who work at least 19 hours but less than half time. In any event, there is no basis in the record for a finding that any such doctors have a sufficient community of interest sep- arate from the doctors employed half time or more as to warrant their exclusion. Cf. Mount Sinai Hos- pital, 233 NLRB 507 (1977).29 Accordingly, we " See also Yak University, 184 NLRB 860, 862 (1970); Cornell Universi- ty, 183 NLRB 329, 335-336 (1970). " On the other hand, nothing in the record indicates that the parties' agreement to exclude doctors employed fewer hours per week violates any express statutory provisions nor established Board policies, and we shall not override that agreement on "community of interest" grounds. See White Cloud Products Inc, 214 NLRB 516 (1974). shall include all doctors employed 19 hours or more per week. Rikers Island Health Service Rikers Island, located between the boroughs of Bronx and Queens in New York City, is the site of a number of the city's correctional institutions. To provide medical services for the approximately 5,000 inmates of these institutions, the city con- tracts with the Medical Center for the operation of the Rikers Island Health Service (herein the Serv- ice). The Service provides routine physical exami- nations to every admittee, a sick call clinic similar to those provided in the military service, several specialty clinics, an alcohol and drug detoxification program, and 24-hour emergency care. The Serv- ice is staffed, inter alia, by Medical Center employ- ees, including physicians, so and is administered by an administrator and a medical director, both Medical Center employees. The medical director determines, within the budget limitations imposed by the contract, the number of physicians to be employed. He hires them, determines their starting salary and merit increases, evaluates them, and han- dles their grievances. The full-time physicians re- ceive fringe benefits, including vacations, similar to those received by other Medical Center physicians. There is no bargaining history for the Service phy- sicians, but registered nurses, LPNs, and other technical and clerical employees of the Service have been represented for a number of years by labor organizations which bargain with the Medi- cal Center over their terms and conditions of em- ployment. 3 1 We need not pause long over the Medical Cen- ter's contention that the Service shares the political subdivision exemption of the city of New York pursuant to Section 2(2) of the Act. In spite of cer- tain limitations imposed by the city, it is apparent, both from the authority exercised by the medical director and the history of bargaining with respect to other employees, that the Medical Center retains sufficient control over the terms and conditions of employment of those employed at the Service to be capable of effective bargaining. Therefore, we shall assert jurisdiction over the Medical Center's oper- ation at the Service. See National Transportation Service, Inc., 240 NLRB 565 (1979).32 "There are no dentists at this facility. " In Montefiore Hospial and Medical Center, Case 2-RC-18512 (1980) (unreported in Board volumes), the Board certified the New York State Nurses Association as the representative of the registered nurses em- ployed at the Service. " In agreeing to assert jurisdiction over the Medical Center's oper- ations at Rikers Island, Chairman van de Water does not rely on the tionale or conclusions reached in National Transportation Servrie Inc. Continued 575 DECISIONS OF NATIONAL LABOR RELATIONS BOARD The parties agree that any bargaining unit of the Service physicians should be separate from the unit in Case 2-RC-18594, which we have found above to encompass a multilocation grouping. The ques- tion that remains, therefore, is the composition of the Service unit. The parties differ on whether cer- tain physicians should be included as regular part- time employees. There are approximately 12 full- time physicians, paid on a salary basis and receiv- ing the full range of fringe benefits, and one part- time physician receiving salary and benefits on a pro rata basis. Neither party questions their inclu- sion. The Petitioner would also include, and the Medical Center would exclude, approximately 30 other physicians who regularly work weekly shifts of either 16 or 8 hours, performing physical exami- nations and providing emergency care during hours when the sick call facility and the specialty clinics are closed. 33 These part-time physicians, who typi- cally work elsewhere as hospital residents, are paid on an hourly basis and receive no fringe benefits. The Medical Center's contention that these part- time physicians should be excluded is based on their possession of a separate community of interest because they are hourly paid, receive no fringe benefits, have no contact with the full-time physi- cians, and hold other full-time jobs. In other cir- cumstances, these facts might support a finding of a sufficient separate community of interests to war- rant separate representation should a labor organi- zation seek to represent them separately. Even then, we would have to be mindful of the legisla- supra. He notes the prior bargaining history for registered nurses, LPNs, and technical and clerical employees for a number of years by labor or- ganizations and that the medical services performed here are more sus- ceptible to a subcontracting than more essential city services like fire and police. s There is, further, an additional group of physicians employed at the Service with less regularity. The parties agree that they are casual em- ployees and should be excluded. tive concern over proliferation of bargaining units in the health care industry. In any event, the facts on which the Medical Center relies do not negate the common community of interests these regular part-time employees share with their professional colleagues.3 4 Accordingly, we find that a unit of all full-time and regular part-time physicians employed by the Medical Center at the Rikers Island Health Service is an appropriate unit. We therefore find the following units appropriate for the purposes of collective bargaining within the meaning of Section 9(b) of the Act: In Case 2-RC-18594:35 All physicians and dentists regularly employed 19 hours or more per week by the Employer on its West and East Campuses in the Borough of the Bronx, New York, New York, and at the Comprehen- sive Health Care Center, 230 East 102nd Street, New York, New York, and the Neigh- borhood Family Care Center, 168th Street and Gerard Avenue, Bronx, New York, excluding guards and supervisors as defined in the Act. In Case 2-RC-18629: All regular full-time and part-time physicians employed by the Em- ployer at the Rikers Island Health Service, Rikers Island, New York, New York, exclud- ing guards and supervisors as defined in the Act. [Direction of Elections and Excelsior footnote omitted from publication.] 34 Although they do not work with the full-time physicians, and in some cases work in different buildings, they work alongside the same corps of nurses with which the full-time doctors work and which is rep- resented on a Service-wide basis. S' As the unit found appropriate herein is larger than the unit request- ed, the Petitioner is accorded a period of 10 days in which to submit the requisite showing of interest to support an election herein. 576