Presbysterian/St. Luke'S Medical Center

PRESBYTERIAN/ST. LUKE'S MEDICAL CENTER Presbyterian/St. Luke's Medical Center and St. Luke's Federation of Nurses and Health Profes- sionals AFT, CFT, AFL-CIO, Petitioner. Case 27-RC-5935 June 20, 1988 DECISION ON REVIEW BY CHAIRMAN STEPHENS AND MEMBERS JOHANSEN AND BABSON On December 11, 1979, the Regional Director for Region 27 issued a Decision and Direction of Election in this proceeding. He found appropriate for collective bargaining the petitioned-for unit of registered nurses employed by the Employer at St. Luke's Hospital in Denver, Colorado. The Hospital is one of three facilities that comprise the Presbyterian/St. Luke's Medical Center. In accord- ance with Section 102.67 of the National Labor Relations Board Rules and Regulations, the Em- ployer filed a timely request for review. The Em- ployer contended that the smallest appropriate unit was an all-professional unit, which included the employees at all three of its Denver-area hospitals, i.e., St. Luke's, Presbyterian Hospital in Denver, and Presbyterian Hospital in Aurora. By telegraph- ic order dated January 8, 1980, the Board denied the Employer's request for review. An election was held, and the Petitioner was cer- tified as the exclusive bargaining representative for the Employer's registered nurses at the St. Luke's facility on February 24, 1980.' Following the Em- ployer's refusal to bargain, the Board found that the Employer had violated Section 8(a)(1) and (5) of the Act, and issued a bargaining order.2 On July 8, 1981, the United States Court of Appeals for the Tenth Circuit denied enforcement of the Board's Order and remanded the case to the Board for fur- ther consideration.3 On October 9, 1981, the Board accepted the court's decision as the law of the case. i An Intervenor on the ballot was the Colorado Nurses' Association, affiliate of the American Nurses' Association The Intervenor has indicat- ed that it would not participate in an election in an overall professional unit 2 Not reported in bound volumes of Board decisions. S Specifically, the court held that the Board's application of the tradi- tional presumption favoring single facility units failed to consider Con- gress' directive against unit proliferation in the health care industry The court, therefore, held that in making unit scope determinations in the health care industry, the factors that the Board traditionally considers must be balanced against the public interest in preventing fragmentation In this regard, the court directed the Board to specify the manner in which its unit determination implements or reflects Congress' admonition that due consideration be given to preventing proliferation Presby- terian /St. Luke's Medical Center v NLRB, 653 F 2d 450, 455 (10th Cir 1981) Further, the court found sufficient evidence to sustain the appro- priateness of an all professional unit, focusing on the disparity of interests between employee groups which would prohibit or impede fair represen- tation of the employees' interests Id at 456 249 On August 24, 1984, the Board remanded the case to the Regional Director for further consider- ation consistent with its decision in St. Francis Hos- pital, 271 NLRB 948 (1984) (St. Francis II). Pursu- ant to the remand, and after a hearing at which fur- ther evidence was taken, the Regional Director issued a Second Decision and Direction of Election on June 26, 1985. He found that an overall profes- sional unit was the smallest appropriate unit. The unit included all professional employees (except physicians) at all three of the Employer's facilities. The Petitioner requested review of the decision re- garding both issues, and the Board granted review on August 27, 1985. The National Labor Relations Board has delegat- ed its authority in this proceeding to a three- member panel. The Board has considered the entire record in this case, including the Employer's brief on review, and has decided to affirm the Regional Director's determinations regarding the issues of unit scope and unit composition for the reasons stated in this decision. In 1979, St. Luke's Hospital Association, which operated St. Luke's Hospital, and the Presbyterian Medical Center, which operated Presbyterian Hos- pital in Denver and Presbyterian Hospital in Aurora, merged and became Presbyterian/St. Luke's Medical Center. Presbyterian Hospital is lo- cated 10 blocks from St. Luke's in Denver. Presby- terian Hospital in Aurora, an acute-care institution, is located about 12 miles from Denver. In his Second Decision and Direction of Elec- tion, the Regional Director found that since the merger, a number of centralized policies have been implemented and others strengthened. A single board of directors was established with representa- tives from the former boards of both of the merged companies. Corporate offices are located in a sepa- rate building. Corporate officers include three vice presidents and an administrator for each hospital, who report to the president of the Medical Center. The corporate officers are responsible for the over- all centralized management of the three facilities, including a centralized accounting system, budget- ing and staffing decisions for each hospital, pur- chasing and distribution of supplies, and employee educational programs. The hospital administrators have no authority to change corporate policies or to deviate from determinations regarding wages, benefits, and staffing. The Medical Center is surveyed, reviewed, and accredited as a single entity by the Joint Commis- sion on Accreditation of Hospitals. The record shows that the three "campuses" are functionally integrated. The staff physicians have admitting 289 NLRB No. 30 250 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD privileges at all three facilities, and it is a common procedure for patients to be transferred among the hospitals for specialized care not available at the admitting hospital. The Employer's human resources department is responsible for all the standardized personnel poli- cies, including a systemwide employee handbook and a supervisor's manual; wage rates and fringe benefits; and disciplinary and grievance procedures. The Employer has uniform qualifications and hiring standards for jobs. Job openings are posted systemwide and seniority is accrued systemwide. A significant number of transfers have occurred since the merger, and employees of one facility have hiring preference at the other two facilities. We note, however, that the hiring of registered nurses continues to be done at each facility, and that the newspaper advertisements for Presbyterian Medical Center designate which campus or campuses have openings. The record shows that all applicants for profes- sional positions submit identical job applications, have the same orientation course, are subject to the same disciplinary procedure, and have the same grievance program. In addition, all professional employees have identical benefits, including extra vacation days and continuing education days, which are not extended to the nonprofessional em- ployees. The professional employees, including the registered nurses, are among the Employer's high- est paid employees (the majority of these employ- ees are in grades 13-17, and the nurse anesthetists and pharmacists are in grade 22). The registered nurses are the largest group of professional employees and they work 24 hours a day, 7 days a week. The record shows that a number of other professionals, e.g., pharmacists, di- eticians, and respiratory therapists, also work the same schedule. All the Employer's professional em- ployees have specialized skills, training, and educa- tion which require post-secondary education. Their common educational background (in certain courses of study) provides for some overlap in qualifications, skills, and duties with the other pro- fessionals. The record also shows frequent contact among the registered nurses and other professional em- ployees. The pharmacists (who also have areas of specialization) participate in inservice education programs, have frequent contact with the nurses regarding medication dosages, and may work at permanent pharmacy units which are being set up on the nursing floors (in addition to the central pharmacy facility). The social workers and clinical dieticians spend over half of their time in the pa- tient care units coordinating patient care with the nurses. Further, the Employer's team approach to health care includes a procedure that necessitates daily contact and substantial sharing of informa- tion, in addition to "committee" planning by groups of professionals for total patient care. Regarding contact between the facilities, the Medical Center has a wide variety of specializa- tion, but not all specialities are available at each fa- cility. Therefore, nursing specialists may "float," or perform work at one of the other facilities. Clinical specialists in the Employer's education division work at all three facilities, as do the inservice edu- cators. There is evidence that a few nurses work at two facilities on a regular basis; that nurses who perform the same job may cover at another hospi- tal for a vacationing nurse; and that on low patient- census days, the registered nurses are given the option of taking the day as a cost-containment day without pay, or of working in one of the other fa- cilities, if needed. The Regional Director concluded that the degree of integration shown among the three facili- ties is sufficient to negate both the separate identity of the St. Luke's facility and the appropriateness of a unit limited to St. Luke's employees. Further, he concluded that all the professional employees share a community of interest because they have common concerns and are subject to common poli- cies. Thus, applying the standard set forth in St. Francis Hospital, supra, he found there are no "sharper than usual differences" between the regis- tered nurses and the Employer's other professional employees, and that the smallest appropriate unit must include all the Employer's professional em- ployees. With respect to his conclusion that the smallest appropriate unit must include all three of the Em- ployer's facilities, the Regional Director found that the three facilities are located in close proximity; the administration and management are centralized; all personnel and labor relations policies, wages, and benefits are uniform; there is contact and inter- change among the facilities as certain nurses and professional employees may "float" among the three, and may cover for one another on the same job at another facility; and jobs are posted and se- niority is honored systemwide.4 Applying the 10th Circuit's decision as the law of the case, we agree with the Regional Director's conclusion that, based on these facts, the multifacility unit is the appropri- 4 We note that prior to the 1979 merger, the Board directed an elec- tion in a two-facility unit of registered nurses at Presbyterian's Denver and Aurora facilities See Presbyterian Medical Center, 218 NLRB 1266 (1975) PRESBYTERIAN/ST. LUKE'S MEDICAL CENTER 251 ate bargaining unit in which the election should be in St. Francis II and mandated by outstanding held.5 precedents to the facts set forth above, the smallest We also agree with the Regional Director that appropriate unit must include all the Employer's applying the disparity-of-interests standard set forth professional employees. S In making this determination , we have not applied the presumption favoring single facility units in the instant case because of the strictures of the Tenth Circuit's remand We note, however, that the Board recently reaffirmed the validity of the presumptive appropriateness of a single fa- cility unit in the health care industry in Manor Healthcare Corp, 285 NLRB 224 (1987), a policy to which we adhere In Manor, the Board found that a consideration of the congressional policy against prolifera- tion in this field does not warrant a health care industry exception to the single facility presumption . Rather, the Board stated that the concern against undue proliferation could best be accommodated by retaining the single facility presumption, and "allowing the party opposing such a unit to rebut the presumption by a showing of circumstances that militate against its appropriateness, including an increased risk of work disruption or other adverse consequences . " 285 NLRB supra at 225. We be- lieve this approach accords with, and is not inherently inconsistent with, the Tenth Circuit's direction that traditional factors be balanced against the public interest in preventing fragmentation Ibid. Accordingly, we shall remand this proceeding to the Regional Director in order that he may con- duct the election pursuant to his Direction of Elec- tion, issued June 26, 1985, except that the payroll period for determining eligibility shall be that ending immediately before the date of issuance of this Decision on Review. 6 St. Vincent Hospital, 285 NLRB 311 (1987) See also North Arundel Hospital Assn., 279 NLRB 311 (1986), Keokuk Area Hospital, 278 NLRB 242 (1986) As noted in St Vincent, the Board currently is engaged in the process of rulemaking, which is anticipated to reduce the need for lengthy and costly case-by-case adjudication of bargaining unit issues in the health care field, however, the Board is continuing to process cases under existing law until the final rule has been issued