Fighting City Hall: The People's Medicine in Action (cont'd.)
Some histories of house staff activism in the 1960s and 70s suggest that "bread-and-butter" trade union issues of wages and hours were paramount for residents, with improved patient care the justification for their organizing efforts but not an end in itself. Petit denies that this was the case in Worcester:
There was an attitude that City Hospital was worth saving as well … We had a couple of health clinics in the city of Worcester in 1977 or 1978 or whatever, where we attempted to talk to people about the importance of patient care and the importance of the hospital, and gave free medical care at one of the schools, I think maybe [at] Woodland Street School we set up an all-day workshop where people could come and have their blood tested and all kinds of things. It was interns and residents that were involved in doing this. And we reached out to various groups. [With] the Hispanic community, we talked to them very seriously and stuff, and I remember they wrote letters to the City Manager articulating their support for the house staff association and what they were trying to do. So it wasn't a group of people who were just trying to do something for their own self-interest. There was a lot of effort on their part to expand out the nature of the effort and get the community involved as well.(93)
With this additional context, we can now return to the events at Worcester City Hospital, which lasted from the summer of 1975 through the summer of 1978. In August, 1975, City Hospital residents led by second-year residents Dan Doyle, Bruce Kaler, and Len Finn (Family Medicine) and Diana DeCosimo (Internal Medicine), formed the WCH Physicians' Housestaff Association (PHA) to negotiate new contract terms with hospital Superintendent Murphy. Murphy appears to have been initially noncommittal, telling a reporter that, "I told them it was good, as long as it was effective and did not concern strictly wages." Although wages were clearly an issue (at the time residents at City earned about $11,000 per year), more important were the brutal on-call hours to which residents were subjected and which, they believed, jeopardized their ability to care for patients.(94)
A few months after that initial meeting, they began to document systematic deficiencies in patient care, staffing arrangements, and equipment at WCH. As they wrote in a letter to the senior medical staff in the fall of 1976, "Over the past nine months house officers at Worcester City Hospital have been attempting to document inadequacies in patient care through the use of incident reports. We have concentrated on correctable problems—those due to inadequate or insufficient equipment, facilities, or staff." In one report, composed on February 27, 1976 during the 11:00 PM to 7:00 AM shift, Dr. Doyle reported the following:
1 RN on 4-N alone w/ 31 patients, had help of 1 RN floated from Obstetrics for 3 hours. 2 patients on O2 [oxygen], 1 pt. on --- … Because of short staffing no pt had VS [vital signs] taken more than once.(95)
In a letter written by the House Staff Organization to City's Superintendent and senior medical staff in February 1976, at a time when the PHA was beginning to pursue collective bargaining rights, the residents reported more of what they had found:
grossly inaccurate lab values causing confusion and errors in patient management were reported, as were 8 incidents of lab tests ordered and being either not performed or performed too late to be of value. These lab shortcomings are so commonplace on a daily basis as to be almost taken for granted by the housestaff. Equipment malfunction is also a common problem…including the repeated breakdown of the machine for determining blood oxygen levels…
The respiratory therapy department … largely because of inadequate equipment or noncompetitive salaries [has very high turnover and thus is understaffed]. Nine incidents were documented in which IPPB treatments—breathing treatments of critical importance to many patients with severe lung and heart disease—could not be given as ordered because of short staffing.
In February 1976 the night shift staffing of each of the major medical and surgical floors (30 patients each) consisted of one registered nurse or one licensed practical nurse with assistance from one LPN, nurses' aide, or student nurse who was shared with another floor. We have documented 10 incidents of shortcomings in patient care—e.g. doctors' orders not being carried out—directly caused by inadequate staffing.
Electrocardiograph machines in particular have often been in short supply: in one instance no ECG machine was available for emergency use on the entire fourth floor for four days; in another instance, no ECG machine was available on 5-S during the first ten minutes of a cardiac arrest.(96)
Feeling that no response would be forthcoming from either the hospital administration or from City Hall, the PHA had already taken the first steps needed to become a certified bargaining unit. By January 1976, the PHA had ratified a constitution, established a set of goals, and voted to join the national organization, the PNHA, with Gene Petit designated its regional organizer in Worcester. In the following month they met with the senior physicians at the hospital as well as with Paul Murphy's immediate superior at City Hall, Demitrios Moschos. On March 1, 1976 they met with City Manager Francis McGrath to "request recognition for our organization as the exclusive collective bargaining representative for all house officers (interns, residents and fellows) of Worcester City Hospital." They hoped to begin negotiations immediately for the new contract year, which would begin on July 1.(97) According to a typewritten list of "MAJOR THINGS WE ARE FIGHTING FOR," besides asking for formal recognition as a bargaining unit, their demands included a maximum work week of eighty hours with "no house officer working more than 30 (thirty) hours straight, and improvement in working conditions such as "adequate" nursing and ancillary provider coverage, "readily available consultative services," and adequate facilities such as "30 minute emergency lab results," "EKG machines on every medical surgical floor," and weekly in-service training programs for all medical and nursing staff. Most of all, they insisted that, "WAGES ARE NOT A MAJOR ISSUE. WE EXPECT TO BE GIVEN THE SAME SALARY INCREASES AND BENEFITS AS OTHER CITY EMPLOYEES."(98)