Minnesota Attorney General Lori Swanson listening to Sanford executive testimony

Sanford Health has a lot of money and a lot of hospitals, but one more thing they’re bringing to Minnesota is scrutiny.  The nonprofit healthcare giant that runs facilities from Adrian to Wheaton now wants to add the Twin Cities to its corporate footprint, but Sanford executives got an earful of how their arrogance caused them to underestimate the height of the hurdles needed to takeover Fairview Health and the University of Minnesota Medical Center and research labs.

Minnesota Nurses have been talking about the short staffing situations in Bagley, Bemidji, Thief River Falls, and other facilities since Sanford took those over.  MNA President Linda Hamilton and Bemidji bargaining unit chair Peter Danielson were invited to give testimony.  Hamilton was asked to speak about the effects of the continued corporatization of healthcare through hospital takeovers.  She prepared a statement showing how local hospitals become funnels for corporate giants to send patients to their hospital headquarters out of state.  She also came ready to talk about the lack of investment in needed women’s care versus Sanford’s expansion into high-dollar facilities such as orthopaedics and cath centers.

Danielson was invited to speak as a nurse in a Sanford facility who has seen patient care decline due to cost-cutting.  He tells of how a nurse with a patient recovering from lung surgery, for example, should only receive one more patient assignment but at Sanford they can get five more.

The Attorney General’s inquiry into a possible Sanford takeover of Fairview reveals that the cruel cost-cutting nurses have experienced is only the proverbial tip of the iceberg.

Swanson started by indicating that her office had been investigating Sanford Health for months for, of all things, incomplete nonprofit paperwork.  Swanson said, when her office subpoenaed Sanford for 21 necessary inquiries to approve nonprofit status in Minnesota, Sanford failed to respond, and her office noted that Sanford only recently replied with one document of answers.

Before calling representatives of the three parties, Sanford, Fairview, and the U of M, Swanson established through healthcare and non-profit experts that a deal of this type would have to be extraordinarily analyzed to pass muster.

Brian Short, a consultant in non-profit governance, noted that non-profits do have shareholders because the taxpayer pays the taxes that non-profits don’t to help them with their mission.

Swanson thanks MNA President Linda Hamilton and Bemidji nurse Peter Danielson for agreeing to testify in the Sanford-Fairview merger

David Feinwachs, former attorney for the Minnesota Hospital Association, agreed that not only would this deal be like selling the county library to Barnes & Noble, but Sanford getting the U of M Medical Center sounds more like the library going to Wal-Mart.

Sanford executives clearly looked uncomfortable in their seats when their speakers, COO and Senior Vice-President Becky Nelson, and Senior Executive Vice-President David Link got grilled by Swanson.  Nelson told the Attorney General and her staff that Sanford and Fairview should be allowed to pursue these preliminary talks but then revealed that months of regular meetings between the two companies had been going on, which produced 10-15 “synergy” documents and cost analysis.

Sanford Vice-Presidents under cross-examination by Minnesota Attorney General

Nelson and Link both shrank from questions about Sanford’s many donations to sports teams and stadiums by calling them investments into youth physical fitness.

Then Sanford execs sounded unclear on the relationships between the non-profit Sanford Health systems and Sanford’s other, for profit companies.  It was revealed that Sanford Health still uses the Sanford-owned Premier Bank to process payments.  The hospital chain uses a debt-collection company called Rushmore Service Center, also a Sanford company.  The A-G also pressed the two vice-presidents on a new company, Sanford Applied Bioscience, a medical research company.  When Swanson pressed for who sits on the board of the for-profit laboratory, neither could answer.  When she asked Link again, he suddenly remembered that he was.

Sanford attorneys answering the Minnesota AG about why they haven’t responded to simple requests for license information

Nurses and patients in the standing-room only hearing room heard some news that would indicate that a Sanford-Fairview takeover is far from a done deal.  Fairview acting-CEO Chuck Mooty said that if the University of Minnesota is opposed to this deal, it won’t go through.  When Swanson asked him to clarify who would make that decision, Mooty indicated that U of M President Eric Kaler has the veto vote.  U of M General Counsel Mark Rotenberg also said that any deal would have to address the U’s missions of educating healthcare professionals and medical research.  Rotenberg also told the Attorney General that the U of M would not accept any alumni contributions to any sports teams or facilities that could show a conflict of interest during this inquiry.  That may have been in response to a recent newspaper story that Kaler was spotted in Augusta, Georgia, with T. Denny Sanford at the Master’s Golf Tournament.

Due to the length of the cross-examination of witnesses, two invited MNA witnesses didn’t get a chance to speak.  Swanson said Hamilton, Danielson and other witnesses will take the stand at the second public hearing over Sanford and Fairview on April 21.

NOTES ON NURSING

Better Staffing Would Help  Hospitals Fail to Take Simple Measures to Thwart Deadly Infections    The culprit is a strain of a spore-forming bacterium known as Clostridium difficile, or C. diff—in particular, a relatively recent strain that has grown more virulent and resistant to drugs.

LABOR UPDATES

Twin Cities Metro Plumbers Devote a Day of Service to Help Those in Need   It’s a chance to help Minnesotans who might not otherwise be able turn to a professional plumber, and to reduce wasted expenses going down the drain.

CEO Percs Flying High    Dodd-Frank rules? Securities and Exchange Commission lawyers? Leave them behind. And let yourself sink into the buttery leather seat of your corporate jet as it soars through the clouds.

HEALTH CARE

Swanson Grills Sanford Execs on Fairview Merger; MNA Leaders Testify    The merger proposal that could give Sanford Health control of the University of Minnesota Medical Center also has focused attention on the U’s relationship with Denny Sanford, an alum who is a major benefactor of U athletics.

MN Safety Net Hospitals Changing the Rules of the Game to Help Underprivileged   Under the Minnesota experiment, “those at a higher risk now have a care team who works with each patient, to keep them out of the emergency room,” said Peggy Metzer, CEO of People’s Center Health Services.

Nevada Discharging Mental Health Patients with Bus Tickets to Other States   Preliminary reports suggest that Nevada has made a habit of discharging mental patients by bus to other states. Rawson-Neal, the state’s primary hospital for mentally ill people, bused about 100 state psychiatric patients to California between July 1, 2012, and the end of February, and scores more to other states, according to data provided by Nevada health authorities.

Standards of Care Update

MNA nurses and representatives continue to meet with legislators to update them on the goals of the Standards of Care Act.  MNA is proposing that hospitals be required to report their staffing plans and actual nurse hours per patient day, and a Department of Health study of hospital staffing and its effect on nursing sensitive indicators like infections, falls and pressure ulcers.  We are confident that a MDH study will validate what nurses already know–that proper nurse staffing leads to better nurse outcomes–but we also recognize the need for Minnesota-specific data.  Our main objective for the remainder of the 2013 legislative session is to ensure that a comprehensive and accurate study is completed.  Ultimately, our goal is safe staffing in every facility, on every unit and during every shift.

We still differ significantly from the hospitals on this bill. So it continues to be very important for nurses to contact our legislators to ask them to support a comprehensive and accurate study.

Contact your state legislators and ask them to support strong consumer transparency language, nurse staffing reporting and a comprehensive study that gathers real data about the correlation between staffing and health outcomes. Let them know unsafe staffing is still a problem for Minnesota patients and we need meaningful data-collection to protect patients.

Click here to use the MNA Grassroots Action Center to send an email.

Possible Sanford/Fairview Merger

Attorney General Lori Swanson is holding a public hearing this Sunday, April 7 at 1:30 pm to shed light on the possible merger of Fairview Health Services and South Dakota-based Sanford Health. This merger would further the trend of the corporatization of healthcare in Minnesota, where profits and productivity are a higher priority than patient care. Please support the Attorney General’s effort to hold these two health care corporations accountable to the taxpayers of Minnesota. RSVP to geri.katz@mnnurses.org.  

WHAT:                 Attorney General Lori Swanson’s public hearing on possible Sanford-Fairview merger
WHEN:                 Sunday, April 7, 1:30pm
WHERE:               Room 15, State Capitol, 75 Rev. Dr. Martin Luther King Jr. Blvd, St. Paul, MN 55155
DIRECTIONS/PARKING INFO: Click here

Meanwhile, the news broke yesterday that the University of Minnesota is also interested in taking over the entire Fairview system. Read the Star Tribune article here.

We are glad to see some competition for this important health care system, and we are looking forward to learning more details about both proposals. Our ultimate concern is that whatever happens, patient care and safety be the first priority of any change to Fairview.

Governor’s Budget
The Governor’s Health and Human Services budget proposal was heard in the legislature this week. The Governor proposes to increase Health and Human Services spending by $170 million, after many years of cuts to services for the elderly, disabled and vulnerable. His proposal would provide access to health care for 145,000 uninsured low-income Minnesotans, invest in school-based mental health services for our children, and reform and streamline the delivery of health care services in Minnesota.

MNA continues to support the Governor’s commitment to progressive taxation and investment in key state priorities.

Mayo “Destination Medical Center” Proposal
MNA has joined other unions to raise questions about Mayo’s request for over half a billion dollars from the state for their “Destination Medical Center” expansion project in Rochester.

We are concerned this plan lacks transparency and leaves too many questions unanswered about patient care, jobs and the impact of the project on the community. For the state to consider such a major investment in a private entity, we believe these questions must be answered first. Read more here.

Willmar State Mental Health Facility
Both the Governor’s supplemental budget and legislation proposed by Willmar lawmakers Sen. Lyle Koenen and Rep. Mary Sawatzky propose keeping the 16-bed state mental health facility in Willmar open. This facility has been slated for closure in past years, so we welcome these proposals and remain dedicated to keeping this important mental health facility open.

Legislator Town Hall Meetings

MNA nurses Cassie Hamilton, Pat Webster and Mary Turner speak up about patient safety at a town hall meeting with Sen. Alice Johnson, Sen. John Hoffman and Rep. Jerry Newton in Coon Rapids on Thursday.

Governor Dayton and many legislators will be holding public meetings this spring to discuss the state budget and hear constituents’ concerns. These meetings are a great opportunity to meet your elected officials close to home, build a relationship with them, and educate them about nursing issues. Please attend a town hall meeting if one is coming up in your district:

Saturday, April 6

Senator Ann Rest
9:30-10:30 am
Robbinsdale City Hall, 4100 Lakeview Avenue North, ROBBINSDALE

Senator Lyle Koenen and Representative Mary Sawatzky
8:30-10:00am – Coffee and conversation
Sunberg Creamery Café, 403 Central Avenue, SUNBURG

Representative Shannon Savick
9:00-11:00am – coffee and conversation
The Bakery, Retail Room, 345 E. Main St., BLOOMING PRAIRIE

Representative John Persell
10:00am-12:00pm – Coffee and conversation
Common Ground Coffee, 1428 Hwy 5, LONGVILLE

Representative Barb Yarusso
10:00am-12:00pm
Mounds View Public Library Meeting Room, 2576 County Road 10, MOUNDS VIEW

Representative Paul Marquart and Senator Kent Eken
10:00-11:00am
Minnesota State Community and Technical College, 1900 28^th Ave S, MOORHEAD

Representative Ben Lien
10:00-11:00am
M State Technical School, MOORHEAD

Senator Rod Skoe, Senator Tom Saxhaug and Representative John Persell 1:00 – 2:30pm
Bemidji City Hall, 317 4th Street NW, BEMIDJI

Tuesday, April 9

Governor Mark Dayton, Meetings with Mark town hall tour
6:00-7:30 pm
Conference Hall/ Auditorium at South Central Community and Technical College 1920 Lee Blvd, NORTH MANKATO

Saturday, April 13

Representative Zach Dorholt
9:00-11:00am
Whitney Senior Center, 1527 Northway Dr., ST. CLOUD

Representative Shannon Savick
9:00-11:00am – Coffee and conversation
Prairie Wind coffee, 211 S. Broadway, ALBERT LEA

Representative Mary Sawatzky
9:00-11:00am – Coffee and conversation
Lulu Bean’s, Small downstairs meeting room, 1020 1^st St. S, WILLMAR

Tuesday, April 16

Governor Mark Dayton, Meetings with Mark town hall tour
6:00-7:30 pm Commons Area of Mesabi Range Community and Technical College 1001 West Chestnut Street, VIRGINIA

Click window link to view story

KSTP-TV reports the final audit confirms what Minnesota Nurses have long argued-that the healthcare system in the state is need of greater transparency and some of Minnesota’s HMOs owe the taxpayers a refund.

“When taxpayer dollars for patient care are so scarce,” said MNA President Linda Hamilton, “it’s unconscionable that even one penny could be wasted when it could’ve gone to treat somebody’s mother or grandmother.  Instead it’s padding somebody’s bank account somewhere.”

An independent auditor, the Segal Company, reveals in a report issued March 31 the government overpaid the four insurance companies that run the state’s Medicaid program by $207 million.  They say the amount owed is “concerning,” and they question the length of time HMOs were overpaid.   From 2003 to 2011, HMOs were able to run even double-digit profits on Medicaid programs and pocket millions of dollars into their own “reserve” accounts that were many times over what’s considered the minimum.

MNA President Linda Hamilton told KSTP-TV in 2010 that it’s a “disgusting” show of how taxpayer dollars can be used compared to how it could’ve been utilized to care for patients.  The reason behind this is the industry’s lobbying of the state of Minnesota to avoid transparency, battle back against public reporting, and to remove caps on how much they can collect to manage public programs.

Link to KSTP-TV story: http://kstp.com/news/stories/S2982096.shtml?cat=127

More background on the HMO overpayments story:

http://mnablog.com/2012/04/24/mna-rns-and-the-nearly-4-billion-question/

LABOR UPDATES

Harry Kelber:   1914 – 2013     Harry Kelber spent 80 years as a labor activist. Through it all he championed worker ownership of their unions. When Labor Notes commissioned a roundtable on “organizing the unorganized” in 2007, Harry’s contribution argued that rank-and-file workers should be part of organizing drives.

HEALTH CARE 

Did Hospitals Profit Off Drugs Meant for the Poor?   An inquiry by a U.S. senator has found that three nonprofit hospitals in North Carolina have made millions from a discount drug program intended to help the poor and uninsured.

Mortality Rates at Critical Access Hospitals Racheting Higher    The nation’s critical access hospitals have higher mortality rates on several key measures than do urban and rural hospitals without the specia l designation, and the trend steadily worsened over the past eight years, according to a new study by Harvard researchers.

CMS Reverses Course   The insurance industry chalked up one of its greatest political victories in recent memory on Monday as the Obama administration reversed course on a proposal to cut Medicare Advantage rates. After intense lobbying, the agency said Monday that it would change the proposed 2.3 percent cut to those plans to a 3.3 percent boost. That’s a significant swing worth billions of dollars to the industry next year alone.

Departing Wellpoint CEO’s Compensation Ballooned to $20.6M Last year, as Insurer’s Shares Fell   The compensation paid to outgoing Wellpoint Inc. CEO Angela Braly last year rose 56 percent, even as the company’s shares slid on lower enrollment in its Blue Cross Blue Shield health plans.

NOTES ON NURSING

Fatigue is Pervasive in the Health Care Industry; Directly Linked to On-the-job Errors     Sixty-nine percent of healthcare professionals surveyed said that fatigue had caused them to feel concern over their ability to perform during work hours. Even more alarmingly, nearly 65 percent of participants reported they had almost made an error at work because of fatigue and more than 27 percent acknowledged that they had actually made an error resulting from fatigue.

PA Considers Nursing by the Numbers   A pair of Democratic state lawmakers have introduced bills in both the House and Senate that would mandate a minimum number of registered nurses-to-patient ratio at all hospitals in the state. The concept has been embraced by nursing unions but is not being warmly received by hospitals and related organizations.

HEALTH CARE

Overpayment for Minnesota Medicaid Raises Serious Concerns     David Feinwachs, the health care insider who blew the whistle on Medicaid spending, tells 5 EYEWITNESS NEWS it is “time the government goes after the excess profits” from the four insurance companies that run the state’s Medicaid program.

Is Sanford Deal in Minnesota’s Best Interests?  But if a merger between South Dakota-based Sanford Health and Twin Cities-based Fairview Health Services, which owns and operates the U’s teaching hospital as well as other major metro hospitals, is a serious possibility, Minnesotans deserve to be informed and to weigh in.  Note:  Attorney General Lori Swanson has scheduled a Public Hearing for Thurs. April 7, at 1:30 p.m. in Room 15 of the State Capitol.  More details here.

Access to Medicaid Reduces Mortality Rates   Research shows a strong connection between mortality rates and insurance status: The uninsured are more likely to have poor health and higher mortality rates than those with insurance.

LABOR UPDATES

New Study Finds Record Level of Disengaged Workers   The working stiffs, whose productivity skyrocketed as wages stagnated in recent years, aren’t buying management’s shtick.

Nurses support Attorney General Review of Sanford-Fairveiw

(St. Paul) – March 28, 2013 – The Minnesota Nurses Association welcomes Minnesota Attorney General Lori Swanson’s inquiry into the possible merger of Sanford Health and Fairview Health Services and the continued corporatization of healthcare in Minnesota.  Investigators need to continue to look into the effects that big corporations are having on Minnesota patients.

“We congratulate Lori Swanson for having the courage to examine any deal that further puts the operation of more Minnesota hospitals into the hands of fewer corporations,” said Walt Frederickson, RN, MNA Executive Director.  “It’s time to hit the brakes on hospital mergers until we can determine what’s best for the state and especially its patients.”

Sanford and Fairview are reportedly in talks to merge, which would put the Fairview-run University of Minnesota Medical Center and the state research hospital under the control of a South Dakota company.  Fairview’s Board of Directors will reportedly discuss the merger at a retreat starting April 8, 2013.

“Considering it took more than a year to accept Fairview’s acquisition of the University hospital,” Frederickson said, “it’s entirely appropriate and necessary for the A-G’s office to start public hearings on April 7.  If this deal gets fast-tracked, it will be the people and patients of Minnesota who may be met with an unhappy surprise.”

As nurses previously warned during the Park Nicollet-HealthPartners merger, one size does not fit all, and any deal that impacts patients deserves close scrutiny.   Especially when a deal involves tax dollars and a non-profit/for-profit relationship, then that deal deserves a microscope.

Nurses have long warned that focus on the bottom-line has cost them patient care hours and impacted patient outcomes.  The concerns that hospital care had turned to a production-line process led 12,000 union nurses to walk off the job for a day in 2010.  Today those fears continue to materialize.  If such simple costs as staffing are cut to meet the demands of a spreadsheet, then the investment of research and medical training will be subject to the same cost-benefit analysis.  What’s different here is the investment in Minnesota’s medical professionals pays off by the decade, not the fiscal year, as more than 70 percent of doctors in the state are trained here and Minnesota continues to employ tens of thousands of other medical device and health care workers.

“The state and the citizens of Minnesota have faithfully invested into the research and education at the University of Minnesota,” Frederickson said, “and we believe these resources need to stay in the control of Minnesotans.  Nurses will continue to monitor and assist in the process in any way we can.”

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NOTES ON NURSING

RN Grad Student:  “The $4450 Urgent Care Visit     “This was one patient on one day in one healthcare facility incurring every form of systemic waste Fineberg puts forth in his article and is also illustrated by Stephen Brill’s lengthy account of overcharging, particularly those who are uninsured or underinsured.”

HEALTH CARE

Fairview-Sanford Merger Talks Bring Scrutiny   Fairview Health Services, the Twin Cities’ second-largest hospital and clinic group, is weighing a merger with South Dakota-based Sanford Health in negotiations that have triggered concerns on the part of Minnesota Attorney General Lori Swanson.  Editor’s Note:  Nurses, consider adding your thoughts about this merger in the article’s Comment Section.    Related:  Attorney General Swanson to hold April 7 public hearing regarding Fairview/Sanford Health. Full Story.  Click Here for letter announcing hearing.

State Lax in Overseeing MinnesotaCare Eligibility   Minnesota has failed to properly vet people enrolling in a $550 million taxpayer-subsidized health insurance program despite a decade of warnings that it was breaking state and federal law, according to the Legislative Auditor.

Mental Health System Feeling the Hard Punch of Sequestration   According to the White House, if sequestration is fully implemented 373,000 mentally-ill adults and children across our nation will have to go untreated. Mental Health America reports that over the past three years, states across the country have had to cut approximately $4 billion in mental-health budgets — yet there are more cuts on the way with sequestration.

21 Graphs That Show America’s Health Care Prices are Ludicrous   This is the fundamental fact of American health care: We pay much, much more than other countries do for the exact same things. For a detailed explanation of why, see this article. But this post isn’t about the why. It’s about the prices, and the graphs.

LABOR UPDATES

MI Republicans May Slash University Funds in Revenge for Union Contracts

But majority Republicans on the state House’s higher education subcommittee were furious at what they perceived as an attempt to get around the new right-to-work law. So they voted to slash both schools’ state aid by 15 percent.

NOTES ON NURSING

Study Says NICUs Need Nurses   A surprising number of the nation’s neonatal intensive care units (NICUs) have too few nurses, a new study by researchers from the University of Pennsylvania and the University of Medicine and Dentistry of New Jersey (UMDNJ) has found.

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