National Nurses United

firms to surgery centers. One of these consultancies, Quorum Health Resources, manages another 156 hospitals, putting CHS in de facto control of a total of some 362 hospitals. The list even includes an insurance company incorporated in the Cayman Islands, and two debt collection agencies. Despite these considerable resources, Community Health Systems can't even get enough thermometers on the floors at Bluefield Regional. That's because, nurses say, CHS runs its hospitals in a way that focuses solely on the bottom line at the expense of patients and its staff. The other major issue besides lack of equipment and sup- plies, RNs say, is that CHS understaffs its hospitals to the point of compromising patient safety. Over the last few years, nurses at a handful of CHS hospitals in Ohio, West Virginia, and California have chosen to unionize with National Nurses United affiliates—primarily as a way of improving working conditions to be able to provide safe patient care. But instead of bargaining with the nurses and despite multiple National Labor Relations Board orders to cooperate, CHS has repeatedly ignored, harassed, intimidated, and fired RNs. The federal government has taken notice of CHS' business prac- tices as well. The U.S. Department of Justice is now investigating both CHS and a Florida-based hospital chain it acquired this January, Health Management Associates, for defrauding Medicare and Medi- caid by admitting patients who did not need inpatient hospital care. Registered nurses working for CHS facilities say it is critical for staff, patients, the public, government, and shareholders to hold the corporation accountable. Recently, they have written a letter to the Securities and Exchange Commission alleging that CHS has been dishonest in its reporting to the commission that there are no labor relations problems with its employees and publicly protested at a CHS shareholders meeting discussing the corporation's acquisition of Health Management Associates. And, of course, nurses at CHS facilities continue to challenge management in working toward win- ning a first contract. "I think that with CHS owning more hospitals than anyone else, they run basically like a monopoly, especially in the more rural areas," said Meadwell, who has lived in the Bluefield area since she was 12 years old. "If no one is watching them and challenging them to do right by their patients, whether it's safe patient care or their high hospital charges, then they can do whatever they want to make the most money. If they are not monitored and are allowed to rule healthcare, patients will suffer." U nlike some hospital chains that started out rooted in a religious, community, or nonprofit mission and grew into what they are today, Community Health Systems was created from the get-go as a purely profit-making venture by three men who had previously worked as hospital executives: E. Thomas Chaney, Charles Miller, and Richard Ragsdale. According to the company's website, it was found- ed in March 1985, and bought its first hospital just a couple months later. It bought its second hospital in 1986 and continued adding facilities, shopping for financially struggling, nonprofit hospitals in rural communities without nearby competitors, according to the company's history page on referenceforbusiness.com. The company went public in 1991. Five years later, a private equity firm called Forstmann Little and Co. bought the entire company for about $1 bil- lion, which took the company private again, and hired Wayne Smith, a former Humana executive, as president and CEO. The company continued to aggressively purchase rural hospitals and eventually went public again in 2000 so that Forstmann Little could recoup its investment and CHS could raise capital for further expansion. As it grew bigger and the hospital market consolidated, CHS was not necessarily buying individual hospitals, but whole chains of hospitals. It did this in 1994 when it bought Hallmark Healthcare of Atlanta, which doubled its size. In 2007, CHS bought Triad Hospitals of Plano, Texas, which added 54 hospitals and Quorum Health Resources to its portfolio. And most recently, in January, CHS bought Health Management Associates, a Naples, Fla.-based chain, for $7.4 billion, which brought its total number of hospitals up to 206. This shopping spree hasn't been cheap, though. Though CHS has annual revenues of $13 billion, it cleared only $141 million net income in 2013, a profit margin of 1.09 percent. CHS is a "signifi- cantly leveraged" company, meaning the cost of its aggressive expan- sion has been to take on high levels of debt. Despite its size, influence, and financial resources, Community Health Systems hospitals do not advertise that they are, in fact, Community Health Systems hospitals. Nowhere on the hospitals' websites or "about us" pages, letterhead, or buildings is it explained that Community Health Systems owns and runs these facilities. Nurses believe that this lack of disclosure allows CHS to avoid cor- porate accountability for its business practices and to hide behind the façade of the local "community" hospital, exploiting the usually positive public relations that small, rural hospitals enjoy. "When I was hired, I didn't realize that Fallbrook was owned by a large, for-profit company," said Veronica Poss, a medical-surgical RN who worked for four years at Fallbrook Hospital, which voted to unionize in May 2012. "The name 'Community Health Systems' is not on the hospital at all. Their name isn't anywhere on anything, except on your paycheck, if you really look." Poss said that it was clear to nurses through doing outreach to the local community that resi- dents had no idea that Community Health Systems owns Fallbrook. "It's not a little community hospital run with the welfare of the community in mind," continued Poss. "Community Health Systems doesn't care about Fallbrook. They just care about how much money they can make off of Fallbrook." Likewise, Meadwell said that Bluefield Regional in late May just fin- ished constructing some brand-new signage in front of the hospital, but there's no mention of CHS. "This thing is substantial," said Meadwell. "With bricks and lights and everything. Nowhere does it say 'CHS.'" I f Community Health Systems' corporate ownership of its hospitals is not apparent on the outside, it certainly is on the inside. Accord- ing to nurses, many of whom had worked at their hospitals before, during, and after CHS purchased their facilities, these small hospitals are very much controlled from the company's corporate headquarters in Franklin, Tenn. with the goal of making profit in mind. Nurses' requests for more staff, more supplies, and better equip- ment are always met with a "We'll have to check with corporate" response. Meadwell said that before CHS bought Bluefield Regional, it had been very clear which administrators did what, and that she could pick up the phone and call them up to make appointments to see them at any time if she had an issue. Now, she said, "They are not accessible." Under CHS, she has asked for appointments with the chief nursing officer as well as other executives, but been turned down. Other RNs said it is even difficult to figure out who is in charge of what, because the turnover among directors is high and CHS is constantly assigning people "interim" titles. Perhaps nowhere is CHS' corporate, bottom-line mentality more apparent than in the way it understaffs its hospitals. Many nurses J U N E 2 0 1 4 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 13

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