Health Care Reform
In 1996, Albertans were faced with another year of government debt reduction at the expense of health care, education and social services.
In February, the Salvation Army Grace Hospital in Calgary closed. 1996 also saw the closures of the Charles Camsell Hospital in Edmonton, the Holy Cross Hospital in Calgary and the Minburn-Vermilion Health Unit.
Also in February, the government announced that they were putting $11.4 million dollars into Regional Health Authority budgets to alleviate the long waiting lists for joint replacement and for cardiac surgery. Even as they made this announcement, the government was careful to disclaim any responsibility for the long waiting lists saying that the lists had nothing to do with health care cutbacks of the previous years.
Also in February, the government made its fifth announcement of the one-time injection of $40 million into community care services.
In February, UNA produced an Alberta Health Care Fact Sheet showing that prior to any cuts being made in health care, Alberta spent less of its total wealth on health care than any other Canadian province. Before 1994, Alberta spent only 5.99% of its wealth on health care, compared to the national average of 6.97%. After 1994, Alberta’s health care expenditure percentage was reduced dramatically.
The total number of permanently-employed registered nurses in Alberta plummeted by 30% over 1995. When UNA publicly released this information, the government ceased collecting the data and statistics for 1996 were not available.
The Alberta government lost $422,000 per month in federal transfer payments because of the Alberta government’s refusal to ban private clinics.
UNA did a survey of its membership to determine whether health care services were deteriorating on the front lines. The results confirmed that not only were health care workers expected to work harder, work faster, work leaner, work meaner—they were also expected to shield patients and clients from the serious effects of cutbacks. It became apparent in 1996 that despite heroic efforts to maintain safe care levels, health care providers could not stop the deteriorating effects of cutbacks and downsizing.
In March 1996, the government formed the Health Profession Act Implementation Committee whose task it was to make recommendations regarding the replacement of health care professional legislation with a new omnibus Bill that would reduce regulation and licensing controls.
In the same month, the government announced the formation of the Advisory Committee on Restricted Services whose mandate was to advise the Health Professions Act Implementation Committee on all matters related to which health care providers could perform which restricted activities.
The Alberta Association of Registered Nurses announced their statistics which showed that between 1993 and 1995 the number of registered nurses in Alberta dropped by 3,100 resulting in the statistic that for every 10,000 Albertans there were now only 39.3 registered nurses down from 57.2 nurses one year earlier.
Heather Smith, President of UNA, was invited to a by-invitation-only National Forum on Health Dialogue: Seeking Solutions to Health and Health Care. It provided UNA with an opportunity to meet with people from other parts of Canada interested in hearing the effects of the Klein government’s cuts to health care as well as providing an important forum to exchange information and to strategize on how to protect and expand the Canada Health Act.
In November, the Minister of Health, Halvar Jonson, acknowledged that Alberta has serious health care problems including:
-longer waiting lists
-inadequate statistical information
-restrictive patient complaint and appeal procedures
He announced increased funding to the Regional Health Authorities.
Regional Health Authorities
In February, Region 10 eliminated 57 registered nurse position and replaced them with 57 licensed practical nurse positions—a theme that seemed to be adopted across the province.
One weekend, cardiac patients at the University of Alberta Hospital in Edmonton were cared for by Holy Cross Hospital nurses who were brought up from Calgary leaving Region 4’s ICU units understaffed.
On July 2, Region 10, the Capital Health Authority, applied to the Labour Relations Board for a single union certificate for each category of health care worker at the University of Alberta Hospital, the Royal Alexandra Hospital and the Glenrose Hospital—the so-called referral hospitals. This employer application affected six different health care unions and fifteen different Collective Agreements. For UNA it meant that the employer wanted only one nurses’ union to represent nurses at these hospitals.
UNA’s position was that the status quo was appropriate but in the event that a runoff vote was ordered by the Labour Relations Board, then nurses at the Grey Nuns, the Edmonton General, the Misericordia and the Sturgeon hospitals should be included in the vote.
The unions were given a July 19 deadline to respond to the Labour Relations Board on such things as the process to be used, the types of evidence and documents to be produced and distributed and the specific issues needing to be addressed through the hearing procedure.
A series of meetings were held in 1996 in which UNA first consulted internally and with UNA lawyers, then with other unions and finally with all the unions and the Labour Relations Board and the employer.
It was a long and ponderous process—to say nothing of being very expensive. The actual hearings were not scheduled to begin until January 1997, but much of the preliminary work was done in 1996.
In July, the Regional Health Authority in Calgary announced plans to build a new hospital in that city’s South area by the year 2005 at the cost of $150 million—this in the face of having just announced the closure of three large and recently-renovated Calgary hospitals—the Salvation Army Grace, The Holy Cross and the Calgary General.
The Capital Health Authority in Edmonton negotiated an agreement with the Canadian Army to place thirty army nurses in hospitals throughout the Edmonton area. These nurses would be supernumerary—that is, over and above regular staffing numbers—and their presence in Edmonton area hospitals was to maintain their skill levels and knowledge base after the closure of the base hospital. These army nurses began working at the Sturgeon Hospital in St. Albert and were expected to be assigned to other hospitals thereafter.
In 1996, UNA organized a number of new Locals:
-Local #197Peace River Health Unit
-Local #198Our Lady of the Rosary Hospital, Castor
-Local #199Peace River Auxiliary and Nursing Home
-Local #202Willow Creek Auxiliary and Nursing Home, Claresholm
In the summer of 1996, the UNA Local at the Royal Alexandra Hospital was once again the focus of an attempted raid—this time by the Alberta Union of Provincial Employees. UNA Local #33 members made it very clear that they wished to remain part of UNA and the raid failed.
Also in the summer of 1996, a series of raids was launched against UNA by the Staff Nurses Associations of Alberta. Again, all of these raids failed.
As a result of regionalization, many UNA health unit Locals found themselves fractured such that pieces of the former health unit were now in two, three and even four of the new Regions.
A part of the former Wetoka Health Unit found itself in Region 6, the David Thompson Regional Health Authority, where most of the health unit nurses were not unionized. UNA’s attempt to organize all the health unit nurses in Region #6 was unsuccessful and as a result former UNA members are now working in non-union sites. The challenge remains.
In Region 3 (Headwaters), Region 5 ( Drumheller area), and Region 7 (Alberta East Central area), where health unit nurses were organized in more than one union, and where UNA members were clearly outnumbered by the other union, runoff votes were held at the direction of the Labour Relations Board, and UNA was unsuccessful. In Regions 3 and 5 health unit nurses would now be represented by the Staff Nurses Associations of Alberta and the Region 7 health unit nurses would now be represented by the Alberta Union of Provincial Employees.
In Region 1, the Chinook Regional Health Authority in the Lethbridge area, UNA won the runoff vote and would now represent all the health unit nurses in Region 1.
In Regions 8 (West View) and 12 (Lakeland) where UNA had the majority of unionized nurses, the employers did not apply for a single certificate and the Labour Relations Board, therefore, did not order a runoff. Consequently, both UNA and SNAA continued to represent health unit nurses in each of these Regions.
In Region 2, the Palliser Regional Health Authority in the Medicine Hat area, UNA continued to represent a very small number of health unit nurses in the Oyen area.
The total result has been that health unit Locals experienced severe disruption and fragmentation by the process of regionalization. UNA’s response has been threefold:
– to continue to organize nonunionized health unit nurses
– to work towards one nurses’ union in Alberta
– to embark on an internal organizational review process which will include recommendations to address health unit Local problems
1996 was a year dominated by bargaining. Most of UNA’s Collective Agreements expired in the early part of 1996 and preparations were made in 1995 to begin negotiations as soon as possible in 1996. But speed was not going to be a hallmark in these rounds of bargaining.
On January 30, hospital bargaining commenced and shortly thereafter long term care and health unit tables began. The employers in a number of long term facilities chose to separate themselves from the hospital table and UNA’s provincial hospital negotiating team was faced with doing two sets of bargaining. The provincial health unit team was also faced with multiple tables as not all Regional Health Authorities wanted to be part of the group health unit table.
UNA’s three major demands at all tables were:
– effective ways to address patient/client/resident care concerns
– job security issues
– monetary increases including the return of the 5.38% rollback
The employers seemed equally adamant that UNA would have to accept rollbacks in a number of places in the contract but especially in layoff and recall language. They were completely uninterested in patient/client/resident care concerns and were not inclined to return the wage rollback. The long term care employers tabled massive monetary rollbacks and were shameless in their statements that long term care nurses were not real nurses like hospital nurses were.
Most UNA health unit nurses either never took the wage rollback or had it returned at the expiry of their contracts. Their Collective Agreements contained language which guaranteed a return to pre-rollback wage levels. Their major focus was on parity with hospital nurses—a goal that the employers at first acknowledged and said they shared.
During health unit negotiations, different employers began to withdraw from group bargaining in favour of negotiating directly with UNA. This increased the workload of the UNA negotiating committee because it increased the number of tables at which they were now bargaining.
Bargaining for all three groups of nurses—health units, hospitals and long term care—continued through the first half of 1996 with little or not progress. The hospitals table broke off in the summer and re-commenced in September. During this break, UNA did a survey of its members to check on whether or not the initial priorities were still the top issues of concern. The membership responded in an overwhelming manner and made their voice crystal clear. Their priorities were:
– patient care issues including a nurse in charge at all times and nurse/patient ratios and skill mix ratios.
– job security including the maintenance of layoff and recall rights
– monetary increases and the return of the 5.38% wage rollback
Once back in bargaining in September, hospital negotiations soon broke down and UNA applied for informal mediation.
In November, UNA filed a complaint with the Labour Relations Board alleging that the health unit employers, using the Provincial Health Authorities Association (PHAA) as their bargaining agent, were not making any effort to negotiate and conclude a Collective Agreement.
On November 27, informal mediation talks between PHAA representing hospital employers and UNA failed when the employers called a halt to the facilitated discussions. There were still rollbacks on the table and the employers were refusing to deal with patient care issues and staffing problems.
On December 2, PHAA acting on behalf of the hospital employers applied for formal mediation. The year ended with little or no progress to show for twelve months of bargaining at multiple tables.
Grievances, Arbitrations, Appeals and Hearings
1996 was another year in which the Union was faced with the serious task of monitoring the application of UNA Collective Agreements and grieving violations. UNA members, Local executives, grievance committees and labour relations staff filed grievances, mediated settlements and, where settlement was not possible, arbitrated the issues.
UNA filed 570 grievances in 1996, scheduled over 75 arbitrations and represented grievors at 21 arbitration hearings.
In addition, UNA also provided representation to members at disciplinary hearings of the Alberta Association of Registered Nurses and the Registered Psychiatric Nurses Association of Alberta; at Workers’ Compensation Board appeals; at Unemployment Insurance hearings; at pension appeals; and at proceedings with insurance companies over long and short term disability claim denials.
Another venue in which UNA provided representation was at hearings of the Labour Relations Board. In addition to bargaining complaint hearings, UNA also represented UNA members at the Central Park Lodge in Edmonton where the employers laid off all bargaining unit nurses and hired back some of them as management. They replaced the remaining positions with lesser-skilled workers. UNA alleged that the employer was union-busting and the LRB found in favour of the Union saying that the employer could not simply eliminate union positions and then re-hire the nurses back as management.
In 1996, UNA continued to implement the educational program which attached a workshop to every District Meeting in order to provide on-going leadership training to Local Executives. In addition, UNA also provided workshops at the Local level to Committee members, Local Executive members and rank and file members. The standard workshops were taught on local administration, professional responsibility, occupational health and safety and grievance. In addition, UNA developed new workshops on nurse abuse, de-skilling and the use of LPN’s to do RN/RPN work.
In 1996, UNA provided 68 workshops to 1516 participants.
UNA also continued to do research and develop position statements on:
– health care reform
– health care restructuring
– de-skilling and the use of generic health care workers
– restricted activities
– professional legislation for regulation and licensing
– code of ethics of the Canadian Nurses’ Association
– North American Free Trade Agreement
– Hotel de Health
– Protection for Persons in Care Act
– drug patent legislation
UNA continued to develop and to revise the education documents available to Locals and to members.
UNA also made information and documentation available to the large number of nursing students who contacted UNA offices.
The UNA NEWSBULLETIN continued to be developed and sent to all members providing such information on such topics as:
– health care reform
– occupational health and safety
– patient care issues
– political action
The UNA STAT was sent out to Locals to keep them up-dated on information and action.
FRONTLINE was produced throughout the year ensuring that all Locals were kept up-dated on bargaining news and the poster format allowed it to be posted on UNA bulletin boards for wide distribution of the information.
A computerized database was developed listing all of the Professional Responsibility issues that were raised by the Locals with their employers throughout the year.
Media work was an on-going piece of work in 1996. As bargaining heated up or hot issues arose, the media constantly sought UNA’s opinions and positions and it was to our advantage to keep a high public profile.
• At the end of 1995, UNA was part of a successful lobby campaign that won a three-month extension for Canadian federal and provincial governments to register their laws and regulations that they wanted exempted from the competition rules of the North American Free Trade Agreement (NAFTA). This was a one-time listing of exemptions and the lobby coalition secured an additional three months in which to urge governments to include all health care legislation and professional legislation for exemption.
Those who thought that health care was safe from out-of-country threats when the three governments of Canada, the US and Mexico agreed on health care exemptions in March of 1996, were brought up short when the Agreement on Interprovincial Trade (AIT) was debated by the First Ministers’ conference in Quebec City. The premiers proposed to delete health care and social services from the list of protected services in the provinces and the effect of this would be to weaken the NAFTA exclusions and put Canada’s social programs back under attack. UNA continued to work throughout 1996 to mount an opposition to this latest attack on health care.
• Another serious issue that arose in 1996 was the Hotel de Health scheme of privatized health care. The Hotel de Health was a group of 50 physicians and business people who proposed to provide health care services to wealthy, out-of-country patients. To do so they proposed to lease space in provincial health care facilities and part of their sales pitch was that this would bring “health tourist” dollars into the local economies of Leduc, Islay and Galahad. In January of 1996, Hotel de Health was selling shares in Toronto and had applied for a listing on the Toronto Stock Exchange.
For the all-inclusive price of some thousands of dollars, a person from Thailand or Indonesia could fly to Alberta, be transported to a Hotel de Health facility, have the required surgery and recuperate with a trip to the West Edmonton Mall, Jasper and Banff.
For communities like Islay and Galahad who were threatened with the closure of their active treatment beds and therefore their long term care beds as well, this offer seemed too good to be true. Hotel de Health would offer acute care services to foreigners and would maintain the long term care beds so the people of the community could continue to have their grandmothers and grandfathers close to them. It was less obvious what the people of Leduc would gain from having Hotel de Health rent an unused floor of the local hospital to offer MRI services and joint replacement surgery. But what the people of Alberta had to lose was a public health care system. This was definitely a big wedge in the door. And as Dr. Daintree, former president of the Leduc-area medical staff association pointed out: “the doctors who operate on foreigners won’t have time to operate on Albertans”.
An independent survey of the residents of Leduc showed that the majority were opposed to the scheme. UNA joined the Friends of Leduc and helped distribute pamphlets in freezing weather and collected signatures on a petition opposing Hotel de Health. They got 5,000 signatures from a population of 14,000 and presented it to the Crossroads Regional Health Authority. With an advertising campaign and hard work, the Friends of Leduc were rewarded when the RHA decided not to lease space to Hotel de Health.
Before the Islay and Galahad plans could be finalized, Hotel de Health had some legal problems of its own and quietly sunk into oblivion.
• In January, UNA was part of the health care union caucus that released a joint statement entitled “Prescriptions for an Ailing System” which critiqued Alberta’s health care system and made recommendations for change.
• In February, UNA joined with the AARN and SNAA made a joint presentation to the Alberta government’s Health Restructuring Standing Policy Committee chaired by Dr. Lyle Oberg.
• In March, UNA developed and implemented an action plan opposing the increased substitution of unskilled and lesser-skilled workers in positions traditionally done by registered nurses and registered psychiatric nurses—a process called de-skilling.
• In April, UNA sponsored health care questions on the Population Research Laboratory’s annual survey of Albertans. Once again it became very apparent that the people of Alberta think that budget cuts have reduced the quality of health care; that the government should make significant reinvestment in health care; that replacing registered nurses with assistants reduces the quality of care; that private-for-profit operators will increase the costs of health care; that a two-tier system is being created; that direct care providers should be licensed; that the Canada Health Act is of critical importance; that community health care services should be provided by the Canada Health Act; and that the federal government should not reduce health care payments to the provinces.
• In the Spring of 1996, the MLA for Ponoka-Rimbey, Halvar Jonson, was appointed as the new Minister of Health. At the same time, Calgary-Varsity MLA, Murray Smith, was appointed Minister of Labour.
• In July, health care advocates, including Heather Smith, President of UNA, met with federal Minister of Health, David Dingwall, to talk about the enforcement and extension of the Canada Health Act; the federal role for leadership and enforcement; national standards; drug patent legislation; and workforce trends and levels.
• Also in July, UNA researched and developed a position statement and brief on the use of auxiliary health care workers in acute care settings. UNA also prepared a position paper in response to the Provincial Council of Licensed Practical Nurses’ proposals for changes to the LPN legislation that would increase their scope of practice and include activities currently done only by RN’s and RPN’s. UNA opposed the proposed changes and sent copies of their brief both to UNA members and Locals and also to government bodies charged with studying the proposed LPN changes and making recommendations.
• In August, UNA prepared a response to the Capital Health Authority Review Committee’s report and presented it to appropriate government ministries and committees.
• UNA also prepared a response to the Advisory Committee on Restricted Activities’ Report analyzing the proposal and opposing reduced regulation and licensing standards.
• Also in August, UNA prepared a response to the AARN’s request for a critique of the Canadian Nurses’ Association’s proposed new Code of Ethics.
• August was also the month in which UNA participated in a rally at the Legislature to keep the Calgary General Hospital open.
• In October, Heather Smith, Bev Dick and David Harrigan met with the Minister of Health, Halvar Jonson, regarding the chaos in the health care system as a result of regionalization which had taken place over 18 months previously but which was still causing serious health and labour problems.
• UNA sponsored a poll in Region 10 re the quality of health care, workplace abuse of nurses and levels of overtime. The results were that 94% of respondents said that the quality of health care had seriously deteriorated; 60% had recently experienced physical and verbal abuse; and massive amounts of overtime were being worked but 62% of nurses surveyed had not claimed for overtime worked.
• UNA endorsed the Health Sciences Association of Alberta’s brief critiquing and criticizing the proposed Protection for Persons in Care Act.
Professional Responsibility Issues
The PRC computerized database was initiated and Locals were urged to make sure that copies of all PRC complaints and the minutes of all PRC meetings were sent to provincial office in order to make this database as complete as possible.
One example of the strength of the Professional Responsibility Committee occurred at Local #183, Alberta Hospital Edmonton. The employer announced the “forensic therapists” would be replacing nurses. More that 100 nurses signed a PRC complaint. The employer backed down and decided not to hire these “forensic therapists” and to maintain the nursing complement.
UNA continued to have a representative on the Board of the Local Authorities Pension Plan. This Board began a process of moving away from government control and towards independence and it was very important for UNA members to have a representative actively involved in the process to protect their interests.
The Regional Health Authorities raised the issue of withdrawing from LAPP and forming their own private pension plan for health care workers. Again UNA representation was critical in raising opposition to such a plan because it would not be as good for current and future pensioners as would staying with LAPP.
Annual General Meeting
The 1996 Annual General Meeting was held on October 22 and 23 in Edmonton and was attended by 450 people. Policy resolutions and constitutional amendments were dealt with efficiently by the delegates and many pertinent debates occurred around health care and union issues.
Of particular importance were discussions around:
– the slow pace of bargaining
– the unification of Alberta’s nurses’ unions
– the organizational review to deal with the effects of regionalization
– plans for UNA’s 20th anniversary in 1997
Goodbyes were said to UNA Locals at the Salvation Army Grace Hospital, the Holy Cross Hospital, the Charles Camsell Hospital and the Minburn-Vermilion Health Unit.
Heather Smith was acclaimed as President of UNA for a two-year term. Dale Fior was re-elected as Secretary-Treasurer of UNA. All UNA members and staff were deeply saddened by Dale’s death in November of 1997, and many gathered in Calgary to bid her farewell. Karen Craik was elected by the UNA Executive Board to replace Dale as Secretary-Treasurer until the 1997 Annual General Meeting.
UNA sponsored an offer by Seabury and Smith Home and Auto Insurance whereby UNA members would get discounted rates.
UNA increased its list of promotional items available through the UNA boutique—pens, watches, t-shirts, sweat shirts, ball caps and tote bags. UNA also designed and ordered thousands of UNA pins, RN pins and RPN pins which were distributed free throughout the membership.
By the end of 1996 all UNA Locals were on the computer and part of the UNA NETWORK. All UNA Executive Board members, both UNA offices and all UNA Locals were connected in a new and exciting system of communication. This single fact has meant huge improvements in the quality, quantity, frequency and timeliness of internal communication.
In 1996, all UNA Locals, Executive Board members and staff were transferred to First Class software for e-mail and network access. The Network changes increased conferencing capacities and UNA Locals discovered how easily and effectively they could discuss issues and share information with each other.
The Network is multi-platform, allowing UNA members with either Mac or IBM computers to join the Network and have access to this new and very helpful system of communication.
Copies of all UNA Collective Agreements were made available for downloading from the Network, and other documents were added as they were produced.