Nov/Dec 1978 Volume 7, No. 5 CITY TO CIR: DROP DEAD · Nov/Dec 1978 Volume 7, No. 5 CITY TO CIR: DROP DEAD ... with exiting HHC chief Joseph Lynaigh and Deputy Mayor for Finance,

Nov/Dec 1978Volume 7, No. 5

CITY TO CIR: DROP DEADRALLY DRAWS 250 PROTESTERS

New York Ci ty is turning a deafear to demands by CIR that new con-tracts include standards upgradingpat ient care in the municipal hospi ta ls.(For a more complete statement ofCIR's c i tywide contract demands anda sampl ing of speci f ic local bargainingissues, see pages four and f ive). Aser ies of meet ings between CIR andthe City negot iators produced nothingin the way of concessions to pat ientcare concerns. Subsequent meet ingswith exi t ing HHC chief Joseph Lynaighand Deputy Mayor for Finance,Phi l ip Toia were f r iendly but f ru i t less.Not only is the Ci ty unwi l l ing tonegot iate on these points of qual i ty,i t can provide no guarantee that al lcurrent interns and residents in themunicipal system wi l l be able tof in ish their t ra in ing programs or thatexist ing programs and services wi l lnot be decimated.

Protest over Ci ty intransigence istaking several forms. On December 6,250 people at tended a CIR-sponsoredral ly at Ci ty Hal l ; where speakers

attested to the urgency of theproblems in the Ci ty 's heal th caresystem. Speaking at the ral ly wereMichael Schoolman, CIR president:Donald Meyer, president of theDoctor 's Counci l ; Glor ia Cappel la ofthe New York State Nursing Associa-t ion; Lester Wright of DC 37; KarenBruce of the Licensed pract lcal NursesAssociat ion; and Al lan Serr ins of theCounci l of Municipal Hospi ta l Com-munity Boards.

At the ral ly, CIR passed out pet i -t ions addressed to Mayor Koch, theEmergency Financial Control Boardand the other " f inancial powers thatrun the City," cal l ing, for an end tosecond-class care for the poor, nomore cutbacks in Ci ty hospi ta l beds,no more City hospi ta ls c losings, fu l ls taf f ing and adequate equipment, andthe opening of Woodhul l hospi ta l byJuly 1979 as a Ci ty hospi ta l .

As we go to press, pat ient care;regot iat ions are st i l l at an impasse.For CIR's plans, see the president 'scolumn on page 2.

BMHC Psych ResidentsForced To Cut Service

Residents who work in BronxMunicipal Hospi ta l Center 's psychiatr icemergency room were forced onDecember 11 to cut services anddraw attention to the $300,000 cut theCity is making in the BMHC budget.The cut is aimed at the center 'steaching af f i l iat ion contract wi thEinstein. Several doctors who teachand supervise residents at BHMC havealready received layoff notices.

The job act ion took the form ofreleasing any of the ward's 100pat ients who were f in ished with t reat-ment but who could use extra t imein the hospi ta l . In addi t ion, emergencypatients were referred to state andpr ivate hospi ta ls af ter in i t ia l t reatment.

The facul ty of BMHC's Departmentof Psychiatry expressed "wholeheartedsupport for the courageous andpr incipled act ion" taken by theirpsychiatr ic residents, making thepoint that the HHC budget cuts wouldreduce medical funct ions to "a cus-todial level ." Facul ty physic ians didnot step in and perform any tasks,except in l i fe threatening si tuat ions.

The mot ion support ing housestaf fwas endorsed by unanimous assent ofthe facul ty, by the Director of Resi-dency Training, by the Director andWard Attendings of the Inpat ientService and by the Director of theOutpat ient and Emergency Services.

CIR President Michael Schoolman addresses City I-.lalt rally.

Page 2

r PRESIDENT'S MESSAGERobbers qnd Copsot HHC

Mayor Koch has been playing copsand robbers in t ry ing to f ind a suc_'cessor for HHC Chairman JoseohLynaugh, whose resignat ion wasdemanded by the Mayor in ear lyDecember.

f i rst ,_Koch appointed Eamon Kel ly,a Ford Foundat ion execut ive who had'been a consul tant to the federalDepartment of Labor. But Kel ly wi th_drew his name from nominat ioh whenit became known that a federal judgeaccused him of ' ,poor judgmeni ' , inrecommending a pol i t ical ly inf luent ia llaw f i rm to defend a leading laborf igure who pleaded gui l ty tdembezzl_ment. The Aflanta law firm recom_mended was said to have hadmembers who were close fr iends ofAttorney General Gr i f f in Bel l andPresident J immy Carter.

The Mayor has reacted to th is ta intof impro_pr iety by nominat ing FirstDeputy Pol ice Commissioner JosephC. Hoffman to the top HHC post. 'Herhaps this wi l l keep the HHCabove reproach.

IT'S OFFICIALICIR's pet i t ion to amend the cert i_f icat ion of the House Staf f Oroani_zat ion of the Col lege of Medicineand Dent istry of New Jersey has!911 oltlcially approved Oy tnePERC. Welcome aboard!

rHE ONI.Y 'SSUE

The City of New York is intransioentin i ts refusal to discuss the issue"ofpat ient care in i ts hospi ta ls. SinceSeptember 30, the CIR has at temptedto bargain wi th the Ci ty on theseissues, but has met wi th no success.Instead of concern, we are met wi than " i t 's none of your business,, at t i tude.

At the same t ime, the Ci ty has beensystemat ical ly cut t ing back on pat ientcare essent ia ls, and the qual i ty ofcare in the municipal hospi ta ls isdeter iorat ing, both in respect to directservices and to the t ra in ing programswhich are v i ta l to providing thbseservices. For whatever misguidedreasons - the budget cr is is is theusual one of fered - the Ci ty has fel ti t expedient to cut back services,t ra in ing projects and personnel neededby the economical ly and pol i t icalLy dis-advantaged sect ion of the populat ion.. For us at ClR, pat ient care isn, t iustan issue, i t 's the only issue. Conceinfor the qual i ty of work that we do trans_lates. d i rect ly into reducing miseryand improving the general wel fa ieof those we help to take care of. Goodworking condi t ions and good qual i ty

by MICHAEL SCHOOLMAN. M.D.

of care are inseparable.This being true, we must act ivelv

search out al l avenues avai lable to usto f ight against the deter iorat inocondi t ions we are wi tnessing in" theCity system. Each one of us has toconsider deeply what must be done i fthe col lect ive bargaining route fa i ls .l f l t does, col lect ive pressure mustbe brought to bear. Certainly, we wi l llook for support around us in th isstruggle - f rom anci l lary personnel ,nurses, chiefs of service, administra_tors;*pol i t ic ians - but f inal ly we mustbe able to take on the responsibi l i tyourselves to do whatever is necessaryto insure that these concerns wi thqual i ty of care are addressed insteadof being ignored and al lowed toworsen.

The CIR is now in the process ofdiscussing what can be done, and wefeel that some sort of act ion isimminent. We urge al l of you to getin touch with your CIR delegate-s andto at tend local CIR meet ings. Weneed your support , energy and ideasin order to t ranslate our concernsinto solut ions to th is cr is is in qual i ty.

CITY HAIL PROTESTERSKaren Bruce, LPN rep, calting tor better seryices. ittarcMore housestaft arriving at rally.

(t. to r.) Mike schootman, ctR.; L;;terw, Locat 420;Don Meyer and Max Van Giider, Ooctori iouncil.Jay Dobkin, PNHA president,

as Coney lsland group arrives.

Page 3

Medicore Regs AfrectHousesfoff ond Attendings

l f new Medicare regulat ions gothrough, housestaff duties and respon-sibi l i t ies may be substant ia l ly reducedbecause the federal program will nolonger reimburse physic ians for theirservices at teaching hospitals wheremore than fifteen percent of thepatients are cared for by housestaff.That is, at tending physic ians wi l l notbe al lowed to bi l l Medicare pat ientsa fee-for-service charge in addition towhat the hospital itself is chargingMedicare for the treatment of thepatient.

Possible responses to the new laware a retreat of attending physiciansfrom teaching hospi ta ls (resul t ing indecreased supervision, and increasedwork for housestaff) or an increasedtaking on of responsibi l i ty by at tend-ings, i f they f ind that they can thuscol lect the higher Medicare fees.

The AMA Resident Physic ians Sec-t ion feels the new reimbursement rulesare bad for housestaff and wil l lockthem into strictly service roles. OneMedicare gf f ic ia l who helped wri tethe rule, however, suggests that bydrawing the at tendings further intopat ient care, the rules should helpimprove the teaching and supervis ionof interns and residents. He predictedthat pr imari ly municipal , county andstate hospitals wil l be affected byhaving their physic ians' Medicarecharges discont inued.

Under the new rules, fee-for-servicecharges wil l only be paid if the attend-ing physician personally examinesthe pat ient and is present dur ing andsupervises c l in ical procedures.

The i rony is that the AAMC foughthard to make housestaff studentsunder the NLRB. Perhaps now theycan see the flaws in their arguments.

FMGs leoyeOhio Pediofrics Program

Medical school pol icy towardsforeign medical graduates, a long withintolerable working condi t ions appar-ently were the cause of 17 out ol 22pediatr ics residents ' leaving theirposi t ions at Medical Col lege of Ohio(MCO) in Toledo. The resignat ion ofthe department chairman fol lowed theexodus of the residents, most ofwhom were FMGs.

LABOR N EWSOne apparent reason for the mass

abandonment of the program was thenew pol icy of the school towardsFMGs. The recent ly appointed MCOpresident, Dr. Richard Ruppert , in aneffort to "effect a balance" betweenforeign and American residents, haddecided to recrui t no fur ther residentsfrom foreign programs. According tosome, th is pol icy lef t the currentFMGs with the feel ing that the school 'sadministrat ion bel ieved them to be" less good or rel iable" than theirAmerican counterparts. However,according to one former resident, theactual move to resign occurred whenit was learned that - because onlyFMGs were avai lable - no new resi-dents were being brought into theprogram to rel ieve the heavy workload.

Another former resident c i ted workproblems as mbre im,portant than theFMG issue in precipi tat ing the resig-nat ions. Second year residents had thesame on-cal l dut ies as interns, not ime was al lot ted for reading andelect ives and residents covered fourhosf;ritals in rotations that were asshort as two weeks.

When housestaff drafted a letter ofcomplaint and construct ive sugges-t ions, they were not acknowledged bythe MCO administrat ion. When aresponse was received more than fourmonths later, many of the residentshad already decided to leave.

PNHA leoder FightsFor PolienfsAnd Wins

The President of Los Angeles' JointCounci l of Interns and Residents,Dr. Greg Anderson, was reinstated tohis posi t ion at Harbor General Hospi ta laf ter having been f i red last summerby hospi ta l of f ic ia ls. l t was Anderson'sconnect ion wi th JCIR and i ts at temotto block a hir ing t reeze at the couniy 'shospitals which apparently resultedin his being f i red.

At a Los Angeles county hear ing inJune, Anderson (represent ing theJCIR) test i f ied that the reduct ion ofcustodial staff resulting frorn the lasthir ing f reeze was impl icated in theoutbreak of uncontrol !ed hosoi ta l -acquired infect ions in county inst i tu-t ions. For th is, Anderson was cr i t ic izedby the county board of supervisorsfor "not st icking to medicine," andone week later he was dismissed

from his hospi ta l posi t ion by thehospi ta l administrat ion.

The 28-year-old fourth-year residentresponded by f i l ing a gr ievance withLos Angeles County EmploymentRelat ions Counci l (ERC) and by suingthe board of supervisors for v io lat inghis c iv i l r ights.

Before the ERC hear ing was held,however, Anderson's sui t against L.A.county of f ic ia ls was sett led in hisfavor out of court, and the Los Angelesgrand jury cr i t ic ized the board ofsupervisors for meddl ing in heal thcare and pol i t ic iz ing medical matters.

Polient CoreA Working Condition,Soys lobor Jvdge

An Administrat ive Labor Judgeruled that an Amari l lo, Texas VeteransAdministrat ion hospi ta l commit tedunfair labor pract ices in threateningto br ing charges against the presidentof a nurses' union local who wantedto discuss "pat ient care" on behal fof the union membership.

The judge ruled that "pat ient care"is indeed a labor condi t ion and thati t is appropr iately deal t wi th throughunion channels.

The nurses at the VA were con-cerned with what they fe l t were badeffects on patients resulting from thehospi ta l 's schedul ing of surgery. Theycompi led a report on the subject andsubmit ted i t to the hospi ta l 's president.Soon afterwards, the president of thenurses local , Lena Hal l , was cal ledto the hospi ta l 's personnel of f ice andwas informed that the hospital wasconsider ing f i l ing an unfair laborpract ice charge against the unionbecause matters of patient care werenot the union's af fa i r .

The judge ruled that matters ofpat ient care were the legi t imate con-cerns of both unions and managementbecause pat ient care is a condi t ion"that adversely af fects working condi-t ions i f not g iven proper considerat ionsby both part ies."

l l t t r l l t l t l l | | I I I I

. . .PLEASE.. .ln order for us to keep an accurate, up.to.date membership mail ing l ist, y0U MUSTcooperate by tell ing CIR when you move bysending us the new, complete address.

I l t r t t t l t r totr l l t

Page 4

CITYWIDE DEMANDSAs bargaining began tor 1978-80

contracts, the CtR House of Delegatesoassed a resolution that a single con-'tract

for all housestaft oflicers in the

Metropolitan area be signed' The city'.wide bargaining demands, summarizedbetow, are those stated in addition to

all terms and conditions of the con'tract currently in effect, which will

continue tor the next two years, exceptas they are specifically modified .b.ythe current sef of demands' Citywidedemdnds tall into the tollowing cate-gories:

HOSPTTAL CONDITIONS1. No closing or cutbacks in

hospi ta ls or services.2. .sufficient, round-the-clock staff-

ing bY RN's, LPN's, a ides, messengerstransporters and clerks.

3. 24-hour, 7-daYs availabil itY ofblooddrawing and intravenous teams'

4. Sul f ic ient equiPment: EKGs'def ibr i l lators, crash carts, ambu bags'portable cardicac monitors, respira-tors, IVAC PumPs'

5. Z4-hour, 7-daY laboratorYpersonnel .6. Lab, radiologY and nuclear medi-

c ine tests and t imely resul ts avai lable24 hours, 7 daYs.

T. Access of housestaff to medicalrecords, x-ray fi les and charts 7 days,24 hours.8. No discr iminat ion against pat ients

because of payment mode or inabi l i tyto pay.

9. Suff ic ient basic suPPl ies forpatients (bathrobes, towels, etc').

10. PharmacY: 7 daYs' 24 hours;drugs dispensed as Prescr ibed.11. Secur i tY adequate throughouthospi ta l , on cal l and parking areas.

12. Adequate heat ing and cool ing onal l l loors.13. Arrangement for housestaff toget medical examiners' reports.

14. Suff ic ientbeePers.15. Access to translators.

STAFFING ANDWORKING CONDITIONS16. No increases in workloads, shi f ts,total hours. 60 hour maximum workweek, every fourth night maximum;one weekend off a month.

17. Sufficient back-up staffing fori l lness and vacation absences'

18. On-cal l rooms suff ic ient ly main-tained.19. 772 months not ice of non-renewalof contract.20. Unimpeded access to Personnelf i les; r ight to chal lenge documentsin f i les.21 . Suff ic ient parking, secure and atno charge.22. No increase in hospital-controlledhousing rents.29. Free meals and night dutY mealor monthly meal al lowance.24. Yearly rotational schedules byJune 1st . On-cal l schedules wi th30 days notice.

EMPLOYMENT SECURITY25. Pyramidal structured trainingprograms elQt inated.26' . No ieduct ion in number ofhousestaf f ; increases commensuratewith need.27. Efforts to maintain or reattainaccredi tat ion of t ra in ing programs.

28. Due Process in disciPl inarYmatters; sPeedY adiudicat ion andbinding arbi t rat ion.29. Grievances: three-step procedurewith binding arbi t rat ion before th i rdstep.30. Out-of-tit le disputes defined asgr ievances.31. Adjustments to wages sett ledwithin 30 daYs, or 67o interest onretroactive wages owed'32. No discr iminat ion against house-staff based on Place of medicaleducat ion or disabi l i tY.

TRAINING PROGRAMS33. Elect ives t ime not reduced: Mini-mums PGY 1 and 2 - 2 months; PGY 3and above - three months.

34. Right to take electives outsidehospital when not otherwise available.

35. Past practice in resPect toeducat ional leave t ime, or f ive daYminimum with exPenses'36. Paid time off for examinationsrelated to t ra in ing.37. Benefits accrue as to first daYof contract.38. 12 paid hol idaYs.39. When leaving hosPital , 3 Paidleave days preceding expiration ofcontract.40. 20 days maternity leave; paternity,

f ive days; marriage, 5 days; bereave-ment, 5 daYs.

ECONOMIC DEMANDS41 . A reasonable wage increase.

42. Continuation of anY benefitsgreater than those provided in thiscontract.43. Health and Hospitals Corporationshal l not enter into or cont inueaffi l iations with non-union housestaff.

TOCAL DEMANDSMAIMONIDES

The Negot iat ing Commit tee hastaken a strong stand on the need forstat tests, access to medical recordsand x-ray f i les, EKG machines, def i -br i l lators, secur i ty in the ER, dormsand del ivery sui tes, pre-admissiontest ing and addi t ional anci l lary person-nel to eliminate out-bf-tit le work.

A major demand is stoPPing thepractice of hiring fifth pathway externsto replace Permanent interns.

CIR has also asked for no electiveadmissions af ter 3 P'm.; on-cal lavai labi l i ty of a radiologist and tech-nic ian for night and weekend angio-grams; discret ion for the admit t ingiesident to determine on a "need ofcare" basis what f loor a pat ient shal lbe admit ted to; d iagnost ic rooms forevery f loor; adequate phones, 2 elec-tive months for PGY 1 and 2; and 6elective months for PGY 3 and above.

MONTEFIOREMontefiore housestaff is negotiating

for modif icat ion of admission pro-cedures so that no Patients wil l beadmitted to uncertif ied areas, such aslounges, acceptance of ER emergencyadmissions before non-emergenttransfers from North Gentral Bronx;and no elective admissions after 5 p.m.

Other specific demands are a cen-tral logbook for radiologists to recordsummaries of readings pr ior to formalreports; 1-hour availabil ity of statx-rays wet readings; two additionalcomputer terminals; 24-hour emer-gency room technicians; reading roomfor housestaff; free and unlimitedaccess to x-raY fi les; and reducedpatient load for orthoPedic and

continued on Page 5

Page 5

vascular residents on night andweekend duty.

Housestaff officers on elective arenot to perform emergency room duties;two additional physicians are wantedfor emergency room duty, 24 hoursa day, 7 days a week. l- lousestaff isalso demanding not to be assignedto cover the Loeb Center and improvedresponsiveness from the housestaffoffice in terms of credit requests andreasonable requests regarding nightcall or other assignments.

BELLEVUE

Demands of housestaff at Bellevueare reminiscent of demands throughoutthe City: e.9., availabil ity of lab tests,at a l l t imes, avai labi l i ty of medicalrecords, avai labi l i ty of drugs in thepharmacy; emergency x-rays; equip-ment in the adul t emergency service.Housestaf f are demanding that nursingcoverage be "suf f ic ient to permitproper monitor ing of pat ients andmedications 24 hours a day, sevendays a week."

As at Kings County, Bel levue resi-dents are demanding the instal lat ionof a CT scanner.

METROPOLITAN

Metropolitan housestaff are askingfor remediation of acute shortages ofanci i lary personnel (n ight ward c lerks,patient escorts, housekeepers, nightul t ra-sound technic ian and radiologynursing). The fol lowing equipment isalso being demanded: Harvard pumps,suction machines, lead x-ray apronsand monthly f i lm badges for radiologyresidents.

Like many other housestaff officersin other hospitals in the City, Metro-pol i tan residents are demandino24-hour access to x-ray fi les and'forincreased hours in the medical l ibrary.They are also asking for telephonesin the on-call rooms, x-ray tables inthe operating rooms, and the institu*tion of appointment systems in thesurgery and orthopedic clinics.

KT'VGS COUNTY

A sampling of Kings County,s localdemand s f ol lows - hospital -w i dedemands are separated from demandsin specific departments.

Hospital-WideSecurity guards in the emergency

LOCAL DEMANDSroom and at the ambulance entranceare demanded as are escort servicesbetween bui ld ings at n ight. House-staff is also asking that a room in theemergency sect ion be set aside foruse by bereaved relatives of adeceased patient. Housestaff on rota-t ion to other hospi ta ls are askingreimbursement for meals or f ree meals.There are also demands for increasesin non-physic ian personnel in theICU and nursery on the 4- i2 and8-4 shifts.

DermatologyDemands have been made for pre-

scr ibed drugs to be stocked in thepharmacy and for the instal lat ion andmaintenance of f luorescent lamps.

Family PracticeDemands reflect the need for

suppl ies in the &l ivery rooms andincreasbd staffing by ward clerks.

Internal MedicineHousestaff demands 24-hour staffing

for transportation of patients to x-ray;24-hour staffing for a second broncho-scope and improved staffing andmaintenance of the Pulmonary lCU.

Neurology

Housestaff ask for establishment ofa Neurological ICU; avai labi l i ty ofant iconvulsants and headache agentson al l wards and in the ER; and forinstal lat ion of a CT scanner.

Obstelrics/GynecologyDemands in th is department include

updat ing and replacement of , 'archaic ' ,operating room equipment; an anes-thesiologist on cal l for obstetr ics;an increase in number of nurses oneach f loor; the establ ishment of anendocr ine c l in ic; and provis ion of aculposcope, additional laproscopesand a hysteroscope.

Ophthalmology

- Ophthalmology residents are asking

for a basic sciences course or thatarrangements be made for them toattend these courses at other insti-tut ions.

Oral SurgeryHousestaff in this department are

demanding an EKG machine for thecl in ic and more operat ing room t ime.They are also asking for one weekpaid conference time.

Pathologylncreased assistance for autopsies

is requested along with increasedsecur i ty af ter 5 p.m.

Pediatrics

In terms of equipment, housestaf fin pediatr ics are demanding thatmonitors and other equipment in theICU be increased; for the instal lat ionof a centr i fuge and bi l i rubin meter inthe newborn nursery; proper s izelaryngoscopes and endotracheal tubes.Housestaf f is a lso demanding thatthe chief resident be selected fromamong Kings County incumbents onlyand that pediatr ics residents havepriority over rotators from other depart-ments in al l rotat ional assignments.

Pediatric NeurologyKings County is being asked to

permit parents to stay wl th pediatr icpat ients overnight. Pediatr ic neurologyresidents are also demanding thatlab personnel be increased and that24-hour x-ray transportation be madeavai lable.

PsychialryThere are demands for metal

detectors and increased security inthe ER, as well as for an increasednumber of at tendings in the ERduring the day. There are demandsrespect ing suff ic ient suppl ies for theER as wel l . Lockers, on-cal l rooms.bathrooms are also subject of demandsfor improvement.

Psychiatry housestaff are alsoasking for increases in male aideson wards, and in medical coveraoeand therapists for SUH-52.

RadiologyHousestaff are demanding to be

suppl ied wi lh lead aprons and for anincrease in technic ians and aides toperform procedures and process fi lms.

Rehabil italion

Demands in th is department centeron staffing increases: ward clerks,physical therapists; x-ray techniciansand messengers.

SurgerySurgery housestaff are demanding

the abolit ion of the pyramid system orits l imltation to the cases whenqualif ied residents who leave generalsurgery are tracked into sub-specialt ies.

Page 6

CITY AND FLOWER COLA CHECKS

Under the CIR contracts wi th the

ci i ' anO Flower-Fi f th, a cost-of- l iv ing

aOiustment ("COLA") $336 per annum'" i;1" paio to all house staff officers

on Li in" i the c i tY (H&Hc) or Flower

o"uiorf t for a l l o i part of the per iod--

5; i ; ; ; t , tszo to SePtember 3o' 1e78'

n" " i in i"

wr i t ing many house .staf f .olt i""t. due thishoney have s' ' i l l not

received i t . Here's what 's happentng'

CitY StallsThe CitY has Paid the housestaff

"oii"ntLy bn City payroll but has' for

th; ;;t i Part, refused to make a full

""ur"n of

'City records to identify those

residents who lef t the payrol l on or. .

before June 30, 1978. Central payrol l

c la ims i t does not have the resources

io .""r"n its records' As a result each

hospi ta l has been expected to provtoe

i ' f i r ' intotrnut ion on i ts own' But the

f f f f C n"" not asked the hospi ta ls to. .

"rppfy th is informat ionl The net resul t

hai 'Oeen as You might exPect: Some

hospi ta ls rePort ing some names on

a sporadic basis whi le others have

suppl ieO no informat ion at a l l ' Some

noul"ttuft who left the City payroll on

or before June 30, 1978 have gotten

tn" 'COf-A whi le others have not ' l t

u i i "ot"" down to that o ld song and

Oance ent i t ted " l t 's not mY faul t '

totlon" else has to act before I can'"

CIR has f i led a last steP gr ievance

witn tne Ci ty and every Ci ty hospi ta l

"nO I t PreParing to demand binding

arOitrat ion' to force payment of . a l l

monies due. In the meant ime' house

staff officers can help expedite pay-

ments. l f You are s i i l l owed COLA

money or know someone who has left

the P'aYroll and has not received

bor-h foton"y please notify bolh CIR

"nO tn" nospi ia l 's Personnel Director '

tn orOer to obtain a COLA check

""nO yout name, dates of City employ-

ment,- the name of the hosPital Youworked at , your social secur i ty number

"nO yout current mai l ing address to:

OaviO Stotow, C. l 'R' , 386 Park Ave'

So-, f . f .V. , N'Y' 10016' Once this infor-

tu i ion is received, a c la im wi l l be

suOmit ted bY CIR on Your behal f '

Meanwhile Back at Flower

Despite the dispersal of the Flower

nousei tat t , CIR is able to insure that

al l COLA money due wi l l be Paid ' . .ine nospi tu l ha's agreed to.not i ly a l l

House Statt Otficers by mail at their

last known addresses that they are ...ent i t led to a payment ' The not ice wi l l

asX nousestafi to reply by mail giving

their current mai l ing address' Al l

housestaff replying to the hospital

wi l l be sent COLA checks' To assure

in"t fto*"t has your correct address

oi"" t" cal l Mr. Harold Winkler ' Flower

Fersonnel Dept. at 860-8120' l f not

ruti it i"O call David Stolow at CIR

(212) 725-5500.

DEVETOPMENTAT MARTLAND

On October 26, 1978, the Housestaff

Oroanlat ion of The Col lege of Medi-

cin-e and DentistrY of New JerseY(HOCMDNJ) voted unanimouslY to

"t t l t i " t " wi th The Commit tee of lnterns

and Residents (ClR) ' The vote was

n"io "t

the Housestalf Organization'sf i rst membership meet ing of the year '" ' in

addi t ion to rat i fy ing the af f i l iat ion

with ClR, the membershiP aPProveo

contract ProPosals for uPcomingnegot iat ions which included:

. No out of t i t le workr Due Process and arbi t rat iono UP-giaded on cal l faci l i t ieso A signi f icant wage increaseo A shorter work weeko EverY fourth night on cal lTne first negotiating session with

the state was icheduled for November

28,1978, and the HO-CMDNJ Bar-gi in ing Counci l met November 15'

1978 at Mart land.Residents at Muhlenberg HosPital

in Plainf ie ld and Middlesex Hospi ta l .in r.r"* Brunswick recently received

Oact< pay for meals not provided.them

*ni t" 'on cal l between JulY and

f.louemOer. The hospitals have joined

the rest of the affi l iates in guaran- .ieeing free meals or reimbursementwhi le on cal l .

Residents at Rutgers affi l iatedhospi ta ls f i led a gr ievance throughthe Housestaff Organization because

they were being forced to perform . .on laf f duty more of ten than one night

in three. The problem was discussedwith the Director of the departmentand quicklY solved'

Dr.' Kenneth Casey, Vice-Fresidentof the Housestaf f Organizat ion, wi l l

aooear before the CMDNJ-East OrangeVi- p"un'. Committee to request the

abol ishing of AOD dutY for CMDNJ.iesiOents]rne Housestaff Organizationconducted a Pet i t ion camPaign, met

with the Chief of Service at the VA'

and solicited support for the issue

irot u number of DePartmental .Ch"itt"n who agreed with their

ooiit lon. The VA maintains that they

io not have the money to fi l l the

oositions if housestaff won't do it ''but Dr. Casey is confident of a

oosi t ive outcome.ln most cases housestaff and

administrators al ike are beginning to

see that a grievance Procedure can

be an equitible and orderlY waY of

solv ing problems and cur inE resent-

mentsl but there is sti l l resistancefrom segments of the administration*no n"u-" been doing things their own

way for Years'- ' t in" cbrr"ge refuses to hear a PGY

level qrievance ti led at steP lV on

behalf-of three psychiatry residents -

" "i""t and provable violation of the

"onft""t. We have resubmitted the

or ievance, but wi thout arbi t rat ion' we

ire atraiO the Col lege wi l l re ject i t .

aqui ; , totc ing the Housestaf f Organi-

z i t ion to ei ther forget the gr ievance

and tell the residents that they have

to work for less money than they .are

"ntit l"O to under the contract or take

more drast ic act ion.Aoain, the Col lege told the House-

staff- Organization it cannot fi le

orievances on behalf of residents or

Eommunicate wi th department heads

without f i rst c lear ing i t wi th the

Personnel Office' Either we have aproblem with communicat ions or the

administrat ion is saying i t is o 'k ' to

have a Housestaff Organization as long

as you don' t do anYthing' More on

this when we've had an oPPortunl IYto discuss things with the Administra-t ion.

We exPect negotiations to be

arduous, 'but wi th the af f i l iat ion wi th

CIR and with more residents jo in ing

the Housestatt Organization every day'

we exPect to come out with our

strongest contract ever'

HO-CMDNJ President,Dr. Susan Grossman.

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-t+i LY-\-E1ti ttiHPage B

PNHA Nqtionql ConferenceScheduled for Spr ing

The Annual Meet ing of the Fhysi-c ians Nat ional Housestaf f Associat ionis already being scheduled from Apri l26-29th in Chicago. The PNHA recentlymoved to 1029 Vermont Avenue, N.W.,Sui te 308, Washington, D.C. 20005.For fur ther informat ion about PNHA,write them or call CIR (212) 725-5500.

PNHA ond ResidentPhysicion SeclionNominqle FMG Rep

The Physic ians Nat ional Housestaf fAssociat ion has concurred with theResident Physic ian Sect ion of theArncr ic: : : i l4cdical Lsscciat icn in ncrni-nat ing Dr. Shiban Ganju to succeedDr. Russel l Samson as a representat iveto the Board of Trustees of TheEducat ional Commission of ForeignMedical Graduates.

PNHA First BorgoiningUnit for Docs in DC

The Distr ict of Columbia Board ofLabor Relat ions cert i f ied the House-staf f Associat ion of D.C. GeneralHospi ta l (an af f i l iate of PNHA) as thebargaining agent for the 193 internsand residents and fel lows at theDistr ict of Columbia hospi ta l . Accord-ing to the Labor Relat ions Board, th isis the f i rst bargaining uni t for doctorsin the Distr ict government.

CHICAGO AND tOSwrN PA4ENT CARE G

Interns and residents al l over thecountry share the same concerns asCIR members. Unfortunately, House-staf f in Cook Couniy, l l l inois and inLos Angeles had to str ike to show theval id i ty of their demands for improvedcondi t ions, but gair is were won andincluded in the contracts which wereeventual ly s igned.

The Los Angeles Joint Council oflnterns and Residenfs reoresents morethan 2,000 housestaf f . Their contractprovides that hospi ta l managementand the JCIR recommend the estab-l ishment of a "Qual i ty Pat ient CareFund" by the Los Angeles Departmentof Heal th Services. This mi l l ion dol larfund is to be administered by theindiv idual hospi ta l administrators onthe advice of " teams" of medicalstaf f and housestaf f of f icers. Besidesthe pat ient care qual i ty fund, theL.A.-JCIR contract contains manyprovis ions implement ing demandsfami l iar to local housestaf f : theseinclude 24-hour lab services, upgradedemergency room faci l i t ies, improvedEKG services, adequate nursing staf f ,interpreters, and serviceable equip-ment.

the Cook County House StaftAssociat ion in Chicago has in i tscontract obl iged the Cook CountyHeal ih and Hospi ta ls Commission toestabl ish minimum standards and a setof long-term and short- term goals tobe reached in that County 's hospi ta l .A Medical Care Review Commit tee of

meets regular ly wi th lCook CountyCommission representat ives ( two ofwhom must be members of the medicalstaf f who have pat ient care responsi-bi l i t ies). The purpose of the MedicalCare Review Commit tee is exclusivelythe improvement of the del ivery ofmedical care at Cook County Hospi ta l ,including the monitor ing of the estab-l ished minimum standards, and imple-mentat ion of the long and short- termgoals.

Short term goals ment ioned in theCook County housestaf f contractinclude: improved avai labi l i ty of EKGand blood gas services; t imely com-plet ion of lab reports; a.val labi l i t ) , ofemergency radiology services:adequate equipment in EmergencyRooms; 24-hour avai labi l i ty of sup-port ing paraprofessional personnel ;interoretat ion and translat ion services.

Long term goals include: improvingthe overal l qual i ty of emergencyservices, improving the admit t ingprocedures and staf f ing; upgrading thegeneral wards; provis ion of ward lab-orator ies where appropr iate, equippedwith speci f ied standard i tems;improvement of record avai labi l i ty incl in ics; improving the responsivenessand avai labi l i ty of radiology services;upgrading the organizat ion and avai l -abi l i ty of medical records; and pro-viding a pharmaceut ical service thatis administered in accordance withaccepted "ethical and professionalpract ice."