Asserting that recent policy proposals would jeopardize their ability to provide patient care, unionised psychiatrists and nurse practitioners at Cornerstone Montgomery, an independent behavioural health care provider with dozens of locations throughout the Washington, D.C., region, are accusing management of unfair labour practices.
Psychiatrists and nurse practitioners claim that Cornerstone Montgomery has attempted to “dramatically” increase the number of appointments on their calendars, which would limit the amount of time each behavioural health care provider can spend with their patients and the frequency of their visits. They are represented by the healthcare worker union 1199SEIU.
A union member told DCist/WAMU, “We’re not even able, right now, to handle the amount of clients we have.” Montgomery County people cannot be served, and we fear that the situation will only worsen. Speaking to DCist/WAMU as a collective union, current Cornerstone Montgomery employees expressed their concern that individual identification would jeopardize their employment.
The majority of Cornerstone Montgomery’s patients are underinsured or uninsured, and many of them rely on Medicare or Medicaid to get behavioural health services. Practitioners there frequently treat locals with serious mental diseases.
In addition to operating residential programmes throughout the county, Cornerstone Montgomery also provides community-based services like permanent supportive housing, outpatient mental behavioural health clinics in Bethesda, Silver Spring, and Rockville, and crisis centers, which function essentially as an alternative to emergency rooms for people experiencing mental behavioural health crises.
Practitioners told DCist/WAMU that since the region’s COVID regulations loosened in 2021, they have seen a “progressive degradation” in Cornerstone Montgomery’s capacity to treat patients. This has ultimately prompted them to formally unionize earlier this year. The problems that led psychiatrists and nurse practitioners to organize, such as fatigue, a lack of meaningful involvement with management and clinical staff, and worries about patient care, have not changed.
They assert that management’s most recent endeavour to boost their patient loads only serves to further compromise their capacity to deliver the highest calibre of service. Members of the unit, some of whom have worked for the organisations for more than ten years, stated, “We felt that we were not being heard, and we felt that we had no say over what sort of care we provided our patients.”
According to Leyla Adali, a communications representative for the 1199SEIU in the D.C. area, when management initially tried to raise patient loads and shorten appointment visit durations, the unit demanded that management give a justification for their actions. The union asserted that management is unwilling to engage in collective bargaining with its employees and filed a complaint with the National Labour Relations Board in early June after never receiving that response from Cornerstone leadership.
Adali told DCist/WAMU that “this is all kind of happening because they don’t actually want to solve this through unionization.” “They want to impose it all at once. They refuse to discuss this as a part of the union contract, despite the fact that we obviously have some influence in the union.
Practitioners’ waitlists and patient loads have grown over the last two years, placing a strain on their own job and jeopardizing the region’s wider continuum of care for residents.
Cornerstone Montgomery may be recommended to patients who are discharged from a hospital following a mental behavioural health crisis, but due to high patient numbers, the organisations hasn’t been actively accepting new patients. According to a unit member, if one of their clients skips or cancels an appointment, they won’t be available for two months.
The union member claimed that “high patient volumes in a day lead to eroded clinical alliances […] lower quality of care, loss of individualized care, and lower patient and clinical satisfaction.” A spokesman for Cornerstone Montgomery stated in an email that they were unable to comment on ongoing legal or administrative proceedings but added that management would “continue to bargain in good faith with 1199SEIU.” On the NLRB website, the complaint is posted as open and active.
“Cornerstone Montgomery has always considered and valued the input and feedback provided by prescribers as it relates to patient care,” the statement read. “Cornerstone Montgomery will do so in the limits of its newly established bargaining relationship with 1199SEIU,” the statement reads.
Supposed anti-union strategies
A second complaint against the provider was also submitted in June and concerns the dismissal of a long-term employee for participating in union organising. Patrice Davis, a psychiatric nurse practitioner with more than 20 years of experience, claimed to DCist/WAMU that during the six years she spent working at Cornerstone Montgomery before she was unexpectedly let go at the end of December 2022, she never once received a negative review or disciplinary action. From around July 2022 until she was fired, Davis had been in charge of her team’s unionisationdrive.
Davis said that she was informed in November 2022 that she was ineligible to apply for a vacant chief medical officer post. She was summoned to a meeting with the CEO and director of human resources at the beginning of December, where she claimed she “felt forced to confess” that she was one of the unionising leaders.
According to Davis, Cornerstone Montgomery leaders instructed her to review her private text conversations with coworkers discussing union action and send screenshots. Davis was fired two days after being informed that the discussion was private.
On Friday, which is always my day off, a coworker texted me to inform me that I had been fired, according to Davis. Her immediate termination had been announced in an email to her employees. The most upsetting aspect of that experience was not being able to say goodbye to my clients and leaving them in the dark about why I had to go so suddenly. For financial, legal, and continuity of care considerations, I wasn’t allowed to continue drafting my clinical notes.
Following up through email, Davis claims she was promised a response but never received one. She had asked if there was a way she could complete the clinical documentation and notes that were required for the client’s invoicing and casework. She was not yet covered by a collective bargaining agreement when she was fired since the union had not yet been established, but Davis is proud of her former coworkers for continuing to fight for a seat at the table.
“It’s really a silver lining knowing that my coworkers now have that protection,” she added. We felt as though we had no other option or recourse because of it. A representative at Cornerstone Montgomery declined to comment on Davis’ particular situation.
The labour dispute at Cornerstone Montgomery follows numerous other recent union drives at significant healthcare facilities in the Washington, D.C., area as staff members fought for better pay and working conditions during the COVID-19 issue. A rising number of residency programmes across the US are now unionised after George Washington University Hospital’s medical residents won their union election earlier this year. After months of alleged anti-union agitation by Universal Health Services, the organisation in charge of managing George Washington University Hospital, the nurses at GWUH won their union election over the weekend.