BRATTLEBORO — Donning masks and holding handouts, a group of community members joined former and current Brattleboro Retreat staff at a rally on the Town Common last week.
The United Nurses & Allied Professionals Union, Local 5086, held the June 4 gathering to highlight concerns it has about staffing at the psychiatric hospital.
Specifically, the union members who spoke say that being among these ranks has “put a target on our backs” and has led to unfair firings of several key union leaders.
The final straw, said Robert Smith, interim union president of Unit 2, was the recent firing of union member Sy Creamer.
According to the union members, Creamer, the president of Unit 1, was fired in late May, based on “trumped up allegations of HIPAA violations.” In a press release from the Retreat, management called Creamer's handling of some patient information “egregious.”
HIPAA - the Health Insurance Portability and Accountability Act - is a federal law that protects patient privacy.
At the rally, the union members also called for the hospital to fire Meghan Baston, the Retreat's chief nursing officer (CNO).
“Evidently, there is no limit to the destructive behavior of Meghan Baston,” union leaders wrote in a June 1 letter to its membership, saying her ouster would “excise the cancer she has become on the Retreat.”
This is not the first time union members have raised concerns around staffing levels at the hospital. During multiple informational pickets outside the Retreat during the summer of 2018, members discussed their concerns that low staffing levels were leading to decreased safety for both staff and patients.
At the time, the members and the administration were negotiating the union's contract, ultimately signed in November 2018.
At this month's rally, Creamer charged that, over the past three years, the hospital has gone from being an employer with a good reputation to a place where no one wants to work.
For its part, the administration has raised issues with the state around funding connected to staffing issues. According to union members, the Retreat has lost approximately 335 staff members, with 140 leaving since January.
In the administration's view, a struggle to find permanent staff has meant that the hospital has needed to spend more money on traveling nurses and doctors. Last year, the hospital spent approximately $8 million on temporary staff.
Stepping back from the recent flurry of press releases and press conferences, the discord between staff and administration is at best an $8 million problem for one of Windham County's largest employers.
At worst, it creates strife for the staff, the administration, and the patients at a place intended for healing.
Seeing a disconnect
As people gathered around, Smith said the Retreat faces multiple problems.
But the biggest issue “is that there's a disconnect, and that disconnect has gotten worse over the last three years,” he said. “That's why we're here.”
Smith outlined the union's concerns, which included chronic staff turnover and its consequences: low morale and compromised patient safety because of a lack of core staff.
The union says the Retreat is using mandatory overtime (sometimes called mandates) and contract labor to compensate for low staff numbers, despite a patient load that has dropped in the time of COVID-19 from just over 100 to approximately 70.
The union also says the administration “totally botched” preparation for the pandemic and charges that the hospital was “incapable of protecting staff and providing personal protection equipment.”
Finally, the union has accused the Retreat of “unusually harsh” disciplinary proceedings for staff and comparatively lenient proceedings for members of the administration.
The administration operates without enough oversight, Smith said, “so the discipline used frequently by this administration is you make a mistake, then you become a liability, because you might make another mistake. Therefore, we will fire you.”
Smith also outlined multiple times the management - with a focus on Baston - had retaliated against union members. In turn, he said, the members had grieved the situations and won.
For example, Smith mentioned a manager's meeting where the managers joked about a staff nurse's genitals, prompting a lawsuit.
Needing a culture change
Creamer, who remains the union president despite the fact that she no longer is an employee, says she still speaks with her former rank-and-file colleagues past and present.
She admits to emailing patient information to herself, but said she did so only because she was in the process of documenting issues at the Retreat. According to management, in doing so, Creamer violated hospital policy and privacy laws.
“The union is very much about the Retreat,” she said. “We want to take care of our patients. We want to provide excellent patient care. We want positive patient outcomes.”
Creamer continued, “It is almost impossible to do when you do not have enough staff to provide patient care.”
While describing her recent experience at the Retreat, her eyes water and she seems frustrated.
She said that union members used to tell her regularly that “there's a huge target on your back that gets bigger every day,” she said.
An example of this retaliation: “There were three employees who were on television last year, and we had pickets - all of them were very quickly targeted and either terminated or forced out,” she said.
Creamer herself said she was investigated four times in six months. She said her manager would tell her that someone had filed a complaint but then receive little to no additional information.
“Really, people in the union feel like, 'I can't stand up for myself in the unit because then I will be targeted,'” she said. “It's a really scary place to work, because people are afraid.”
That wasn't always the case, she said.
Creamer started working at the Retreat in 2013. According to her, at that time, staff felt valued and supported. The hospital had a reputation as a great and attractive place to work, she said.
“We felt like we were treated as expert caregivers giving quality care,” she said.
Things changed in 2018 when management announced changes to staffing coverage that was referred to at the time as a “matrix.”
“That does not make anybody feel like they're a valued employee,” she said. “We are not units in the matrix. We are people trying to provide compassionate care.”
According to Creamer, the admissions department used to have 12 registered nurses. Now, one remains. Eight licensed, independent practitioners also worked at the hospital. Now, none do, she said.
Creamer also believes Baston deliberately rid the Retreat of all of its licensed practical nurses (LPNs).
“The reputation in the community, and it's pretty significant, is that it is not a good place to work right now,” she said.
“Definitely COVID makes it difficult,” Creamer admits. “Definitely, the day and the times make it difficult. There absolutely is a national [nursing] shortage, but this is above and beyond a national shortage.”
“They spent $8 million on contract labor last year,” she said. “That's an awful lot of money for a little tiny hospital.”
In a press release from the union denouncing the firing of Creamer and announcing the press conference to call for Baston's removal, Smith said that Winston Salisman, union Unit 2 vice-president, was fired in November after becoming a foster parent and taking in “a child who had a history with the Retreat.”
“He immediately notified the administration at the Retreat of the situation, and asked for their input,” Smith wrote. “When the foster child was placed with his family, Salisman was immediately fired for violating Retreat policy.”
Smith also wrote that Unit 2 Vice-President Ed Dowd was “'relieved of duty' in April, two weeks before he was to go on medical leave, because members of the administration “did not like the tone of Dowd's response to one of their emails.”
“Prior to that, Dowd was improperly disciplined and threatened with termination for exercising his legal rights as a union steward,” he continued. “He won his case in arbitration.”
Refuting the charges
In a press release, the Retreat disputed the union's assertions.
“Although it is the Brattleboro Retreat's normal practice to refrain from commenting on personnel matters, the fact that the Union has decided to publicize certain personnel issues compels us to respond and correct the record. Public statements from the union are replete with inaccuracies and mischaracterizations,” they wrote.
The Retreat stressed that four union members mentioned at the rally were no longer employed for specific reasons.
Creamer and fellow former staff member Winston Sailsman were fired for policy violations, the statement said.
“Furthermore, before his termination, Mr. Sailsman was urged to contact the Retreat compliance officer and check HR policies before going any further with plans to foster a child he was in contact with at the Retreat,” stated the press release. “He did neither and went ahead on his own and violated a clear Retreat policy.”
And according to the Retreat, Edward Dowd is still employed at the hospital, though Dowd told The Commons that he had been relieved of duty. A fourth union official resigned, according to the hospital.
“These issues are about individual employee performance and egregious violations of Retreat policy,” the Retreat wrote. “The management of the Retreat is not anti-union; we are anti-incompetence.”
In responding to union concerns about the hospital admitting out-of-state patients during COVID-19, the hospital wrote, “We can say that, since COVID-19, the Retreat clearly stated and followed through with its intention to prioritize the mental health and addiction needs of Vermonters.”
“A very small number of patients from out-of-state have been admitted when they had no other options for care and had been medically cleared of COVID-19,” said the press release.
In the press release, the Retreat called the number of grievances the union had filed a problem of the union's own creation.
“It is disingenuous for certain individuals to bemoan a grievance caseload burden that they created,” The Retreat said. “The union grieves nearly every disciplinary action and termination that occurs at the Retreat, regardless of the merits.”
What isn't working?
While representatives from the union and Retreat both seem to be talking at each other, they share one common message: something has to change.
In Creamer's opinion, people aren't leaving because of pay. They're leaving because of the hospital's culture.
Those former employees now “drive farther and take less money because they just could not take the culture anymore,” Creamer said. “The culture needs to change.”
In its June 1 letter, the union leaders pointed out that the state eventually honored a request from the hospital for additional funding to cover costs.
In April, the state provided an additional $7.3 million to help the hospital weather COVID-19, which had upended the hospital's finances, just as the pandemic had done to so many other businesses and nonprofits in Vermont.
“It's fair to ask, what good is the additional money when the Retreat can't staff the units and when staff have no confidence in or respect for the Chief Nursing Officer?” wrote the union leadership. “It's time [Retreat CEO] Louis [Josephson] showed some leadership and fired Meghan Baston. If not, he should resign along with her.”
In responding to the union, the administration said that “thankfully, the vast majority of Retreat staff members are caring, hardworking people, and we are lucky to have them.”
“The future sustainability of the Retreat hinges directly on our collective ability to continually raise our standards of performance to allow us to best serve the needs of society's most vulnerable citizens,” the administration continued. “Sadly, there are some who are not so committed to the Retreat's patient care mission.”