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"There was this guy in his 20s, who fell off a scaffolding and had 14 broken bones in his arms and legs," she explains matter-of-factly. "I picked up the chart and it said, 'crutches and splint and send home.'
"OK, he had a splint on one arm. The other wrist was sprained. He had a broken ankle and his other leg broken ... there's no way this guy could walk on crutches. Plus, he's in and out of consciousness because of the [pain] medication.
"This guy was going to go home in the back of a pickup truck with his friend. He had to have a bedpan and a urinal and a hospital bed.
"I told the ER doctor, who fortunately agreed with me. I heard him on the phone saying, 'Just how many broken bones does it take to get somebody admitted nowadays?' "
And, of course, there is no such thing as a routine day in the emergency room.
"If I'm in triage starting at 3 p.m., I might not have a second [nurse] until 6 p.m. If there are four or five people waiting ... and here comes an ambulance in with a heart attack patient. I have to go to the heart attack patient. And I have to go get the charge nurse to help out, and I have to get the most stable patients out of there and into another room. There might be 10 people in line.
"It's my responsibility to keep an eye on that line and see if there's anyone who is really sick or bleeding from the head or what have you. I've got to take them in order of their condition," Cosazza explains.
"And somebody is in the ambulance entrance saying, 'Can you help me to go to the bathroom?' What am I going to do as a responsible nurse? I'm going to have to tell them, 'I can't help you right now.' And sometimes I don't even have time to tell them that. It's perceived as inattention and rudeness, and people think we don't care."
In business theory, this predicament is known as the "speedup effect." Fewer workers must do more things. In health care, though, the speedup effect is not theory but reality, and it's challenging the professional practice of nursing. Registered nurses are required by state law to advocate for patients and to exercise independent clinical judgment. It's part of their license as nurses. This charge makes nurses officially sanctioned whistle-blowers, a status that is particularly annoying if you're a health care conglomerate and want to admit fewer patients and assign more and more routine tasks to unlicensed staff.
The more health care corporations restructure, the more nurses are squeezed by the push for profit. And so, three decades after becoming a nurse, Nancy Cosazza spends her time speaking at legislative hearings, and handing out leaflets to strangers. And standing in the bed of a pickup truck outside a hospital with a microphone, saying,
"Do we know why we're out here and not in there where we should be?
"Corporate tyranny."
Throughout the first few months of this year, the residents of Castro Valley were inundated with television commercials about the caring world of the Sutter/CHS Corp. They received brochures in the mail telling them that Sutter could "save" their community's Eden Medical Center -- a publicly owned hospital governed by an elected board of directors -- from fiscal pressures that were jeopardizing its very existence.
Because Eden is owned by a hospital district, and hence the public, Sutter's bid to purchase it required a vote of the people. The proposed purchase also required Sutter to overwhelm opposition from unions, specifically, the Service Employees International Union. Sutter and the SEIU are archenemies. There is a history of bitter labor fights at other Sutter facilities. The SEIU was not about to let Sutter take over management of another hospital where the union represented employees without a fight.
The union managed to garner support from both the Republican and Democratic central committees, the California Congress of Seniors, the California Physicians Alliance, the Alameda County Firefighters, and a handful of local politicians.
But Sutter had a better weapon: money. Big money. The corporation spent more than $1 million on its campaign in favor of the purchase, outspending the union by about 6-to-1. Aside from television commercials, the money paid for advertisements in local newspapers, more than 15 mailings to prospective voters, and professional phone solicitors. It was the kind of electioneering generally reserved for statewide races.
The campaign worked. On April 22, 54 percent of those voting in the district election gave Sutter approval to purchase Eden Medical Center. And it appears to be a real deal. Sutter snagged Eden, with net assets of $52 million, for about $40 million. From now on, the Sutter corporation will take just under 2 percent of the hospital's operating budget for managing the place, which turns an annual profit of $8 million.
To say that Sutter is in acquisition mode is like saying that the Democrats were exploring fund-raising sources during the last election.
Until the mid-1980s, Sutter operated two hospitals in Sacramento. Today, the $2.5 billion corporation holds 25 hospitals, a handful of home health agencies, a health maintenance organization, 7,600 affiliated doctors, and more than 30,000 employees in its web.
That's the way the game works. And there is no place for the weak competitor.
Because of overbuilding in the 1980s, hospitals in the Bay Area average just 50 percent occupancy. Health care organizations are in a frenzy of buying, selling, and merging with each other. It is a process aimed at reducing the overcapacity and the costs of running the hospital capacity that does exist.
For-profit health systems -- notably Tennessee-based Columbia/HCA -- have shown Wall Street that bottom-line management tactics can increase profits in health care. And hospital profit margins have risen 10 percent since 1991, according to the government's Prospective Payment Assessment Commission.
