A year ago, 18 nurses and four doctors staffed the labor and delivery unit at one of Gallup’s two hospitals. Today, all the nurses are gone, and the last doctor announced her resignation two weeks ago.
The unit closed last week, forcing many soon-to-be parents to find a faraway delivery room and making it harder for women to access health care in Gallup, N.M., and the surrounding area. When it was open, the nurses and four obstetrician-gynecologists delivered between 30 and 40 babies a month, many of them to mothers who come from rural areas like Navajo Nation and Zuni Pueblo.
The unit’s closure might seem like just another casualty of the statewide nursing shortage, one that’s hitting many rural hospitals just like Rehoboth McKinley Christian Health Care Services in Gallup. While former nurses and physicians in Gallup say there are some similarities driving shortages here, they stress there are also some important differences.
The biggest is what they say is a culture of fear and intimidation at the hospital, one that’s intensified in recent weeks as a group of doctors organized to form a labor union and following the firing of a respected Navajo doctor. They accuse an out-of-state company of extracting profits from the hospital, which has harmed patients and driven away longtime staff who had no intention of leaving.
“We are mourning,” said former nurse Sara Pikaart at a community meeting Saturday about hospital issues. “Women come up to me with tears in their eyes. They ask me what is going on there, and where are we supposed to give birth?”
On Oct. 1, doctors voted to become a labor union aligned with the national Union of American Physicians and Dentists. Representing about 25 physicians, it’s the first physicians’ union in the state. The vote was 14-9.
They are demanding a new local CEO, better working conditions, an end to the out-of-state management contracts and more transparency from the Board of Trustees, whose meetings are held in secret, their minutes not released.
The newly formed union is the latest escalation in longstanding tension between employees and administrators at the hospital.
When the Navajo Nation was the epicenter of the coronavirus pandemic early last year, staff and community members gathered in public protests, saying the CEO was forcing employees to work in unsafe conditions.
The CEO, David Conejo, was fired in June 2020, and an audit by State Auditor Brian Colón found in August 2020 that Conejo’s compensation was excessive and that the then-chair of the Board of Trustees got a $250,000 contract for HVAC repair without a bid, among other findings.
In August 2020, the hospital board hired Community Hospital Consulting, a company based out of Plano, Texas, to take over management and placed a senior vice president there, Don Smithburg, to take over as interim CEO the following month. He splits his time between Gallup and Kansas City, Miss., according to the Gallup Independent.
Smithburg told the Independent in May that he inherited a “perilous” financial situation at the hospital, one caused by previous mismanagement and the suspension of elective procedures when the hospital was beating back a ferocious wave of COVID-19 infections.
In July, Smithburg announced 80 hospital employees would be laid off, citing the revenue shortfall. Around that time, Dr. Caleb Lauber was fired and Dr. Andrea Walker, chief of the OB-GYN department, resigned.
Lauber, who says he’s the only doctor at the hospital who speaks Navajo, has since said he was fired in retaliation for being outspoken — and to prevent him from making a bid for CEO.
“In my own personal opinion, I felt that Don Smithburg really did a horrible disservice, not only to the community, but to the Native people that I was serving as well,” Lauber said at a Saturday community meeting.
Walker also quit when she feared she would be fired for being similarly outspoken, according to organizers.
Alarm bells out of order
The departures of Lauber and Walker sparked the unionization attempt, employees said, but issues had been simmering for a long time.
Since the layoffs, health care workers at the hospital say they’ve repeatedly asked to speak with management about poor conditions there for patients and staff but have been ignored.
The hospital’s call system went down months ago, for example. Patients in distress can no longer press a button to hail a nurse. Instead, they ring a bell.
“The bells were of no use if the patient was coding or otherwise in extreme distress,” according to a statement from the union. “After being told by CHC management that they would have to wait until the end of 2021 for a new call-light system, the doctors pooled their money to purchase a temporary call-light system but were prevented from installing it in the hospital themselves.”
CEO Smithburg, in a statement, said installing the nurse-call system is a priority, along with implementing a new electronic records system and increasing efforts to recruit and retain staff.
“We will continue our intense focus on the challenges and opportunities that lie ahead,” he said. “Right now, that means stabilizing the hospital’s financial outlook and quality assurance programs after years of mismanagement.”
The successful union effort has been weeks in the making and overcame what employees described as union-busting tactics. Dr. Christopher Hoover, a urologist, said he was required to sit through hours of training by a consultant the hospital hired to discourage employees from unionizing.
The consultant told attendees he was paid $425 an hour, Hoover said.
“That’s what the money went toward instead of trying to fix the problem,” said Dr. Connie Liu, an organizer and physician at Gallup’s other hospital. “They saw the physician union or people speaking up as a problem.”
Organizers paid to publish a petition Sept. 25 drumming up support for the union in the Gallup Independent. It listed signatories.
An administrator pulled an employee aside last week and said administrators were looking through that list to identify even relatives of employees who may have signed the petition, the worker told Source New Mexico. (The worker asked to remain anonymous for fear of retaliation.)
“I was taken aside in a group and warned that not only is administration looking for staff member names but also family member names on anything related to petitions or unions,” the employee said. “And that, if found, we would have to explain.”
The employee interpreted the interaction as a “scare tactic” aimed to “keep us in check.” Union organizers said they heard from other workers who experienced the same tactics. Trying to intimidate workers out of joining a union could be a violation of the National Labor Relations Act, said Rachel Flores, a representative with the national physicians and dentists union.
Don Smithburg, CEO of the hospital, denied that any administrators tried to intimidate union supporters.
“That absolutely did not happen and would not happen,” he said. “A complete fabrication.”
Steve McKernan, chair of the hospital board, issued a statement on Aug. 23 opposing a union that he said would reward physicians who are already highly paid and would pit unionized physicians against other health care workers.
“We fear that a physician bargaining unit at our hospital will only undermine a true sense of community by demanding rights, privileges and considerations for themselves at the expense of nursing and other colleagues at the hospital,” he said.
But the union countered that their effort was never about increasing physician pay and instead is a way to organize to improve patient outcomes.
“We hope to improve conditions for all staff,” the union said. “We encourage all staff to form a union, as well.”
McKernan is the former CEO of the University of New Mexico Hospitals and was paid $150,000 per year for over two years to stay home after being terminated. He received these payments through the pandemic until June 2021, the Albuquerque Journal reported.
‘Just a huge travesty’
Dozens of employees and community members gathered at a Methodist church near the hospital for a town hall meeting on Saturday, Oct. 2, about the recent closure of the labor and delivery unit and successful unionization effort.
Dr. Hannah Palm is the last OB-GYN at the unit. She announced her resignation a couple weeks ago, effective mid-December. Three others quit ahead of her within the last year.
On Sept. 22, she was informed that a shift was coming up in which there were no nurses available. The bare minimum is two nurses per shift, she said.
“My biggest fear was that a patient would show up who was high-risk,” she said. “We’d have no nurse, and then have, you know, a poor patient outcome.”
So she and hospital executives decided to close the unit. That means patients who’d spent nine months preparing to have a baby at the hospital this month had to scramble to find another hospital, typically in Albuquerque 130 miles away.
Palm said the last straw was when Walker, her mentor, resigned, and she saw how staff at the unit got “zero respect.”
It’s possible the unit will be up and running again in the next few weeks, but that depends on how quickly executives can bring in new nurses. She said the hospital will need at least four.
The nationwide nursing shortage means traveling nurses are in high demand, so the hospital could have to pay huge salaries to staff an entire unit again. The hospital appears to have already posted a want ad, offering more than $4,000 a week for a 13-week rotation.
Until then, a person with an emergency pregnancy will be diverted to an improvised section of the emergency room without specialized staff.
It could all have been prevented, Palm said. It’s a violation of her oath, she said, to not provide safe care to patients who need it. So she felt she had to resign.
“We had a really solid group of four OB-GYNS, and so we wanted to stay here,” she said. “Losing all four of them was just a huge travesty. And that’s very specific to the mismanagement here.”