In the latest development in an ongoing rift between nursing union leadership and the St. Joseph Health administration at Petaluma Valley Hospital, nursing union reps say that despite a recent concession from hospital administration, they do not want St. Joseph to continue running the hospital.

St. Joseph administrators, meanwhile, say that they do not believe the union leaders' stance is reflective of the entire nursing staff, adding that they are listening to the nurses' concerns and seeking input from many community and hospital members to improve hospital operations.

The Petaluma Health Care District, which owns the hospital and leases it to St. Joseph's, recently announced that it has begun to analyze St. Joseph's management as it nears the expiration of its lease agreement in January of 2017. The district has several options with regard to PVH, including putting its lease out to requests for proposals from local healthcare providers, renewing its lease with St. Joseph or operating the hospital itself.

"All we hear from St. Joseph is they are bleeding red ink and have to continue making cuts," said Petaluma Valley registered nurse and union representative Kitty Brown, who has been a nurse for 48 years. "If you haven't been able to make the hospital profitable by now, and you are cutting staff and pay to the point where conditions are no longer safe for patients, then why should the district give you another 20 years?"

Brown was referring to negotiations that took place in the spring of this year over pay and scheduling. The negotiations between PVH nurses and the hospital management team broke down after months of disagreements and led the hospital to declare the talks at an impasse in May. This allowed administration to decrease pay for nurses who take "on-call" shifts — where they can be called into work at a moment's notice on their days off — from 50 percent down to 30 percent of a nurse's normal salary without further negotiations.

PVH nurses filed a claim with the National Labor Relations Board, contending that the hospital illegally implemented the changes. They also staged the hospital's first ever strike, a one-day walkout held on June 13. The claim dragged on for months, and finally ended on Oct. 23, when the hospital decided to return the on-call wage to its former rate and pay the affected nurses back pay for the past five months — a move PVH administrators said was less about the legality of their decision and more about the financial expense of fighting the claim.

"We felt that we did everything legally and continued to stand by that throughout the summer," said Debra Miller, vice president of Human Resources at St. Joseph Health. She added that contract negotiations between the hospital and nurses will resume on Nov. 7 and that on-call pay will likely be up for renegotiation.

Hospital administrators had said previously that, with the Affordable Care Act reducing reimbursements to the hospital, they would need to find ways to cut costs, and that if they did not reduce on-call pay, they would have to look at possibly eliminating nursing positions. While they are not currently looking at cutting positions, Miller said that the hospital will continue to analyze hospital operations and hopes to reduce its costs over the next year.

The doctor's group that contracts with the hospital also expressed some dissatisfaction with St. Joseph, but said that overall the partnership was working for them and that they planned to stick with it, according to Physician Director Dr. Michael Johnson.

He added that the nurses he has spoken to do not share the union leadership's criticisms of St. Joseph's. He said that the union leadership and a select group of nurses who agree with them are split from the rest of the nursing staff: "I don't think the other nurses — the nonsurgical nurses and those outside of union leadership — see a big issue with St. Joseph," he said.

St. Joseph's tenure at Petaluma Valley has included periodic disagreements between staff and management over a variety of issues. Both in 2008 and 2010, a group of doctors voiced concern over St. Joseph's management of PVH, including their perceived inability to recruit doctors. Since St. Joseph's brought in Annadel Medical Group to assist with recruiting doctors and created a contract with the physicians to manage the hospital's operating room, physician concerns appear to have been placated.

Dr. Johnson said that most PVH doctors have learned to work with the health care provider and do not feel changing hospital management would benefit them, primarily due to their profit-sharing deal with St. Joseph.

"I think the doctors believe that St. Joseph's is the devil they know and they've learned how to deal with them," said Dr. Johnson. "It's a known commodity among the doctors — not a liked commodity, but a known commodity."

District CEO Ramona Faith said that the nurses' input will be considered, along with input from other hospital employees, physicians, businesses and community leaders in their decision regarding the lease.

(Contact Janelle Wetzstein at janelle.wetzstein@arguscourier.com)