Concerns About OHSU-Legacy Merger Fueled Strike Vote, Nurses Say

ONA says the union is asking for more information about nurses’ working conditions after the merger goes through.

Share this article!

Erica Swartz wasn’t surprised by the wide margins of this week’s strike authorization vote against Oregon Health and Sciences University.

What was surprising, according to Swartz and to leadership in the Oregon Nurses Association, was what preceded it: OHSU’s August announcement that it intends to merge with Legacy Health Systems.

Swartz, who works in the pediatric oncology department at OHSU and as co-chair of the hospital’s staffing committee, says the merger announcement — exactly one week after nurses declared an impasse in their ongoing contract negotiations with OHSU — took nurses by surprise and has created uncertainty and mistrust between nurses and management. When the merger was announced, OHSU nurses and management had been engaged in bargaining since December of 2022 over safe staffing levels, compensation and other issues.

Nearly 3,000 nurses at OHSU voted to authorize a strike against the health care provider Monday: 95% of those who participated in the vote favor a strike, and 96% of union nurses at the hospital voted.

ONA spokesperson Kevin Mealy told Oregon Business that in April, the ONA bargaining team asked OHSU’s chief financial officer if the hospital aware of any major acquisitions on the horizon, and that nurses were told no.

“[That] was in April and in August, they announced this merger with Legacy so obviously that was already in the making. I think the other piece behind that is there’s a little issue of trust, in this particular discussion, but also more broadly,” Mealy says. “If you weren’t as open about that merger at that point, then we definitely want a backstop or something written in the contract that we will have a role, and not just the CFO or someone else from the executive suite saying ‘Yeah, you’ll have a say; we’re very interested in your input.’”

Sara Hottman, associate director of media relations at OHSU, told Oregon Business over email that OHSU notified members of the merger once the letter of intent was finalized in August. Now OHSU and Legacy Health are in the due diligence phase of the nonbinding letter of intent, and she says they expect to have a definitive agreement by December of this year. Hottman provided an FAQ about the merger, but did not directly address Mealy’s claim about the CFO’s April comments.

Swartz says she has questions about how her future at the company will look under the combined health care system which OHSU has not yet answered, and could impact the delivery of care to patients.

“So far, OHSU has provided no information to us about how our work environments may change,” Swartz says. “At the bargaining table we have been asking for a memorandum of understanding, which is management agreeing with us that if and when the merger happens, they will return to bargaining and work it out with us if our working conditions were to change. They have not been willing to do so, and have expressed sentiment that it is their administrative right to do as they see fit.”

Mealy says that while the ONA is still “cautiously optimistic” about the merger but that in general, health care mega-mergers lead to fewer services and higher costs for patients. According to a 2023 literature review by the health care research nonprofit KFF (formerly known as the Kaiser Family Foundation), a growing body of evidence shows that consolidation in health care provider markets has led to increases in prices without clear evidence of increases in quality.

The quality of care at hospitals acquired during recent waves of consolidation either got worse or stayed the same, according to a 2020 study led by Harvard Medical School published in 2020 issues of the New England Journal of Medicine.

Mealy says having a front-line voice during the process of merging the two healthcare systems means patients and workers will have an advocate as the healthcare systems go about the restructuring process.

“I think there’s a sense that having a frontline voice during that merger process, looking at the details and how we work through combining two different systems with two different sets of standards and ways of working, is going to be very important to make it successful and  something that’s actually good for patients and nurses, as opposed to what we’ve seen across the board, which is that mergers haven’t delivered what they promised.”

The nurses’ contract expired June 30, and the two sides have now completed the required 30-day cooling off period after the impasse declared in August. The union is required to give OHSU 10 days’ notice before calling a strike.