American Academy of Emergency Medicine

EPs File Unfair Labor Practice Charge Against Employer

On August 22, 2000, the Seton Third Coast Emergency Physicians Association (TCEPA) filed an unfair labor practice charge against its employer Third Coast Emergency Physicians (TCEP). The Association is comprised of Emergency Medicine physicians working at Seton and Seton Northwest Emergency Departments in Austin, Texas.

The charge claims that TCEPA's effort to bargain in good faith has been stymied by TCEP's actions. They further allege that the employer withheld bonus payments to its physicians in retaliation for TCEPA having formed a union. In addition, it alleges that the employer's refusal to disclose certain information, including information regarding bonuses and patient collections, billing/collection costs and information related to employee performance evaluations and disciplinary action is making it impossible for TCEPA to bargain effectively with TCEP to develop a labor contract.

The physician members believe that ED quality assurance and patient quality of care suffer due to the present management style of TCEP. TCEP has placed constraints on the emergency department practitioners' ability to communicate their concerns with the nursing staff and hospital administration. These constraints limit the working physicians input and advice on how to improve emergency department activities. This has ultimately had a detrimental impact on patient care as well as physician satisfaction.

The physician employees are attempting to arrive at a contract that would ensure fair compensation and improve physician and patient satisfaction in the emergency rooms. They contend that a fair contract would benefit the physician employees, TCEP, Seton Health Care, and most of all the patients cared for at Seton's emergency departments.

TCEPA is attempting to negotiate a method of patient billing and resultant physician compensation consistent with the AMA's ethical position on reimbursement expressed in the American Medical News 4/27/98, p.21: "Ethical aspects of establishing a group's compensation plan hinge on ensuring that physician professional rewards reflect professional activity (patient care services) rather than such factors as ownership, longevity or name recognition, which smack of fee-splitting."

TCEP's repeated refusal to allow the physician members to have meaningful access to financial transactions of the group, including the amount collected for each physician's patient care, has made it impossible to determine whether TCEP is charging an excessive fee to both the physicians and patients involved.

In spite of repeated requests from the physicians, TCEP's owners continue to refuse to furnish information about the true extent of their profit (see story on page 28). This is in spite of policy statements and directives from the American Medical Association, Texas Medical Association, American Academy of Emergency Medicine, American College of Emergency Physicians, the Health Care Financing Administration and the Office of Inspector General that deal with the excessive diversion of patient fees/fee-splitting and the need for disclosure of billing and collections to the treating physician.

The physician employees providing patient care have limited knowledge regarding what is actually collected in their names. These same physicians have no choice but to accept the present arrangement if they desire to continue to practice their specialty at Seton or Seton Northwest Emergency Departments.

This untenable situation has provided the impetus for TCEPA members to explore other methods to affect change that would allow employee input into policies that had been arrived at in a unilateral fashion. In the process, members met with labor attorneys, Phil Durst and Martha Owen, who gave them reassurances that they had the legal right to try and improve their working conditions and that it would be illegal for TCEP's owners to take reprisals against them for engaging in any collective bargaining activity. Because of fear of reprisal by TCEP, physician employees wanted reassurance that asking for previously refused changes would not result in loss of employment. Joining in a collective manner has given the group more reassurance that they would have some legal remedy in the case their employment was unjustly terminated or "without cause," on which their employment is based. After meeting with Mr. Durst and Ms. Owen, the employees elected representatives to negotiate with TCEP's owners about their employment condition. Unfortunately, however, the owners refused to recognize the elected representatives, forcing TCEPA to go through a long and expensive process to establish the scope and legitimacy of the union that ended with the decision by the NLRB on February 29th.

TCEPA has been involved with negotiations to create a labor contract since about March of 2000. TCEP has elected to deal with TCEPA through an attorney negotiator and has not been willing to have the two physician owners meet face to face with TCEPA's representatives to resolve this issue.

Almost universally, members of Seton and Seton Northwest medical staff who have discussed the situation with members of TCEPA have indicated their support for the union's position. TCEPA's efforts are directed at improving emergency room practices and at continuing to provide the best care available to Seton's patients.

TCEPA has given reassurances to the Seton administration that they fully support Seton and in no way intend to disrupt the care provided at Seton's emergency departments. TCEPA firmly believes that forming a fair and equitable group is the best means to improve the quality of care and working environment in Seton's emergency departments. TCEPA's objectives are intended to create a fair and equitable working relationship with TCEP modeled after other democratic groups present in other medical specialties, including Emergency Medicine. TCEPA's goal, in pursuit of these objectives, is to provide quality patient care in an environment that honors Seton's values of respect, honesty, and integrity.

For further information, please contact Dr. John Calomeni at 512-795-2389 or jcalomeni@austin.rr.com. Dr. Calomeni is a representative and press contact for TCEPA. Also, information can be obtained from TCEPA's lawyer, Ms. Martha Owen at 512-479-5017 or mpowen@wdto.com.