Spring 2005

Welcome to the
Spring 2005 Edition of Nyhart HReport!
In this edition of Nyhart HReport, we are
focusing on one of the fastest emerging
topics in the healthcare industry – charity
care. Many organizations across the country
are being called on the carpet regarding
charity care policies and the amount of
money expended on charity care. We are
pleased to be partnering with Gardner,
Carton & Douglas (GCD) a Chicago based
law firm, to bring you the most up-to-date
information on this topic. We are proud to
have worked with GCD at numerous clients
nationwide. Together, we provide the most
up-to-date and thorough advice to our
clients on the topic of charity care and
pricing practices.
In this edition, you will find information on:
• Why unions and other “public interest”
groups are targeting hospital charity
care policies.
• A sample of what some organizations
are experiencing.
• What your organization can do to brace
for such an attack.
As always, we hope this edition of Nyhart
HReport is informative and useful. If you
would like more information on the
charity care issue, please contact
Adenike Shaffer at (317) 803-7786.

HReport Highlights

The New Attack on Charity Care 1 The New Attack

Avoiding The Wolf At The Door:
What To Do When Faced With The
Threat Of A Corporate Campaign
What To Expect If Your
Organization Is Targeted
Tools for Success
Spotlight On Expert Services
The GCD Vulnerability Assessment
What You Can Do If Your
Organization Is Targeted
Public Interest Groups That Have
Joined In The Charity Care Attack
on Charity Care
Hospitals across the nation are receiving
2 requests for copies of charity care policies,
practices and financial records disclosing the
amount of money spent on charity care.
2 Many are receiving requests for meetings
with hospital administrators to discuss the
issue of charity care. Some are even facing
a complete public onslaught through the
3 media, handbills, picketing and community
mailings disclosing their charity care and
pricing practices. This onslaught is the work
3 of groups such as the Service Employees
International Union (SEIU) and the
Association of Community Organizations for
4 Reform Now (ACORN).

Spotlight On Expertise Some readers might be asking: “Why is a the Corporate Campaign - a campaign
K. Bruce Stickler, Partner 5 union interested in the amount of money a designed to attack an organization through
hospital spends on charity care?” The the use of community activism, political
Our Services 6 answer is simple, this is the new face of leaders, media and clergy.

1
Avoiding The Wolf At The Door:
What To Do When Faced With The Threat Of A Corporate Campaign
By K. Bruce Stickler
Gardner, Carton & Douglas
For many years, conventional wisdom
was that employers who had good products,
excellent service, satisfied customers
and content employees had little to be
concerned about from unions’ attempts
to organize their employees. Not so
What To Expect
If Your Organization
Is Targeted
anymore. In fact, employers
who meet this description
today are more vulnerable to
unionization than ever before.
And this is especially true in
the health care industry due
to labor’s use of a weapon
called the corporate
campaign.
Health care corporate
campaigns can trace their
origins to industrial models
developed more than two
decades ago. Jarol Manheim
in his book, Death of a
Thousand Cuts defines
corporate campaigns as “an
organized assault—involving
economic, political, legal,
regulatory, and psychological
warfare… The attack usually centers around
the media, where the protagonists attempt to
redefine the image—and tarnish the
reputation of the target company until it
yields on whatever the issue in dispute
might be.”
• Mass mailings are distributed to the
community citing the “true cost of
healthcare” and publicizing what
appears to be extreme price inflation by
hospitals across the state.
• Charity care policies and financial
records are requested from the targeted
hospital.
• Meeting with hospital administrators is
requested to discuss specific cases
where the hospital has sued patients for
non-payment or filed property liens
against patients for non-payment.
• Picketing at targeted hospital to raise
public awareness of the campaign
2
Unlike the traditional model of organizing—a
grass roots campaign to organize one
cohesive bargaining unit of employees-- the
corporate campaign is targeted at all of the
health care system’s employees at one time.
Rather than appeal to employees directly,
unions target and pressure governance and
leadership to submit to their demands.
The Service Employees International Union
(SEIU) has refined the model and is the
leading proponent of corporate campaigns in
the health care industry. SEIU’s current
campaigns against health care systems are
masked as “partnership proposals”. SEIU
seeks assurances that providers sign a
neutrality pact allowing the union to organize
their entire workforce in return for labor
peace and other vague union promises.
The core of the Neutrality Agreement
normally contains the following elements:
• provide the union with names,
addresses and other information
regarding all employees;
• give the union unlimited access to
provider facilities to organize all
employees;
against the hospital.
• Targeted hospital becomes the focus of
“Accountability Project”. Such a project
is spearheaded by union and other
public interest groups. The Internet is a
popular vehicle for this type of project.
• Former patients are
encouraged/organized to file a class-
action lawsuit alleging that targeted
hospital violates the law by
overcharging uninsured patients and is
shirking its not-for-profit responsibilities
to provide free and reduced-price
medical care.
• Public interest stories are fed to the

Nyhart HReport
• remain strictly neutral towards the
union’s attempts to gain signatures on
authorization cards (no negative
comments concerning disadvantages of
unionization); and
• recognize the union on the basis of
employees’ signed authorization cards
with no NLRB secret ballot election.
When the health care system refuses to
enter into the neutrality agreement, the
SEIU in effect declares war and initiates
its corporate campaign to malign the
system. Millions of dollars and substantial
resources are devoted by SEIU and other
unions to engage in these campaigns. A five
year or longer commitment is not unheard
of. There are two lengthy campaigns in
California and Connecticut that are still
active. These campaigns sap the energy
of leadership and negatively impact the
system’s business strategy.
GCD works with health care providers and
large systems to prepare for the increased
threat of corporate campaigns. One thing is
clear. When the campaign is launched, if a
provider has not taken steps to be prepared,
it may take a year or more just to catch up.
media publicizing how indigent families
have lost their homes due to excessive
medical billing practices.
• Allegations are made in the community
that Latinos, African Americans and
other minorities receive substandard
care because they do not have equal
access, a full understanding of their
coverage or health insurance coverage.
• Religious associations publicly call for
an end to discriminatory pricing. Faith
based hospitals are particularly
susceptible to this tactic.
• Local governments pass resolutions
to stop “price gouging” by targeted
hospital.
Tools for Success - Spotlight on Expert Services
The GCD Vulnerability Assessment
At Gardner, Carton & Douglas, we believe • Governance issues;
that provider knowledge and understanding • Human Resources policies and
of their own vulnerabilities allow providers to procedures;
make positive changes and continue their • Communications strategies and
focus on quality patient care and strong effectiveness;
employee relations, while reducing their risk • Internal and external public relations
of external union corporate campaigns. and key messages;
• Executive compensation and benefits;
We assist healthcare systems in conducting • Joint venture arrangements and key
a Vulnerability Assessment to identify affiliations and consistency in policies
significant areas of concern that SEIU or and practices;
other unions may use in their corporate • Diversity practices;
campaigns. We assess the risks and • Strength of governmental relations;
recommend means and action plans to • Ties to significant community
reduce the risk of exposure, and organizations;
implementation of changes going forward. • Church and sponsor affiliations, and
The areas examined, in part, include: more.
• Charity care and financial assistance
policies and practices; For more information on the GCD
• Community benefit reports; Vulnerability Assessment, please contact
• Tax exempt policies and practices; Bruce Stickler at (312) 569-1325.
“Wildly inflated sticker prices allow hospitals to charge different rates to different patients.
Unfortunately, the ones who are charged the most are those who can afford it least. If health
insurance doesn’t cover your hospital care, you could be in for a severe case of sticker shock.”
Twice the Price
A report on Ohio hospital pricing policies by Care for Ohio, A project of SEIU District 1199.
March 2005
• State Attorney General and/or political
What You Can Do
leaders launch investigations and
public hearings to address complaints If Your Organization
brought on by the union and other
Is Targeted
public interest associations.
• Task forces of public officials and public
interest representatives are created
to look into “unequal care” for
minority groups.
• Opposition to Certificate of Need
applications and local bond approval.
• Employees/Internal Union
Organizers become spokespeople
against the targeted hospital in their
churches, communities and union-
produced videos.
3
 Public Interest Groups
Nyhart HReport
That Have Joined In The Charity Care Attack
The attack on charity care and pricing practices has taken on many faces. Many of the
so-called public interest groups are merely fronts for unions, particularly the SEIU. Here are
just a few of the groups that have approached hospitals and healthcare systems for this type
of information:

• Association of Community Organizations for Reform Now (ACORN)

“The Service Employees International Union . . .
believes that race and income should not be
barriers to accessing affordable, quality health
care. Large hospital corporations should equitably
distribute precious health care resources to meet
the needs of all the communities they serve –
regardless of race or income. Unfortunately, some
hospitals in Chicago are letting us down.”
Separate and Unequal
A report by the Hospital Accountability Project,
A project sponsored by SEIU
December 2004
• Asian Health Coalition
• Hospital Accountability Project
• Illinois Coalition for Immigrant Rights
• Lakeview Action Coalition
• Jobs with Justice
• Universal Health Care Action Network (UHCAN)
• Families USA
• Americans for Health Care
• Arizona for Health Care
• California for Health Care
• Colorado for Health Care
• DC for Health Care
• Georgians for Health Care
• Illinois for Health Care
• Iowa for Health Care
• Mainers for Health Care
• Maryland for Health Care
• Nevada for Health Care
• New Hampshire for Health Care
• North Carolinians for Health Care
• Oregonians for Health Care
• Rhode Island for Health Care
• Washington for Health Care
• Wisconsin for Health Care

If your organization is the target of a
corporate campaign surrounding charity care
and pricing practices, the most important
thing you can do is to be prepared. Refusing
or hesitating to give information on charity
care policies and practices only makes the
situation worse and begs the question:
“What are they hiding?” Part of a good
charity care policy and practice is easy
access to information for indigent and
uninsured patients. Therefore, if any
individual or organization asks for copies of
policies or information on practices, your
employees should be trained on how to
handle the situation. Here are a few more
steps you can take to get prepared for, and
handle, an attack on your charity care
policies and practices:
• Ensure that your facility has an
aggressive diversity program in place
with a strong, executive level leader.
• Review all charity care policies and
practices. Remember, if your practice
does not match your policy, your policy
is useless.
• Conduct an audit of charity care
expenditures.
• Be open and honest about your charity
care and pricing practices.
• Examine whether your facility is a good
corporate citizen and how much your
organization gives to the community.
• Ensure open and positive
communications with all community
leaders, religious leaders and public
advocacy groups.
• Educate all directors, managers and
front-line supervisors.
• Educate employees about what is really
driving the attack on charity care and
how unionization can impact them.
• Be proactive about resolving issues that
lead to union vulnerability.
• Educate employees about hospital
finance.
• Educate the Board of Directors about
how they might be affected by a
corporate campaign, i.e., phone calls to
their homes, targeting their place of
business, and being approached in
public.
• Educate the Medical Staff about how
they might be affected, i.e., working
relationships with employees and
disruption in workflow.

4
 Spotlight on Expertise
Nyhart HReport
K. Bruce Stickler, Partner
Gardner, Carton & Douglas Counsel to the American Hospital
(312) 569-1325
Association and Illinois Hospital Association
(312) 569-3325 (fax)
bstickler@gcd.com and as labor counsel to several religious
orders, hospitals, health care institutions
K. Bruce Stickler is a partner at the Chicago
and integrated health care delivery
office of Gardner Carton & Douglas. Mr.
systems. He is a former member of the
Stickler is engaged exclusively in
Board of Directors of the Illinois Association
representing management in employment
of Hospital Attorneys.
and labor relations matters. He has
practiced employment and labor law for
Mr. Stickler received his B.A. and J.D.
more than thirty years before federal and
from Southern Methodist University. He
state courts and agencies, including the
is admitted to practice in the states of
EEOC and NLRB.
Illinois and Texas, and before the United
Mr. Stickler has extensive experience in the States Supreme Court and six U.S. Courts
healthcare industry. He has served as Labor of Appeal.

“When a faith-based hospital sues a grieving

widow over medical debt, plunging her family
deeper into poverty, some part of the health care
system has clearly failed. But which part, exactly?
One answer is to blame the hospital, which is
precisely what many advocates, elected officials
and academics have been doing . . .”

Uncharitable?
The New York Times
December 19, 2004

5

Nyhart HReport
Mary Touney, R.N., , M.S.
Senior Vice President
Leslie King, J.D.
Senior Vice President
Lisa McKnight, J.D., SPHR
Senior Consultant
NYHART HR
9320 Priority Way West Drive
Indianapolis, Indiana 46240-1468
Nyhart HR –
Comprehensive HR Consulting
For more information on what you can do to
protect your organization against such an
attack, please contact Nyhart HR. We offer
a full range of consulting services and
strategies to help your organization prepare
for and handle attacks on your charity care
policies and practices. These services
include:
• Assistance in developing internal
communication strategies to deal with
an attack on charity care practices and
policies.
• Advice on how to handle letters and
demands for charity care practices and
policies from public interest groups.
• Assistance in setting up “secret
shopper” programs to insure that front
line employees are handling requests
Save the Date – November 18th, 2005
• Do you want to stay in touch with the most recent information on the subject of
charity care?
• Do you still have questions about the new attack on charity care?
for charity care information
appropriately.
• Review of policies and practices
surrounding picketing, access to
organization property, solicitation and
distribution.
• Assistance in coordination of a strategy
to better inform and involve community
leaders in the organization.
• Management of counter union defense
campaigns, including manager training,
employee communications and strategy
development.
• Conduct Employee Relations
Assessments to identify and resolve
employee relations issues.
• Assistance with the use of focus groups
to help identify and resolve issues.

P.O. Box 80883 Nyhart is partnering with Gardner, Carton & Douglas to present a seminar on the topic of
charity care. This seminar will give you a chance to talk directly to attorneys, consultants,
Indianapolis, Indiana 46280-0883
experts and clients who have experienced this issue first hand. Come find out how other
hospitals and healthcare administrators have dealt with an attack on charity care and
317-803-7786 what you can do to competently prepare your organization for a potential attack.
800-428-7106
Fax: 317-803-7895 This seminar will be held in Chicago. Watch your mailbox for more information or call us
at (317) 803-7786.
E-mail: NyhartHR@Nyhart.Biz

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