Editor's note: This is the first in a series looking at the Altoona Regional Health System's proposed affiliation with UPMC.
Citing concerns with the business practices of UPMC, the union representing registered nurses at Altoona Regional Health System is circulating a petition asking the local hospital to back off its agreement to negotiate exclusively with the Pittsburgh giant as potential partner.
The business practices cited by the union include alleged steering of patients to keep them in the UPMC system, inconveniencing patients due to alleged reprisals against employees who defected to another provider, allegedly refusing to care for subscribers of rival Highmark's low-cost Community Blue health plan and allegedly abusing its nonprofit tax-exempt status.
"Merging our only community hospital with a larger health system - especially one as controversial as UPMC - is not something that should be rushed into," states the petition being circulated by SEIU Healthcare PA within the hospital. "We urge the board to slow down and stop exclusive talks with UPMC in order to re-examine other potential affiliation partners."
Altoona Regional stands by its commitment to negotiate exclusively with UPMC, according to spokesman Dave Cuzzolina.
"Stopping would serve no meaningful purpose," he said Friday. "Extensive due diligence will continue until a definitive agreement is reached."
UPMC repudiated the criticism, saying it does what's best for patients in all cases, that the employees who defected brought the inconvenience on their patients, that the health plan controversy cuts both ways and that Pittsburgh Mayor Luke Ravenstahl is using the tax exemption issue as a distraction.
The union also called on Altoona Regional for more transparency in its affiliation effort and more participation for union members and the community.
Altoona Regional said it is being as transparent as proper and that it's allowing for wide community participation.
Before committing to negotiate exclusively with UPMC, Altoona considered affiliation pitches from Geisinger Health System, UPMC rival Highmark and Penn State Hershey Medical Center. The parties to the decision overwhelmingly chose UPMC, according to Altoona Regional CEO Jerry Murray.
The concerns about UPMC escalated recently when the tax exemption and health plan issues got strong play in the Pittsburgh media.
On March 22, Pittsburgh Business Times reporter Kris Mamula led a column headlined "UPMC under siege" with the metaphorical statement: "Somebody call 911, the top floors of the U.S. Steel Tower [UPMC headquarters] are on fire."
On March 20, Pittsburgh Mayor Luke Ravenstahl challenged UPMC's standing as a "purely public charity" in an effort to obtain additional tax revenue from the $10 billion company.
"UPMC is more than confident of its tax-exempt status," stated hospital spokeswoman Susan Manko in an email.
The mayor launched the attack on UPMC "to distract the public away from his administrations' recently exposed corruption and financial mismanagement," with the encouragement of SEIU leaders in Pittsburgh, who have tried and failed to organize at UPMC, Manko wrote.
Ravenstahl's attack shows a misunderstanding of nonprofit status, according to the hospital, which touts its $622 million worth of "community benefits" contributed just last year.
Earlier in March, Community Blue made the news when a controversial provision took effect, resulting in elimination of most plan subscribers from the patient rolls of UPMC doctors, according to a Post-Gazette story.
Except for emergency care and several other specific exceptions, Community Blue doesn't allow subscribers access to UPMC care, even if they're willing to pay out-of-network costs or cash.
That's not right, according to Highmark.
Highmark has "purposely misinformed the public about the plan," according to Manko.
Both sides were aware of the consequences of the agreement they made that underlies the plan, according to UPMC.
"[The tax exemption] issue and the fact that UPMC is now barring Highmark Community Blue patients from seeing their UPMC doctors, even if they want to pay cash, is cause enough for nurses and others to be incredibly concerned about UPMC's takeover of ARHS," Paula Stellabotte, president of the SEIU local, wrote in an email.
A few weeks ago, Stellabotte was more diffident about the union's concerns.
The union didn't want to stop the merger, just slow it down, given concerns about UPMC business practices, she said.
Pressed for specifics at that time, the union produced a pair of newspaper stories published recently in western Pennsylvania, she said.
One in the Erie Times-News spoke of UPMC Hamot - which doesn't have a pediatric endocrinologist - sending a diabetic child repeatedly to UPMC Children's Hospital in Pittsburgh, despite the presence of a certified pediatric endocrinologist at nearby St. Vincent's Hospital in Erie.
The other story, in the Pittsburgh Post-Gazette, spoke of UPMC cutting ties with five OB-GYN doctors whom rival Highmark had poached, immediately after the doctors gave their required six months' notice.
In connection with the Erie case, UPMC it claims that for all patients at all times, it makes recommendations based only on patients' best medical interests.
In connection with the OB-GYN case, the doctors were dismissed for violating "the mutually agreed on terms of their departure" and by spreading misinformation to patients, telling them they wouldn't be able to deliver at Magee-Women's Hospital of UPMC, Manko said.
The doctors, now employed in another group, didn't respond to the Mirror's requests for comment.