Above Photo: Unionized employees say a new policy would impede their ability to spend adequate time with their patients. Bruno Guerrero / Unsplash. (Bruno Guerrero / Unsplash).
Practitioners say a proposal to increase their appointment load would shorten the time they can spend with each patient.
Unionized psychiatrists and nurse practitioners at Cornerstone Montgomery, an independent behavioral health care provider with dozens of locations across the D.C. region, are accusing management of unfair labor practices, arguing that recent policy proposals would sacrifice their ability to care for patients.
Represented by the healthcare worker union 1199SEIU, psychiatrists and nurse practitioners say that Cornerstone Montgomery has tried to “drastically” increase the number of appointments on the providers’ calendars, which would decrease the amount of time each practitioner can spend with their patients, and how frequently they meet.
“We’re not even able, right now, to handle the amount of clients we have,” a union member told DCist/WAMU. “We can’t serve residents of Montgomery County, and we’re worried that it’s just continuing to get worse.”
Current Cornerstone Montgomery employees spoke to DCist/WAMU as a collective union, fearing that individual identification could put their job at risk.
Cornerstone Montgomery practitioners often treat residents with severe mental illnesses, and its client population is predominantly underinsured or uninsured patients, many of whom rely on Medicare or Medicaid to access behavioral health services. In addition to residential programs across the county, Cornerstone Montgomery also runs outpatient mental health clinics in Bethesda, Silver Spring, and Rockville, community-based services like permanent supportive housing, and crisis centers, which operate essentially as an alternative to an emergency rooms for people experiencing mental health crises.
Practitioners told DCist/WAMU that since COVID restrictions eased in the region in 2021, they noticed a “progressive degradation” of Cornerstone Montgomery’s ability to serve patients, ultimately leading them to formally unionize earlier this year. But the same issues that pushed psychiatrists and nurse practitioners to organize — lack of meaningful engagement with management and clinical staff, burnout, and concerns about patient care – have not improved. Management’s latest attempt to increase their patient loads, they say, only further erodes their ability to provide the best care they can.
“We felt that we were not being heard, and we felt that we had no say over what sort of care we provided our patients,” said unit members, some of whom have been with the agency for more than a decade.
Leyla Adali, a communications representative for 1199SEIU in the D.C. region, said that when management first tried to increase patient loads and decrease appointment visit times, the unit asked that management provide an explanation as to why they were making the changes they were making. The union never heard that explanation from Cornerstone leadership, so they went ahead and filed a complaint with the National Labor Relations Board in early June, arguing that management is not willing to collectively bargain with its employees.
“This is all kind of happening because they don’t actually want to solve this through unionization,” Adali told DCist/WAMU. “They want to unilaterally impose it. Obviously, we have some power in the union, but they don’t want to negotiate this as a part of the union contract.”
Patient Impact
Over the past two years, practitioners’ waitlists and patient loads have increased, straining both their own work and jeopardizing the broader continuum of care for residents across the region. When patients are discharged from a hospital after a mental health crisis, they may be directed toward Cornerstone Montgomery, but due to high patient volumes, the agency hasn’t been actively intaking new patients. One unit member told DCist/WAMU that if one of their clients cancels or misses an appointment, their next availability isn’t for two months.
“High volume of patients in a day results in eroded clinical alliances […] lower quality of care, loss of individualized care, and lower patient and clinical satisfaction,” the union member said.
In an email, a Cornerstone Montgomery spokesperson said they could not comment on pending litigation or administrative charges, but added that management will “continue to bargain in good faith with 1199SEIU.” The complaint is open and active on the NLRB website.
“Cornerstone Montgomery has always considered and valued the input and feedback provided by prescribers as it relates to patient care,” the statement said. “Cornerstone Montgomery will continue to do so, albeit within the confines of its newly formed bargaining relationship with 1199SEIU.”
Alleged anti-union tactics
The provider is also facing a second complaint, also filed in June, regarding the firing of a long-time employee as they became involved with union organizing.
Patrice Davis, a psychiatric nurse practitioner for more than 20 years, told DCist/WAMU that she had never received a single negative evaluation or disciplinary issue in the six years she had worked at Cornerstone Montgomery until she was abruptly fired at the end of December 2022. From roughly July 2022 through her firing, Davis had been leading her colleagues in a unionization effort.
In November 2022, Davis said she was told she could not apply for an open chief medical officer position. In early December, she was called into a meeting with the human resources director and CEO, where she said “felt forced to confess” that she was one of the unionizing leaders. Davis said she was asked to go through her personal text messages with coworkers regarding union activity and send screenshots to Cornerstone Montgomery leaders. Davis was told the meeting was confidential, and two days later she was fired.
“I found out that I was fired when my coworker texted me about the news on Friday, which is always my day off,” Davis said. Her coworkers had received an email, announcing her termination effective immediately.
“The traumatic part of that ordeal is that I wasn’t allowed to say goodbye to my clients, they were not given a reason for my sudden departure. I wasn’t allowed to finish writing my clinical notes – this is all important for financial, legal, and continuity of care reasons.”
Davis said she followed up by email, asking if there was some way she could finish her notes and clinical documentation — necessary paperwork for client’s billing and casework — and was told she’d hear back, but never did. Because the union was not yet formed when she was fired, she wasn’t protected yet by any bargaining agreement, but Davis is proud of her former colleagues for continuing to fight for a seat at the table.
“Knowing that my coworkers now have that protection, it’s really a silver lining,” she said. “It was something where we felt like we had no other choice, no other recourse.”
A Cornerstone Montgomery spokesperson declined to comment on Davis’ specific case.
Cornerstone Montgomery employees’ labor fight follows several other union drives at major healthcare providers around the D.C. region in recent years, as workers demanded better pay and working conditions during the COVID-19 crisis. Earlier this year, medical residents at George Washington University Hospital won their union election, joining a growing list of unionized residency programs across the U.S. Over the weekend, nurses at George Washington University Hospital won their union election, after months of alleged anti-union campaigning by Universal Health Services, the company that manages GWUH.