Mercy Sacramento Hospital

National Labor Relations Board - Board Decisions

Jun 1, 2005

344 N.L.R.B. 790 (N.L.R.B. 2005)

DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
344 NLRB No. 93
790
Catholic Healthcare West d/b/a Mercy Sacramento
Hospital d/b/a Mercy General Hospital d/b/a
Methodist Hospital d/b/a Mercy Hospital Fol-
som d/b/a Mercy Medical Center San Juan and
International Union of Operating Engineers,
Stationary Engineers Local 39, AFL–CIO, Peti-
tioner. Case 20–RC–17967
June 1, 2005
DECISION ON REVIEW AND ORDER
BY CHAIRMAN BATTISTA AND MEMBERS LIEBMAN AND
SCHAUMBER
The issue in this case is whether the petitioned-for
skilled maintenance employees in a presumptively ap-
propriate single-facility unit is appropriate for bargain-
ing. On July 16, 2004, the Regional Director for Region
20 issued a Decision and Direction of Election (pertinent
portions are attached as an appendix) in which he found
that the Employer met its burden to rebut the single-
facility presumption, and that the petitioned-for unit must
include the skilled maintenance employees at all four
acute-care hospitals within the Mercy Healthcare Sacra-
mento (MHS) subdivision of Catholic Healthcare West
(CHW).
Thereafter, in accordance with Section 102.67 of the
Board’s Rules and Regulations, the Petitioner filed a
timely request for review of the Regional Director’s de-
cision. On September 15, 2004, the Board granted the
Petitioner’s request for review.
Having carefully reviewed the entire record,1 we re-
verse the Regional Director, and find that the Employer
has failed to sustain its burden of establishing that the
petitioned-for single-facility unit of skilled maintenance
employees is not appropriate for bargaining.
It is well established that a single-facility unit in the
health care industry is presumptively appropriate. Manor
Healthcare Corp., 285 NLRB 224 (1987). See also, St.
Luke’s Health System, Inc., 340 NLRB 171, 172 (2003);
Visiting Nurses Assn. of Central Illinois, 324 NLRB 55
(1997); Children’s Hospital of San Francisco, 312
NLRB 920, 928 (1993), enfd. California Pacific Medical
Center v. NLRB, 87 F.3d 304 (9th Cir. 1996); Mercy
Health Services North, 311 NLRB 367 fn. 2 (1993). As
the party opposing the single-facility unit, the Employer
has the heavy burden of overcoming the presumption.
Trane, 339 NLRB 866 (2003); Visiting Nurses Associa-
tion of Central Illinois, supra. In order to rebut the pre-
sumption, the Employer must demonstrate integration so
substantial as to negate the separate identity of the single

1 The Employer only presented one witness, and the entire record
consists of 61 pages.
facility. Heritage Park Health Care Center, 324 NLRB
447, 451 (1997), enfd. 159 F.3d 1346 (2d Cir. 1998).
The Board examines factors such as centralized control
over daily operations and labor relations, including the
extent of local autonomy; the degree of employee inter-
change, transfer, and contact; functional integration;
similarity of skills, functions, and working conditions;
geographic proximity; and bargaining history. New Brit-
ain Transportation, 330 NLRB 397 (1999); West Jersey
Health System, 293 NLRB 749, 751 (1989). Moreover,
the Board considers the degree of interchange and sepa-
rate supervision to be of particular importance in deter-
mining whether the single-facility presumption has been
rebutted. Passavant Retirement & Health Center, 313
NLRB 1216, 1218 (1994); Heritage Park Health Care
Center, supra. In the health care industry, the Board also
examines whether a single-facility unit creates an in-
creased risk of work disruption or other adverse impact
upon patient care should a labor dispute arise. Manor
Healthcare, supra at 226. The Board has frequently
found single-facility units in hospitals and other health
care settings to be appropriate. See, e.g., Heritage Park
Health Care Center, supra; Children’s Hospital of San
Francisco, supra; Staten Island University Hospital, 308
NLRB 58, enfd. 24 F.3d 450 (2d Cir. 1994); O’Brien
Memorial, 308 NLRB 553 (1992); Pomona Golden Age
Convalescent Home, 265 NLRB 1313 (1982); Samaritan
Health Services, 238 NLRB 629, 632–633 (1978); Na-
tional G. South, Inc., 230 NLRB 976 (1977); Saint An-
thony Center, 220 NLRB 1009 (1975); Jackson Manor
Nursing Homes, 194 NLRB 892, 894–896 (1972).
In this case, the record establishes that the petitioned-
for Mercy General Hospital is a large, acute-care facility
with 400 beds and 800 employees. The Employer’s cen-
tral office negotiates union contracts, advises on griev-
ance matters, and directly handles grievances at the third
step and beyond. The central office also participates in a
panel that hears employee appeals from adverse actions.
In addition, the nonrepresented employees at all four
facilities share uniform pay rates and benefits. The Em-
ployer has a uniform set of personnel policies and proce-
dures for all of its MHS facilities. Moreover, the Em-
ployer operates on a centralized basis between its four
facilities with respect to payroll processing, accounting,
purchasing, information systems, risk management, and
safety and security functions.
Mercy General operates with substantial local auton-
omy, notwithstanding the high degree of centralization of
administration and labor policies among the four MHS
facilities. It has its own management structure, with
many layers of supervision, including its own president.
It has its own human resources department whose direc-
MERCY SACRAMENTO HOSPITAL 791
tor reports to the hospital’s president. Further, there is an
immediate supervisor who supervises the petitioned-for
skilled maintenance employees. This supervisor reports
to another local manager within the hospital, who in turn
reports to the hospital’s director of ancillary services.
The director of ancillary services reports to the hospital’s
president.
The immediate supervisor of the petitioned-for skilled
maintenance employees has the authority to assign work
to these employees. He may also discipline them and
prepare their performance appraisals (or the appraisal
may be handled by his superior at Mercy General), as
long as his actions conform with the CHW/MHS policies
and procedures.2 The management of each individual
hospital in MHS handles its own scheduling, and there
are differences among facilities as to evening and night-
shift coverage requirements for the skilled maintenance
employees.
Further, local management handles the first two steps
of the grievance procedure. Although the CHW director
of labor and employee relations, who represents the
MHS hospitals in labor relations matters, plays a consul-
tative role to local management in the first two steps of
the grievances involving unionized employees, there is
no indication that he plays this role in the first two steps
of the dispute resolution procedure for nonunionized
employees.
In addition, the local managers at Mercy General Hos-
pital make decisions about local hiring. After new job
applicants are screened on a centralized basis, the local
managers interview the applicants at their own facility.
Local managers then make the decision about whether to
hire an applicant, subject to reversal at the MHS divi-
sional level only if there are conflicts with CHW/MHS
policies or problems with background checks and drug
testing.
Thus, while there are common labor relations policies
among the facilities, and some centralized administration
of certain labor relations matters, such as grievance han-
dling and hiring, the day-to-day labor matters are admin-
istered locally within each facility. The dissent argues
that the centralization of administrative functions and
certain labor relations matters support a multifacility
unit. We find, however, that the centralization of these
functions is not sufficient to negate the separate identity
of Mercy General, particularly in light of the substantial
local autonomy and lack of employee contact and inter-
change. See Heritage Park Health Care Center, supra;

2 The supervisor or his superiors consult with the human resources
director at Mercy General on these matters, and this local human re-
source director would only consult the CHW director of labor and
employee relations on nonroutine matters.
Children’s Hospital of San Francisco, supra; Staten Is-
land University Hospital, supra; O’Brien Memorial, su-
pra; Pomona Golden Age Convalescent Home, supra;
Samaritan Health Services, supra; National G. South,
Inc., supra; Saint Anthony Center, supra; Jackson Manor
Nursing Homes, supra.
Further, the departments at each of the hospitals within
the MHS system formulate their own departmental budg-
ets, which are approved at the individual hospital level
and then submitted to CHW’s chief operating officer for
approval as part of the overall MHS budget. Personnel
files and patient files are maintained at each individual
hospital.
The Employer also failed to establish that there is sub-
stantial contact and interchange between the petitioned-
for employees and the skilled maintenance employees at
other facilities. The record shows that employees are
routinely assigned to work at a single MHS facility, and
that temporary transfers are the exception rather than the
norm. Although the skilled maintenance employees per-
form single and multiday projects at other facilities, usu-
ally in order to make adjustments to machinery, there is
no evidence about how often this occurs.
The Employer has similarly not provided evidence of
substantial permanent interchange. The Regional Direc-
tor emphasizes that the Employer’s system of posting
open positions at all facilities and using common senior-
ity in bidding for jobs is by nature conducive to perma-
nent transfers systemwide. However, if there is a job
opening at a facility and there are other employees per-
forming the same type of work at that facility on differ-
ent shifts, those employees are given the first priority in
bidding on the open shift at their site. Moreover, there is
no specific evidence to establish how often permanent
transfers occur either throughout the system or with re-
spect to the petitioned-for facility. In any event, it is well
established that the Board considers permanent transfers
to be a less significant indication of actual interchange
than temporary transfers. Red Lobster, 300 NLRB 908,
911 (1990).
The geographic distance between the petitioned-for fa-
cility and the other three facilities in the MHS system
further supports the appropriateness of a separate unit.
These hospitals are 12 to 20 miles away from Mercy
General. Under similar circumstances, the Board has
found single-facility units to be appropriate. See New
Britain Transportation Co., supra; O’Brien Memorial,
supra; Manor Healthcare Corp., supra at 227.
Further, we disagree with the Regional Director’s find-
ing that the history of collective bargaining in the MHS-
wide units represented by the California Nurses Associa-
tion and SEIU Local 250 is more relevant to this case
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD792
than the certification issued in 1998 in the single-location
skilled maintenance unit at Methodist Hospital in Case
20–RC–17442.3 Those multifacility units did not involve
the classification of employees sought here. Moreover,
the parties agreed on the unit scope in those situations,
unlike in the Methodist Hospital case. Although the Re-
gional Director found that there was no history of collec-
tive bargaining in the single-facility unit prior to the Un-
ion’s disclaiming interest in August 2000, this is incon-
sistent with his earlier finding that bargaining did occur,
albeit no collective-bargaining agreement was reached.
Indeed, the record shows that the parties bargained for an
extended period of time. Contrary to the dissent’s sug-
gestion, the parties’ failure to reach a contract does not
negate the single-facility bargaining history or its rele-
vance. Thus, although we agree with the Regional Di-
rector that this single-facility bargaining history is not
controlling, we do not agree that reliance should be
placed on the multifacility bargaining history under the
facts here.4
In sum, we find that the Employer has not met its bur-
den to demonstrate that the integration among the MHS
facilities is so substantial as to negate the separate iden-
tity of Mercy General. Mercy General has its own man-
agement structure and human resources department. Its
local supervisors exercise substantial local autonomy
with respect to such matters as assignment of work, dis-
cipline of employees, preparation of performance ap-
praisals, scheduling, grievance handling, and hiring. In
addition, Mercy General and other MHS hospitals formu-
late their own departmental budgets, subject to the ap-
proval of CHW’s chief operating officer. Further, the
record fails to establish substantial contact and inter-
change between the petitioned-for employees and the
skilled maintenance employees at other facilities. The
geographic distance between Mercy General and the
other MHS facilities also supports the appropriateness of
a separate unit. Finally, there is no determinative bar-
gaining history.

3 A Decision and Direction of Election issued in this case on Sep-
tember 4, 1998. The Board denied review on October 14, 1998.
4 Our dissenting colleague asserts that the Board’s decision in Mercy
Hospitals of Sacramento, Inc., 217 NLRB 765 (1975), enf. denied and
case remanded 589 F.2d 968 (9th Cir. 1978), cert. denied 440 U.S. 910,
99 S.Ct. 1221, 59 L.Ed 2d 458 (1979), which found a multifacility unit
appropriate, was consistent with the congressional mandate against
proliferation. We find reliance on that case to be misplaced. There, the
scope of the unit was agreed upon by the parties and was thus not at
issue before the Board. Further, it appears that the single-facility pre-
sumption would in any event have been inapplicable, inasmuch as the
petitioner sought a multifacility unit. Finally, the Board made no
mention of the congressional mandate as it related to the scope of the
unit found appropriate.
The dissent’s reliance on Congress’ admonishment to
the Board to guard against the undue proliferation of
units in health care institutions is misplaced. In Manor
Healthcare, the Board explained why applying the sin-
gle-facility presumption in the health care industry was
not inconsistent with the Congressional admonition
against undue proliferation of units. The basis for the
admonition was Congress’ concern that multiple bargain-
ing units in healthcare could lead to increased strikes,
jurisdictional disputes, and wage whipsawing that might
disrupt the provision of health care. See Manor Health-
care Corp., supra. However, the Board found that there
was nothing in the legislative history to indicate that is-
sues of unit scope, rather than unit composition, were a
focus in this admonition. Id. at 226.5 At the same time,
in order to address the concerns about increased disrup-
tion in the health care industry, the Board found that the
single-facility presumption could be rebutted by weigh-
ing, in addition to the usual community-of-interest fac-
tors, any evidence, presented in the employer’s rebuttal
case, demonstrating that approval of the single-facility
unit will threaten the kinds of disruptions to continuity of
patient care that Congress sought to prevent. Id. at 225,
226.
At the same time, the Board observed in Manor
Healthcare that “[i]t is difficult to see how, as a practical
matter, we would create a greater risk of the spread of
work stoppages or other disruptions from one facility to
another than we would by permitting representation only
in a multi-facility unit.” Id. at 226. To the contrary, the
Board stated that “often the broader unit will increase the
danger that a work stoppage will have an adverse impact
on the delivery of health care services in a relevant geo-
graphical area–a result Congress could not have in-
tended.” Id.
Notably, courts have agreed with the Board’s applica-
tion of the single-facility presumption in the health care
industry. See, e.g., Massachusetts Society for the Pre-
vention of Cruelty to Children v. NLRB, 297 F.3d 41 (1st
Cir. 2002); NLRB v. Heartshare Human Services of New
York, Inc., 108 F.3d 467, 471 (2d Cir. 1997); Staten Is-
land University Hospital v. NLRB, 24 F.3d 450, 456–457
(2d Cir. 1994) (the Board has “good reasons to use the
single-facility presumption”); Local 144 v. NLRB, 9 F.3d
218, 223–225 (2d Cir. 1993); California Pacific Medical
Center v. NLRB, supra at 308–310 (single-facility pre-
sumption, rather than disparity of interests test, for unit

5 In enacting the Healthcare Rules, the Board indicated that “the
proposed rule does not purport to address the issue of the appropriate-
ness of the single facility when an employer owns a number of facili-
ties, which the Board will continue to address through adjudication,”
citing Manor Healthcare. 284 NLRB 1532.
MERCY SACRAMENTO HOSPITAL 793
scope determinations was appropriate for determining
bargaining unit for nurses after merger of two hospitals 1
mile apart).
Here, the Employer has failed to show that allowing
representation of employees at the Hospital alone in a
single-facility unit will have any greater impact on the
provision of health care than that contemplated by the
Board in Manor Healthcare, in Rulemaking, or in subse-
quent cases. Indeed, the Employer does not assert, and
there is no evidence to show, that a single-facility unit in
this case would create an increased risk of work disrup-
tion or other adverse impact on patient care should a la-
bor dispute arise. See Heritage Park Health, supra at
452; Children’s Hospital of San Francisco, supra at 929;
Manor Healthcare Corp., supra, at 228–229. Cf. West
Jersey Health System, supra (a labor disruption at the
petitioned-for single-facility units could adversely affect
health care provision, where certain equipment was only
available in some facilities and, in some instances, the
employees who operated the equipment rotated from
facility to facility, and all hot food served to patients and
employees was prepared in one facility).
This case is distinguishable from Stormont-Vail
Healthcare, Inc., supra; St. Luke’s Health System, supra;
and West Jersey Health System, supra, relied on by the
Regional Director. In Stormont-Vail, the Board found
that the single-facility presumption did not apply because
the parties in that case stipulated at the outset that a mul-
tifacility unit was appropriate. The Board found that the
Regional Director arbitrarily excluded RNs in the em-
ployer’s off-campus psychiatric facility, outlying clinics,
and community nursing centers from the otherwise em-
ployerwide RN unit found appropriate. In this case, by
contrast, the Petitioner seeks to represent only the skilled
maintenance employees in the Mercy General facility,
and the Employer seeks to add additional facilities. In
addition, the unit at issue in Stormont-Vail, unlike here,
did not comport with a coherent administrative, geo-
graphic, or supervisory grouping, and the amount of em-
ployee contact and interchange, and the integration of
operations were greater in Stormont-Vail than here.
In St. Luke’s, the Board found that the employer rebut-
ted the single-facility presumption and thus the unit had
to include all 21 clinics at 16 clinic locations. The evi-
dence of regular interchange was more specific and sub-
stantial than here (up to 20% of the employees within all
job classifications within the clinic work force floated to
other locations in any given year), and there was very
limited local autonomy accorded to the individual onsite
clinic managers. In that case, unlike here, three directors
oversaw the clinics’ operations and were responsible for
different functional areas. Local clinic managers exer-
cised authority on pro forma matters such as developing
inclement weather directives and smoking policies,
scheduling employees, and making “time off” determina-
tions. Although the local clinic manager decided which
candidate to hire for his or her facility from the screened
list (with background checks completed) provided by the
human resources department, the human resources de-
partment possessed the authority to reverse a hiring deci-
sion or rescind a job offer. By contrast, in the instant
case, the decisions of local managers are only reversed if
the decision conflicts with CHW/MHS policies or there
are problems with background checks or drug testing.
In West Jersey Health System, supra, the Board found
that a system-wide multifacility unit was the only appro-
priate unit. In contrast to the present case, there were,
among other things, significant permanent interchange
and steady temporary interchange among the facilities.
In addition, the Board found that a labor dispute would
adversely affect the provision of health care.
Accordingly, based on the foregoing, we reverse the
Regional Director’s finding that the single-facility pre-
sumption has been rebutted. We remand the case to the
Regional Director for further appropriate action.
ORDER
The Regional Director’s Decision and Direction of
Election is reversed, and the case is remanded to the Re-
gional Director for further appropriate action.
CHAIRMAN BATTISTA, dissenting.
My colleagues have found that a separate unit of
skilled maintenance employees at the Mercy General
Hospital is an appropriate unit. I disagree. I would af-
firm the Regional Director. I would find that the Em-
ployer was correct in asserting that the appropriate unit
consists of the skilled maintenance employees at all of
the Employer’s four facilities. All four facilities are in
the Sacramento, California area.
I recognize that there is a presumption in favor of a
single-facility unit. However, that presumption must be
tempered by two important considerations: (1) Congress
has admonished the Board to guard against the “undue
proliferation of units in health care institutions”;1 (2) the
history of collective bargaining of this Employer is con-
sistent with that Congressional admonition.
In the latter regard, the Board has found multifacility
units appropriate in Mercy Hospital, 217 NLRB 765, 766
(1975), and in Mercy Hospital, 244 NLRB 229 (1979).
Similarly, in 20–RC–17195, the California Nurses Asso-

1 S. Rept 93-766, 93d Cong., 2d sess. 5 (1974); see also H Rept. 93–
1051, 93d Cong., 2d sess. (1974). 120 Cong. Rec. S. 6940 (1974). 120
Cong. Rec. S. 7311 (1974).
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD794
ciation was certified in a multifacility unit of the Em-
ployer. Finally, since 2000, SEIU Local 250 has repre-
sented a multifacility unit of employees of the Em-
ployer.2
As against this, there is only one situation where there
was a single-facility unit. However, the Employer here
was a mere holding company at the time of that case.
The testimony in the instant case shows that the Em-
ployer is now the operational entity. Further, the bar-
gaining in that unit came to naught. The Union was cer-
tified in 1998, no agreement was reached, and the Union
disclaimed interest in 2000.
The specific facts of the instant case also support a
multifacility unit. The Regional Director, whose deci-
sion I would affirm, has comprehensively set forth these
facts. I shall highlight only some of them.
The Employer centrally controls important labor rela-
tions matters. In regard to unionized facilities, the Em-
ployer’s central office negotiates union contracts, advises
on grievance matters, and directly handles grievances at
the third step and beyond. In regard to nonunion facili-
ties, the Employer’s central office sets the pay, benefits,
policies, and procedures. It also participates in the panel
that hears employee appeals from adverse actions.
The Employer has a uniform set of personnel policies
and procedures for all of its facilities. Evaluation criteria
are the same at all hospitals. As noted above, pay and
benefits for unionized facilities are negotiated by the
central office. The pay and benefits for nonunion em-
ployees are the same at all facilities. The skilled mainte-
nance employees sought here do the same work as
skilled maintenance employees at the other facilities, and
their pay and benefits and other terms and conditions of
employment are the same as at all other facilities.
If there is a vacancy at a facility, employees at all fa-
cilities can bid on it, and there is no preference given to
applicants from the facility where the vacancy exists.3
Seniority is employerwide and is used in selecting among
bidders.
With respect to matters beyond labor and employment,
the evidence shows that the Employer operates on a cen-
tralized basis as to such important areas as accounting,

2 In citing the Board cases supra, I am not suggesting that the Board
has definitively ruled on the issue of single vs. multifacility units as to
the Employer. I cite the cases because they are relevant to the factor of
bargaining history.
My colleagues say that these cases involve nurses rather than main-
tenance employees involved herein. However, the concern about undue
proliferation is obviously not confined to the type of separate unit that
is sought.
3 There is one exception, i.e., a preference is given to an employee
who performs the same work at that facility (on a different shift).
budgeting, purchasing, information systems, risk man-
agement, and safety and security functions.
I recognize that some day-to-day matters are decided
locally. However, given the nature of these matters
(work assignments, scheduling), it is not surprising that
they are handled locally.
As to other day-to-day matters, they are subject to cen-
tralized control. For example, although the local super-
visor can discipline employees and prepare evaluations,
those actions must conform to central policies and proce-
dures. Similarly, as to hiring, the process begins with
centralized screening. A local decision to hire is subject
to reversal, on stated grounds, by central authority. In
short, centralized authority exercises control at the start
and at the finish of the hiring process.
In sum, several of the day-to-day functions are subject
to central control, and all of the major matters are subject
to central control.
My colleagues rely on Manor Healthcare, 285 NLRB
224 (1987), for the proposition that the single facility
presumption is not inconsistent with the Congressional
admonition against undue proliferation of units in the
healthcare industry. However, the Board there was care-
ful to note that consideration of the Congressional policy
is not foreclosed, i.e., an employer’s rebuttal evidence is
to be carefully considered in the context of that policy.
As demonstrated above, I believe that the Employer’s
evidence here, particularly when weighed in the context
of the Congressional policy, clearly demonstrates the
inappropriateness of a single-facility unit. That is, the
centralized control, the multifacility history, and the un-
successful bargaining in a single-facility unit, all support
the Employer’s rebuttal.
Based on all of the above, I would not “proliferate” the
units by separating out this single facility.4 That would
be contrary to the Congressional admonition, the bar-
gaining history of this Employer, and the facts of this
case.
APPENDIX
. . . .
By its amended petition, the Petitioner seeks to represent a
unit comprised of all full-time and regular part-time engineers,
carpenters, maintenance technicians and bio-medical techni-
cians employed at the Employer’s Mercy General Hospital
facility located in Sacramento, California; excluding all other
employees, groundskeepers, guards and supervisors as defined
in the Act. There are approximately 17 employees in the peti-
tioned-for unit. The Employer contends that in order to be

4 It would seem obvious that the prospects for periodic strikes and
whipsaw tactics are greater where there are four separate units rather
than one unit.
MERCY SACRAMENTO HOSPITAL 795
appropriate, the unit must include employees in the petitioned-
for classifications at all of the hospitals within the CHW subdi-
vision called Mercy Healthcare Sacramento (MHS), which, as
discussed below, is comprised of four acute care hospitals lo-
cated in the Sacramento area. There are about 60 employees in
the unit that the Employer contends is the appropriate unit.
The only witness to testify at the hearing was CHW’s Direc-
tor of Labor and Employee Relations, Renae Bugge.
The Employer’s Operation. The petitioned-for employees
work at Mercy General, a 400-bed hospital employing about
800 employees that is within the MHS subdivision of CHW.
CHW is a multi-hospital healthcare system doing business in
California, Arizona and Nevada. It includes primary acute care
hospital facilities as well as some non-acute care medical facili-
ties. Since the late 1980s or early 1990s, MHS has been a sub-
division of CHW, that includes four acute care hospitals, Mercy
General Hospital, Methodist Hospital, Mercy Hospital Folsom,
and Mercy Medical Center San Juan. Until the late 1990s, the
CHW/ MHS system also included another acute care facility,
Mercy American River Hospital, which is no longer part of the
system.
All four MHS hospitals are located in the Sacramento area.
Specifically, Mercy General and Methodist Hospital are both
located in the City of Sacramento. Methodist Hospital is lo-
cated in the southern part of the City, just north of the town of
Elk Grove. Mercy General is situated near downtown Sacra-
mento, about 12 to 15 miles north of Methodist Hospital.
Northeast of Sacramento, in the City of Citrus Heights, is
Mercy Medical Center San Juan (herein called Mercy San
Juan), which is about 15 miles from Mercy General. Mercy
Hospital Folsom (herein called Mercy Folsom) is located in the
City of Folsom, which is located about 20 miles from Mercy
General and about 15 miles from Mercy San Juan. MHS also
has a business administrative office located in Rancho Cordova,
California, which provides most of the centralized services for
all four MHS hospitals, including patient accounting, payroll,
human resources, payor contracting, marketing, information
systems, risk management, safety and security and the Em-
ployer’s legal department. The Rancho Cordova office is also
in the Sacramento area and is located about the same distance
from all four MHS facilities.
Mercy General and Mercy San Juan are much larger hospi-
tals than Mercy Hospital Folsom and Methodist Hospital. At
the time of the Decision and Direction of Election in Case 20–
RC–17442, in 1998, which is discussed below, Mercy General
included the main hospital and a medical office condominium
building. The record does not disclose any changes in the
Mercy General campus since that decision issued.
Collective Bargaining History. I take administrative notice
that on September 4, 1998, the Acting Regional Director of
Region 20 issued a Decision and Direction of Election in Mercy
Healthcare Sacramento d/b/a Methodist Hospital, Case 20–
RC–17442, finding that a petitioned-for unit of “all full-time
and regular part-time maintenance technicians, engineers, bio-
medical equipment technicians and bio-medical maintenance
technicians employed by the Employer at its Methodist Hospi-
tal facility located in Sacramento, California; excluding all
clerical employees, guards and supervisors as defined in the
Act,” constituted an appropriate unit. This finding was based
on the conclusion that the Employer in that case had failed to
rebut the presumption that the petitioned-for single location
unit was an appropriate unit. As in the instant case, the Em-
ployer therein contended that the only appropriate unit was one
comprised of employees in the petitioned-for classifications
working at all of the MHS hospitals, which at that time in-
cluded the four hospitals involved in the instant case as well as
Mercy American River Hospital, which the Employer no longer
operates. The record shows that the Petitioner and the Em-
ployer bargained in the unit certified in Case 20–RC–17442,
but no collective-bargaining agreement was ever reached. Em-
ployer Director Bugge incorrectly testified at the hearing that
the unit at Methodist Hospital had been decertified. I take ad-
ministrative notice that in Case 20–RD–2299, by letter dated
August 7, 2000, the Petitioner disclaimed interest in represent-
ing the unit certified in Case 20–RC–17442 and the decertifica-
tion petition in that case was withdrawn on August 8, 2000.
The California Nurses Association (herein referred to as the
CNA) was certified on December 23, 1996, in Case 20–RC–
17195, to represent employees in a multi-location unit that
includes the four MHS hospitals herein as well as additional
CHW medical facilities in the Sacramento area. Administrative
notice is taken of the fact that this unit was certified pursuant to
the results of a stipulated election proceeding. Since 1996, the
CNA has represented registered nurses in the MHS unit. Over-
all, it represents registered nurses at twenty CHW facilities.
Since approximately 2000, SEIU Local 250 has represented
non-professional and technical employee units covering em-
ployees at all four MHS hospitals and at a non-acute care medi-
cal facility within MHS. These units were not certified by the
Board. In its brief in this case, the Employer’s counsel repre-
sented that SEIU Local 250 has consolidated all of its CHW
bargaining units, including the MHS hospital unit, for purposes
of negotiating with CHW. She further asserts that SEIU Local
250 continues to have a single local supplement to its agree-
ment for MHS. Director Bugge testified that certain contrac-
tual provisions of the SEIU Local 250 contract apply uniformly
to all CHW employees represented by the SEIU Local 250, and
certain provisions apply only to those within the MHS system.
I also take administrative notice of two earlier Board deci-
sions involving the same facilities, Mercy Hospitals of Sacra-
mento, Inc., 217 NLRB 765 (1975), and Mercy Hospitals of
Sacramento, 244 NLRB 229 (1979), where multi-location units
of professional employees, service and maintenance and office
clerical employees at Mercy General and Mercy San Juan were
found to be appropriate units.
Administrative and Labor Relations Functions and Policies.
CHW Director Bugge testified that in 1998, when the Decision
and Direction of Election in Mercy Healthcare Sacramento
d/b/a Methodist Hospital, Case 20–RC–17442, issued, CHW
served only as a holding company, which loosely bound to-
gether the many hospitals within CHW. In 1998, approxi-
mately four regions existed within CHW with MHS operating
as an entity within this regional structure. These regions were
subsequently changed into two divisions with MHS operating
as part or all of one of these divisions of CHW. According to
Bugge, since 1998, CHW has developed into an operating en-
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD796
tity rather than a holding company, and its board of directors
has assumed a much greater degree of control over its constitu-
ent hospitals. Many of the operating hospital and community
boards within the system have been dissolved or restructured
such that CHW now operates as a single employer.
CHW Director Bugge represents the MHS hospitals in labor
relations matters, and is involved in negotiating union con-
tracts, advising hospital management on grievance administra-
tion and handling, and assisting individual hospitals in dealing
with union organizing and election matters. In addition to
Bugge, there is also common human resources leadership over
MHS by CHW Vice President of Human Resources Tracy
Church. With regard to grievance administration under union
contracts, Bugge is involved in a consultative capacity in the
early steps of the grievance procedure at all four MHS hospitals
and is involved directly at the third step of the grievance proce-
dure. The Employer also has a uniform multi-step dispute reso-
lution procedure for non-represented employees at all four
MHS hospitals, with the first two steps of this procedure taking
place at the local hospital level with hospital supervisors and/or
managers. If a grievance is not resolved at the local level, the
employee can appeal to an MHS panel where the employee and
the Employer each choose panel members and the decision of
the panel is final and/or the dispute may proceed to arbitration.
CHW Director Bugge is the Employer’s representative on that
panel. In this regard, she testified that she had not been in-
volved in any dispute resolution proceedings involving any
employees in the petitioned-for unit within the past year.
The Employer has a uniform set of personnel policies and
procedures for employees at all MHS hospitals. Revisions to
these personnel policies are the responsibility of the Em-
ployer’s human resources council, which is comprised of hu-
man resources administrators, benefits and compensation man-
agers and training managers from each MHS facility, as well as
CHW Director Bugge. The council meets on a monthly basis.
The Employer also has a labor strategy group comprised of
CHW Director Bugge, CHW’s Chief Operating Officer Bill
Hunt, the MHS director of finance, and the president, nurse
executive and ancillary service director of each of the four
MHS hospitals. This group provides bargaining strategies on
local practices for all MHS hospitals, such as the posting of
jobs and floating between facilities. On global issues, the
group serves in an advisory capacity to CHW bargaining strat-
egy leaders such as Bugge. This group meets three or four
times a year and more often as needed during contract negotia-
tions. According to Bugge, there are no committees at the indi-
vidual MHS hospitals that set labor policy.
Transfers & Hiring Procedures. The record reflects that
where an opening exists at a facility and there are other em-
ployees performing the same type of work at the same facility
on different shifts, they are given the first priority in bidding on
the open shift at their site. Otherwise, job openings for all
MHS hospitals are combined on a single integrated list and
distributed to each MHS facility and seniority for purposes of
applying for open positions is determined on an MHS-wide
basis among employees at all MHS hospitals. Employees of
MHS hospitals are also given priority to transfer into open posi-
tions before persons are hired from outside MHS.
New job applicants are screened on a centralized basis and
then their applications are distributed to individual hospitals
based on where an open position exists and where the applicant
prefers to work. The applicant is then interviewed at the indi-
vidual facility by the supervisor and/or manager at that facility,
who makes the decision of whether to hire the applicant. This
decision is then communicated back to the centralized recruiter
or employment specialist for all four MHS facilities, who de-
termines whether the selection comports with CHW/MHS poli-
cies and the results of background checks and drug testing re-
sults received after the applicant was referred to the facility for
interviewing. If there are no problems with the hiring decision,
the recruiter sends out a letter informing the applicant that he or
she has been hired. If the recruiter or employment specialist
does see a problem, then the hospital supervisors or managers
who made the hiring decision are asked to consider other job
applicants.
All four MHS hospitals utilize the same common format for
job descriptions and evaluation forms and employees are evalu-
ated under the same standardized criteria. However, Director
Bugge testified that job descriptions are individualized for each
employee with different performance standards and specific
tasks outlined in the description. Bugge further testified that
she is not involved in the appraisal process for the employees in
the petitioned-for unit and that appraisals are handled either by
the immediate supervisor of these employees at Mercy General
or his superior at that facility.
The Employer has a uniform probationary period of ninety
days and a uniform reduction in force procedure for all MHS
hospitals. All MHS hospitals use similar employee identifica-
tion badges with the MHS logo, except that the badges identify
the individual hospital where the employee works.
Nonrepresented employees at all four MHS hospitals have
uniform pay rates and benefits. There is a centralized payroll
and benefits administration system for all four MHS hospitals
located at the Rancho Cordova office. There is also a common
patient accounting system. The MHS facilities have a common
marketing strategy department and a common information
technology system that is contracted out to the same entity,
Perot Industries. The MHS hospitals also use the same fund-
raising foundation.
MHS has a consolidated budget process. Departments at
each hospital within the MHS system formulate their own de-
partmental budgets, which are approved at the individual hospi-
tal level and then submitted to CHW’s chief operating officer
for approval as part of the overall MHS budget. Purchasing for
all four MHS facilities is done by a single centralized purchas-
ing entity.
Personnel files and patient files are maintained at each indi-
vidual hospital. Bargaining, financial, payroll and patient regis-
tration records are maintained for all MHS hospitals at the Ran-
cho Cordova office.
Supervision of the Petitioned-For Employees. The peti-
tioned-for employees report to Mercy General Supervisor Jim
Peterson. Peterson reports to another manager within Mercy
General, who in turn reports to the Hospital’s director of ancil-
lary services, who in turn reports to the Hospital’s president.
Each of the four hospitals within MHS is headed by a separate
MERCY SACRAMENTO HOSPITAL 797
president and each hospital also has its own human resources
department and its own human resources director, who reports
to the hospital’s president. The president of each hospital re-
ports to CHW’s Chief Operating Officer Bill Hunt. Hunt’s
jurisdiction covers not only the MHS hospitals but also CHW
facilities throughout Northern California.
As indicated above, interviewing for jobs is conducted at the
individual hospitals and hiring decisions are made by supervi-
sors and/or managers at each hospital but are subject to reversal
at the MHS divisional level if there are conflicts with
CHW/MHS policies or problems with background checks or
drug testing.
Supervisor Peterson has the authority to assign work to em-
ployees within the petitioned-for unit and he can also discipline
them and prepare their performance appraisals, so long as his
actions conform with CHW/MHS policies and procedures and
he or his superiors at Mercy General consult with the human
resources director of Mercy General, Linda Gregory, who re-
ports to Mercy General’s president. According to Director
Bugge, Gregory is authorized to advise Peterson on all “rou-
tine” matters, but if an issue is “out of the ordinary,” the hospi-
tal consults with CHW Director Bugge.
The management of each individual hospital in MHS handles
its own scheduling and there are differences between facilities
as to p.m. and night shift coverage requirements.
Employee Functions and Skills. No job descriptions for the
petitioned-for employees are in evidence. Bugge testified that
although job descriptions for employees are individualized and
she was not familiar with the specific job descriptions for em-
ployees in the petitioned-for unit, many of the jobs they per-
form would be standard with some variations due to the nature
of the equipment in use at different facilities.
Interchange. The record shows that the Employer has an
MHS-wide system of job postings and utilizes MSH-wide sen-
iority in bidding for jobs. Although Director Bugge testified
that employees are routinely assigned only to work at a single
MHS facility, and that temporary transfers are the exception
rather than the norm, she further testified that skilled techni-
cians do perform single and multiday projects at other facilities,
usually in order to make adjustments on machinery.
Analysis. No party disputes that the petitioned-for unit is
comprised of skilled maintenance employees, one of the eight
units deemed appropriate by the Board in its Health Care Rule.
54 Fed. Reg. 16336, 16347–16348, 284 NLRB 1579, 1596–
1597 (1989). Nor do the parties dispute the individual unit
inclusions or exclusions. The only issue is whether the peti-
tioned-for unit, which is limited to skilled maintenance em-
ployees at Mercy General, is an appropriate unit, or whether the
unit must also include skilled maintenance employees at all
MHS hospitals. The Employer contends that the unit must
include employees in the petitioned-for classifications at all
MHS facilities, and the Petitioner takes the position that the
petitioned-for single location unit at Mercy General is presump-
tively an appropriate unit.
The Board applies a presumption that a single-facility unit in
the health care industry is appropriate. Manor Healthcare
Corp., 285 NLRB 224 (1987); Heritage Park Health Care Cen-
ter, 324 NLRB 1318 (1997); Lutheran Welfare Services of
Northeastern Pennsylvania, 319 NLRB 886 (1995). This pre-
sumption can be overcome by showing that the single facility is
so effectively merged into a more comprehensive unit, or so
functionally integrated, that it has lost its separate identity.
D&L Transportation, 324 NLRB 160 (1997). In determining
whether the single-facility presumption has been rebutted, the
Board examines the following factors:
1) Geographic proximity of the employees in question;
2) Similarity of employee function and skill;
3) Similarity of employment conditions;
4) Centralization of administration;
5) Managerial and supervisory control of employees;
6) Employee interchange;
7) Functional integration of the employer;
8) Bargaining history.
See Stormont-Vail Healthcare, Inc., 340 NLRB No. 143
(2003); St. Luke’s Health System, Inc., 340 NLRB No. 139
(November 28, 2003); University Medical Center, 335 NLRB
1318 (2001); Hartford Hospital, 318 NLRB 183, 191 (1995);
Staten Island University Hospital v NLRB, 24 F.3d 450 (2d Cir.
1994); Passavant Retirement & Health Center, 313 NLRB
1216, 1218 (1994); Toledo Hospital, 312 NLRB 652, 652,
(1993); West Jersey Health System, 293 NLRB 749, 751
(1989).
As in St. Luke’s Health System, Stormont-Vail, and West Jer-
sey Health System, the Employer herein has a high degree of
functional integration. Thus, the record establishes a high de-
gree of administrative centralization between its four MHS
facilities that includes centralized payroll processing, account-
ing, purchasing, information systems, risk management, and
safety and security functions. This uniformity also extends to
labor relations policies, including a common employee manual,
the same pay rates and benefits, and the same hiring and dis-
pute resolution policies.
CHW/MHS management has veto power over the decision-
making of local hospital management in personnel matters such
as hiring and firing and handles the dispute resolution proce-
dure after step 2, as was the case in West Jersey Health System,
293 NLRB at 750. In addition, policy making in labor relations
is handled jointly by officials of all four MHS hospitals to-
gether with CHW/MHS officials. The record also shows that
most of the work of the employees in the petitioned-for classi-
fications is similar at all facilities.
With regard to interchange, the record shows that the Em-
ployer has a system of posting open positions at all facilities
and common seniority is used in bidding on jobs. Such a sys-
tem is by its nature conducive to permanent transfers facility-
wide. In addition, Bugge testified that skilled maintenance
employees sometimes work on single or multiday projects at
other than their assigned facility in order to make adjustments
on equipment.
The geographic separation between these facilities is of no
greater magnitude than that present in Stormont-Vail Health-
care, St Luke’s Health System, and West Jersey Health System,
all cases in which the Board found that the single-location pre-
sumption had been rebutted.
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD798
Finally, with regard to the factor of collective-bargaining his-
tory, it has been over 5 years since the certification issued in the
single location unit at Methodist Hospital in Case 20–RC–
17442. The record reflects that the Employer has become more
centralized in its operations and administrative functions as
well as its handling of labor relations matters during those in-
tervening years. Furthermore, there is no history of collective
bargaining in the unit certified in that case. No contract was
ever reached between the Employer and the Petitioner covering
that unit, and in 2000, the Petitioner disclaimed interest in rep-
resenting that unit. By contrast, there has been successful bar-
gaining in the MHS-wide units represented by the CNA and
SEIU Local 250. For these reasons, I find that the certification
in the prior case is not controlling to my determination herein.
Rather, I find that the history of collective bargaining in the
other MHS-wide units, which is ongoing, is the more relevant
consideration with regard to the appropriate unit in this case.
In sum, based on a careful consideration of the foregoing
factors, I have concluded that the single facility presumption of
appropriateness has been rebutted in this case and that the four-
hospital MHS unit is the appropriate unit for collective-
bargaining purposes. I note that this finding comports with the
Board’s policy against proliferation of units in the health care
industry.
Accordingly, I am directing an election in the MHS-wide
unit.