Douglas Rooks has been a Maine editor and columnist for 41 years. His biography of Gov. Ken Curtis, “Transformational,” is now available. He welcomes comment at [email protected].

The vote last week by Central Maine Medical Center nurses in Lewiston to unionize says a good deal about organizing prospects in the state, but even more about the mismanagement of Maine hospitals.

Driven by the perverse incentives of fee-for-service reimbursement, hospitals compete for a larger share of the revenue pie, ignoring opportunities for rational consolidation as care becomes increasingly specialized and high-tech.

The situation at CMMC, which has been under severe financial stress, has all the makings of a train wreck. Last year, Prime Healthcare of California, a for-profit chain, agreed to buy CMMC and formed a nonprofit subsidiary to make the acquisition — a maneuver that fooled no one. Nonetheless, the state issued a Certificate of Need approving the sale, in which Prime agreed to maintain designated staffing levels, invest in new services and — somehow — improve the financial balance sheet.

The immediate response by hospital employees? Nearly 20% of the staff resigned. Earlier this year, surgeries were briefly suspended and transferred elsewhere when the state found inadequate operating room sterilization.

The nurses’ campaign then came as no surprise — though hospital management’s response did. Just days before the union vote, Prime fired or suspended 20 nurses, most of them involved  in the organizing drive, allegedly for neglecting their duties. Prime has employed similar union-busting tactics elsewhere, but it’s unprecedented in Maine hospitals.

The move drew a stern rebuke from Gov. Janet Mills, writing to Prime, “I strongly urge you to immediately reinstate every nurse who has been wrongfully fired or suspended.” To date, Prime has not responded — just as MaineHealth’s board in Portland ignored Mills’ plea, and that of the Democratic nominee for governor, Hannah Pingree, to delay closing the birthing center at Miles Memorial in Damariscotta, the 12th such closure statewide in recent years.

CMMC nurses voted 204-21 in favor of a union, a rate of 91% It followed a similarly successful effort to organize at Maine Medical Center in 2021 by the Maine Nurses Association, affiliated with National Nurses United, the third such attempt. Nurses at Northern Light Eastern Maine Medical Center in Bangor have had a union since 1976; labor will now have a seat at the management table in three of the state’s largest hospitals.

But the union campaigns reflect a larger reality — an apparent inability to adjust the state’s hospital structure to reflect changing demands for care within a community structure, as opposed to the often debilitating competition for patients and revenue.

Lewiston provides a case in point. Thirty years ago, Central Maine and St. Mary’s both had similar number of beds and budgets, and it was already clear that consolidation should be considered. Instead, CMMC embarked on an unwise expansion plan that led to the current crisis.

It briefly owned Parkview Hospital in Brunswick, which was then engaged in a highly public war of words with Mid Coast, itself a merger of hospitals in Brunswick and Bath, that ended only with Parkview’s bankruptcy. When Mid Coast took over operations, it declined to adjust or reduce any services and, overextended, had to sell to MaineHealth, which from its Portland headquarters now controls the majority of the state’s hospital services.

Or consider Waterville, where Inland, the state’s only osteopathic hospital, was closed by Northern Light last year. It’s possible it could have been saved. When the state approved the merger of Waterville’s other hospital, Mid Maine, with Augusta on the new MaineGeneral campus, it curiously allowed Waterville’s Thayer Hospital to retain a 24-hour ER, even though the facility downsized to outpatient care. Two emergency rooms in one small market vastly exceeded demand, with Inland the casualty.

Just as MaineHealth controls the majority of the state’s hospitals, under the Affordable Care Act federal and state governments have assumed the bulk of healthcare spending, well over half. This requires a larger state role in planning, and if necessary directing, the provision of services so patients and staff are protected, not forced  out.

In the 1980s, the Maine Health Care Finance Authority regulated hospital charges, moderating rate increases while maintaining care standards, but was later abolished. Reviving it, while reviewing mergers and takeovers and offering alternatives, would be a good first step. The Prime Healthcare fiasco is exactly what the state must avoid repeating.

A national healthcare system, rising to prominence in this year’s campaigns, is ultimately the solution to many of our woes. The state can play an important role, however, and a new administration is the ideal place to start.