Seachange Bulletin #135August 17, 2004Seachange Bulletin ArchivesEmail the editorSeachange Bulletin #135: Massachusetts Marvels Yet another study was published today linking poor staffing conditions in hospitals to poor care for patients. In this case, a new study in the journal Health Affairs shows a significant increase in medication errors by nurses who work overtime. The report, one of a series of scientific studies published in the last year, provides further evidence in support of legislation pending in Massachusetts to ban mandatory overtime and to establish safe RN staffing levels in Massachusetts hospitals. Nurses who worked shifts lasting at least 12.5 hours were three times more likely to commit an error, such as giving a patient the wrong medicine or the wrong dose, than nurses who worked less than 8.5 hours, according to the study from the University of Pennsylvania School of Nursing. ... "The errors nurses reported in this study occurred in the context of well-documented deficiencies in nurses’ practice conditions in US hospitals, deficiencies that nurses have been reporting for well over a decade. The long and unpredictable hours documented here suggest a link between poor working conditions and threats to patient safety." ... The Working Hours of Hospital Staff Nurses and Patient Safety Both errors and near errors are more likely to occur when hospital staff nurses work twelve or more hours at a stretch. Ann E. Rogers, Wei-Ting Hwang, Linda D. Scott, Linda H. Aiken & David F. Dinges <http://www.massnurses.org/safe_care/Rogers.pdf> ... Several trends in hospital use and staffing patterns have converged to create potentially hazardous conditions for patient safety. High patient acuity levels, coupled with rapid admission and discharge cycles and a shortage of nurses, pose serious challenges for the delivery of safe and effective nursing care for hospitalized patients. ... "The long and unpredictable hours documented here suggest a link between poor working conditions and threats to patient safety." ... What will it take to solve the nursing shortage? Jeffrey Klineman, CommonWealth, Special Health Care Issue 2004 <http://www.massinc.org/handler.cfm?type=1&target=2004-S/nurses.htm> Sitting on a Brighton hilltop like a fortress against disease, the beige brick edifice of St. Elizabeth's Hospital stands out against the gray March sky. The driveway, which carves a path up to the emergency room and where one might expect to hear the blare of ambulance sirens, is clear and quiet, but motorists heading down Cambridge Street toward the Charles River break the silence by honking their horns in support of the nurses gathered in demonstration at the foot of the hill. As always, wages and benefits are at issue, but the chief source of labor unrest is another matter - one that doesn't go away even when a settlement is signed here a few weeks later. Nurses at St. Elizabeth's, and elsewhere, say that the quality of their work life is suffering, and the health of their patients is in danger. In Massachusetts hospitals, they say, on too many hospital floors, too many patients are looked after by too few nurses. "I'll tell you straight out: If you get sick, I fear for your life," says Rita McMillan, a fiftysomething nurse in St. Elizabeth's neonatal unit. "There aren't enough of us to go around." ... Massachusetts has one of the highest numbers of registered nurses, relative to population, in the country. Yet, in 2002, 9.9 percent of budgeted nursing positions were vacant, a level of job openings not seen since 1988 and up from a low of 2 percent in 1996. ... In Massachusetts, a vital nurse workforce is doubly important: important not only for care but also because of the health care industry's prominent place in the state's economy. Any loss of confidence in its internationally renowned hospitals could be as painful to the state as a medical error could be to a patient. ... Compounding the supply problem, a lot of nurses aren't happy. They believe the only way they will be happy is if there is a legal limit on the number of patients they each are required to care for. Though it may be a legislative blunt instrument, many nurses say that it would guarantee good care for patients and good working conditions for them. ... It's not "whether," it's "when" we get RN-to-patient ratios into law Julie Pinkham, RN, Executive Director, Massachusetts Nurses Association, July 2004 <http://www.massnurses.org/News/2004/07/ed_message.htm> The proponents of RN-to-patient ratios have one common denominator: patient advocacy. The opponents of RN-to-patient ratios break down into two categories: those who are concerned with corporations/money and those who want to be close to the first category. When we first began this pursuit for safety several years ago, we had a few legislators and four advocacy groups signed on with the MNA to implement this safety net for patients. In 2001, we broke away from a primary opponent of safe staffing: the ANA. Since that time the new MNA has focused its efforts on passing safe staffing legislation, with some very measurable dividends, including 102 legislators co-sponsoring the bill and the formation of the Coalition to Protect Massachusetts Patients - a powerful alliance that now includes over 70 advocacy organizations. In addition, the bill was for the first time favorably reported out by the Joint Health Care Committee where previously it had languished for years. Taking another step forward, a pilot program of the ratio bill (with a full implementation plan effective in 2007) was passed by the Senate in their budget. While the final budget did not include the language, make no mistake: this policy initiative is generating a lot of interest at the Statehouse and the Senate has already passed language and the House will have to address it as well. This is why it is not a question of "whether." It is a question of "when" we will pass this legislation. ... In The Wake of a Shocking Report Showing 195,000 Preventable Deaths Per Year in Nation’s Hospitals, Mass. Nurses & Patient Advocates Make Final Push to Pass Safe Staffing Bill Majority of Deaths Detailed in Report Result from Complications Caused by Poor RN Staffing. Legislators Have Until July 31st to Pass Legislation to Establish Safe, Minimum RN-to-Patient Ratios in Hospitals. Massachusetts Nurses Association, July 29, 2004 <http://www.massnurses.org/News/2004/07/new_study2.htm> Boston - In the wake of the release this week of a shocking report that found more than 195,000 patients die needlessly every year in our hospitals from a series of complications directly related to poor nurses staffing, nurses in Massachusetts will be leafleting legislators outside the State House when they return to work on Friday and flooding legislators’ offices with phone calls and emails in a final push to convince lawmakers to pass legislation, H.1282, a bill to establish RN-to-patient ratios in acute hospitals, before the end of the legislative session on July 31st. The report, entitled "Patient Safety in American Hospitals" was released this week by HealthGrades, Inc., a leading health care quality research firm. ... Legislative Session Comes to End without Final Passage of Safe RN Staffing Legislation Much gain made on Beacon Hill Legislation poised to cross final hurdle Massachusetts Nurses Association, August 2, 2004 <http://www.massnurses.org/News/2004/07/bill.htm> Despite a tremendous effort from RNs and patient advocacy groups across the state, in the early morning hours of July 31st the 2003-04 legislative session came to an end without final passage of Safe RN Staffing Legislation. State Representative Christine Canavan lead a final attempt to attach the Senate passed pilot program to a 'supplemental' budget but the House did not take up the supplemental spending bill. While the Legislature did not pass the Safe RN Staffing legislation, due to the hard work of RNs and patient advocates much progress was made. The legislation was passed by the Joint Committee on Health Care for the first time and the State Senate passed in its budget a 10-hospital pilot program of the Safe RN Staffing bill. 102 members of the legislature co-sponsored the bill and 70 organizations endorsed the effort, forming the Coalition to Protect Massachusetts Patients. This issue is not over. While formal legislative sessions are finished until January 2005, Legislative leaders intend to convene a working committee to have a bill ready to act on for next year. The efforts of RNs and others should be commended. Your phone calls, letter writing, postcards and meetings with your legislators had an enormous impact. ... Editorial Comment: The following ‘dear colleague’ letter was submitted for publication in the Summer issue of Contact, the newsletter of MNA’s Region 5: July 30-31, 2004 Dear Colleagues, I’m writing these words as I sit in the balcony overlooking the Massachusetts House of Representatives on the final day of the 2003-2004 legislative session. Fearing to be seen taking sides between patient advocates and the hospital industry, the majority of legislators have failed to acknowledge the possible consequences of their historic inaction. One or more of the following responses could be pursued: * We will remember every November. In our battle for safe staffing, the argument has been won. It’s not a question of intellect but of will, or, rather, of backbone. Under pressure from the score of lobbyists from the Massachusetts Hospital Association and its subsidiary, the Massachusetts Organization of Nursing Executives, key House leaders and most members opted not to bring safe, minimal, enforceable RN-to-patient ratios to a floor vote, even in the form of the compromise worked out between the Coalition to Protect Massachusetts Patient s and the Senate leadership, which had been attached to the Senate’s version of the FY2005 state budget. We recognize those legislators who stood proudly with us, and those who ducked for cover. The pages of The Massachusetts Nurse will help us determine who deserves our support and who merits our wrath. NursePLAN will endorse candidates using our safe staffing criterion. And our MNA Awards Banquet at Convention in Boston on October 6th will shine a light on some of those who truly are friends of nursing in the Commonwealth. * Costly strikes may be called to protect our patients and our licenses. Members in local bargaining units will no longer feel hesitant to put staffing language on the bargaining table and to push it, since effective legislation is no longer imminently pending. Some legislators may have remembered the forty-nine-day strike against the Tenet Corporation in Worcester in 2000 and the 104-day strike in Brockton in 2001 against an arrogant CEO who refused to agree to safe-staffing language at the bargaining table, thereby blowing a six-million-dollar surplus and the chance to host a regional cardiac surgery center. Denial is no excuse. * RNs and our allies may choose to put the question to the voters. Next year we may decide to collect voters’ signatures and take the other steps needed to place RN-to-patient ratios on the November 2006 ballot, thereby indicting the majority of legislators for deadly inaction. This way, patient advocates and the industry will duke it out in front of the electorate, the vast majority of whom already support patient safety. Our true friends on Beacon Hill will understand this necessity, and our phony friends are useless anyway. * We will resubmit legislation. With some minimal tweaking, our bill may be resubmitted in December for consideration in the next legislative session. This way every senator and representative will know there is a way, with the stroke of a pen, to stop the bad press, the strikes over unsafe staffing and the embarrassing ballot question. * We will endorse the MNA Five Year Plan. The ANA disaffiliation dividend was wisely spent to strengthen our organization and carry out the mandates of the membership. We’ve come a long way, but the trek isn’t over by a long shot. We’ve won every argument and placed minimal, enforceable RN-to-patient ratios on the public’s radar screen. But we don’t have them in place yet. We’ve begun to create the national voice that speaks for front-line nurses, the American Association of Registered Nurses, but we don’t yet share a national office within the Beltway to assure our constant, visible presence on Capitol Hill. We’ve merged our statewide governing bodies so as to speak with one voice and to act effectively. We’ve transformed our divisive District structure into Regions but, in Region 5 at least, we have not yet taken full advantage of this coordinating and funding vehicle. We’ve laid the groundwork for our Labor Institute, but this school for rank-and-file activists needs to be rolled out across the state. The members assembled in the MNA business meeting on October 7th will decide whether to fund the plan in order to realize the vision, to become the power-house needed to defend our patients and our practice, to complete the revolution and move forward. We all need to be there and engage in the dialogue and vote. We need to take our collective future into our own hands. Sandy Eaton, RN Staff Nurse, Progressive Care Unit Quincy Medical Center Ousted Caritas chief got $1.4m last year Other Hub hospital CEOs also did well Liz Kowalczyk, Boston Globe, August 14, 2004 <http://www.boston.com/business/articles/2004/08/14/ousted_caritas_chief_got_1 4m_last_year> Dr. Michael Collins, who was unexpectedly ousted as president of Caritas Christi Health Care in April, earned $1.4 million in compensation last year, far more than most other Boston teaching hospital executives. Collins's compensation, which included a one-time $500,000 payment related to prior years, came when the state's largest Catholic hospital system was trying to turn itself around financially after years of struggle. ... Nonprofit hospitals have until Monday to file with the state attorney general's office last fiscal year's financial reports, including compensation for their highest paid employees. The office's public charities division collects salary information in part so it can monitor whether nonprofits, which are supposed to pump profits back into community services, are paying their executives excessive salaries. ... Elaine Ullian, chief executive of Boston Medical Center, also a hospital that largely serves the poor, earned $902,721 in compensation last year, up 5.6 percent from $854,927 the previous year. ''Last year was the seventh year of the most successful hospital merger in town and perhaps the most difficult," said chairman Marshall Carter, referring to the merger of Boston City Hospital and Boston University Medical Center. ''We didn't think a 5.5 percent increase was that unusual. She's really skinny-ed down the staff, and she's operating without a chief operating officer. She's running the place herself." ... Hospitals report earnings Liz Kowalczyk, Boston Globe, August 14, 2004 <http://www.boston.com/business/articles/2004/08/14/auto_insurers_seek_hike> Buoyed by growing numbers of patients, Partners HealthCare, the parent organization of Massachusetts General and Brigham and Women's hospitals, posted a $30 million operating profit for the quarter ended June 30, a 32.2 percent jump over the $22.7 million more than the year-ago quarter. Revenue grew 8.7 percent to $1.3 billion, up from $1.2 billion. All Partners acute care hospitals, including Mass. General, the Brigham, Faulkner Hospital, North Shore Medical Center, and Newton-Wellesley Hospital posted operating profits in the quarter. Boston Medical Center, where the numbers of patients and surgeries also are growing, posted an operating profit of $3.2 million in the quarter, compared to a $1.2 million loss in the year-ago quarter. Revenue shot up 9.8 percent, to $170.6 million from $155.3 million. Beth Israel Deaconess Medical Center posted an operating profit of $12 million compared to a break-even quarter a year ago. Revenue grew 19.2 percent to $255.7 million, up from $214.5 million. Health Rights Advanced: Pols debate health care Kyle Cheney, The Daily Free Press (Boston University), April 6, 2004 <http://www.dailyfreepress.com/news/2004/04/06/News/Pols-Debate.Health.Care-65 2451.shtml> Massachusetts lawmakers will hear a proposal today for a constitutional amendment requiring universal health care for all Massachusetts residents. Dr. Barbara Roop, co-chairwoman of Health Care for Massachusetts and an author of the proposal, said the amendment would expand health care to 600,000 state residents who currently have inadequate care and "force the Legislature to act" because of its amendment status. "There is a tremendous amount of waste in out health care system," Roop said. "Thirty-nine cents of every health care dollar is spent on administration." Along with Dr. John Goodson, an internist at Massachusetts General Hospital, Roop acquired the 71,000 signatures (sic) required for the initiative to be placed on the ballot as early as 2006, should the Legislature approve it this year. ... Legislators wary about health care for all amendment Tom Benner, The Patriot Ledger, April 7, 2004 Boston - Several lawmakers are casting a wary eye on a proposal to guarantee that all Massachusetts citizens have access to health insurance, with some speculating that taxpayers would end up footing the bill for diet programs and sex change operations. Proponents want lawmakers to give initial approval next month to a constitutional amendment that would require the state to find a way to provide health insurance for the uninsured, now estimated at 600,000 people. But several lawmakers attending a State House hearing on the proposal yesterday criticized members of the Health Care for Massachusetts campaign for not saying what the promise might cost. Representative William C. Galvin, D-Canton, a member of the Legislature’s insurance and health care committees, said a written guarantee in the constitution would be an invitation for lawsuits. "Someone is going to be unhappy with it, and they’re going to go to the courts," Galvin said. "It would be a lot better for us to do it through the legislative process than a constitutional amendment." Representative Geraldine M. Creedon, D-Brockton, questioned whether a written guarantee to provide health insurance would lead to the state paying for diets, gym memberships and sex change operations. ... Health care crisis in Massachusetts Sandy Eaton, RN, Quincy, The Patriot Ledger, April 21, 2004 <http://ledger.southofboston.com/articles/2004/04/21/opinion/opin03.txt> Your recent article on the State House hearing on the proposed health care amendment to the Massachusetts Constitution (‘‘Legislators wary about health care for all amendment,'' April 7) failed to capture the richness of the four-hour debate. While the fiscal caution expressed by two South Shore legislators was reflected, the urgency of the unfolding health care crisis in the commonwealth expressed by witness after witness was overlooked. The CEO of Massachusetts General Hospital and other leaders called for swift action, with the ranks of the uninsured in Massachusetts having now swelled to 600,000. The executive directors of the Massachusetts Public Health Association, Health Care For All and the Latin American Health Institute, as well as spokespeople for the Black Ministerial Alliance, the Massachusetts Senior Action Council and the student bodies of the state's four medical schools, detailed how we cannot afford the deteriorating status quo. Weymouth's Karen Higgins, president of the Massachusetts Nurses Association, reiterated organized nursing's commitment to universal access to affordable, comprehensive and quality health care as a basic human right. A healthy opportunity Adrian Walker, Boston Globe, May 13, 2004 <http://www.boston.com/news/local/articles/2004/05/13/a_healthy_opportunity> Khalil Landers is a man pursuing a dream. An aspiring emergency medical technician, he works for the city on the mayor's Health Van. A sort of clinic on wheels, it travels the city screening patients' cholesterol and blood sugar levels. A temporary employee who expects his job to end in June, Landers holds an ironic distinction. Though training for a career in health care, he does not himself have health insurance. He has plenty of company in Massachusetts. Of the 600,000 adults without insurance, an estimated 275,000 of them hold jobs. "When I applied for MassHealth I was rejected because it wasn't accepting new members," he said yesterday. "With the lack of insurance, it's been my experience that you don't always get what you need." Help, perhaps, is on the way. A constitutional amendment to extend health insurance to the uninsured has garnered 81,000 (sic) signatures and could come to a vote by legislators next month. If it passes, that would put it on the road to appearing on the ballot in 2006, though its fate is unclear. ... Many back care amendment Jennifer Heldt Powell, Boston Herald, June 29, 2004 <http://business.bostonherald.com/businessNews/view.bg?articleid=33777> A group pushing for universal health care coverage in Massachusetts appears set to clear a major hurdle next week. Fifty-one lawmakers have promised to vote at the July 7 Constitutional Convention in favor of a constitutional amendment proposed by the Health Care for Massachusetts Campaign. That is one more than the group needed to keep the issue in play. "It shows we're gaining momentum," said Barbara Roop, the group's co-chairwoman. For the measure to be adopted by the state, it must be approved by a Constitutional Convention two years in a row, then by voters. The proposal, which contains few details, orders the state to ensure "that no Massachusetts resident lacks comprehensive, affordable and equitably financed health insurance coverage ... " Proponents said they left out details on purpose so experts could work together to determine how best to carry out the order. ... Boston City Council Adopts Resolution Barbara Waters Roop, Health Care for Massachusetts Campaign, June 30, 2004 Thanks to the careful and determined sponsorship of Councilor Felix Arroyo, the Boston City Council approved a resolution in support of the Amendment for Affordable Health Insurance today. We are very grateful for Councilor Arroyo's efforts and to the entire City Council which interrupted their budget deliberations to express their support. They will be issuing a press release tomorrow morning and sending copies to all the members of the Boston delegation. Health insurance is a constitutional matter Barbara Waters Roop & John D. Goodson, CommonWealth, Special Health Care Issue 2004 <http://www.massinc.org/handler.cfm?type=1&target=2004-S/argument.htm> It's almost a cliché: The Massachusetts health care system is in crisis. Every stakeholder is unhappy. It is not a crisis of technology - new drugs, machines, and methods abound, so that, at its best, medical treatment here is at the cutting edge. It is a crisis of affordability and finance. A new wave of medical inflation is sending shock waves through the system, exposing it for the Rube Goldberg device it is. The recession compounds the crisis. Whenever inflation ripples through our gerry-built system, the ranks of the uninsured grow - by 65,000 for every 10 percent jump in employee premium costs, according to the Division of Health Care Finance and Policy. All purchasers of health care, public and private, seek protection from rising prices by cutting coverage and shifting costs to others. State and federal programs cap access and cut reimbursement rates. Employers raise contribution rates, cut benefits, or drop coverage. Individuals drop coverage, betting that the cost of getting sick will be lower than the cost of insurance; losing often spells financial catastrophe. ... An amendment won't provide a health cure Richard C. Lord, CommonWealth, Special Health Care Issue 2004 <http://www.massinc.org/handler.cfm?type=1&target=2004-S/counterpoint.htm> The proponents of a state constitutional amendment to establish an individual right to comprehensive health insurance, enforceable against the Commonwealth, have clearly given a lot of thought to the problems besetting our health care system. Apparently, however, they have given no thought at all to how those problems might be solved. Instead, they offer a very dangerous political ploy. Their proposal is political in two senses. Explicitly, it is a device to force the state Legislature to immediately reshape our health care system - risky enough, one might think. The implicit political aim is much worse: to induce voters to approve a general statement of principle without regard to its practical consequences. A constitutional amendment creating an entitlement will inevitably produce irreversible legislative and judicial results that, though to a significant extent unpredictable, are certainly not anything the public would willingly entertain. What are these consequences? In the absence of a real plan, we can only speculate, based on a review of the three general approaches to universal coverage: incremental, individual mandate, and single payer. This sobering exercise quickly reveals just why the amendment's proponents avoid specifics so assiduously. ... Richard C. Lord is president and CEO of Associated Industries of Massachusetts. Pre-Con Con, Speaker Urges Yes on Rainy Day Fund, No on Universal Care Amy Lambiaso, State House News Service, July 6, 2004 On the eve of a potential vote on the issues, House Speaker Thomas Finneran joined business leaders Tuesday in pushing for a permanent Rainy Day fund and rejecting a proposed constitutionally mandated universal health care system. The call came as lawmakers prepare to reopen the Constitutional Convention - a joint session with the House and Senate - Wednesday to vote on an array of issues such as abolishing the Governor’s Council, requiring the election of judges, and filling a vacancy in the lieutenant governor’s position. Finneran is the sponsor of an amendment to require 1 percent of annual tax revenues to be deposited into the state’s Rainy Day fund, requiring 3/5 of the House and Senate members to approve any spending of the reserve fund. The amendment also limits spending from the fund each year to 50 percent of its balance. But with Finneran’s amendment at the bottom of the convention calendar, lawmakers must get through all the other items first - either approving, rejecting, or delaying action on each one. One calendar item is a citizens' petition requiring the Legislature to establish a system of universal health care in the Constitution. Some members are eager to vote on the proposal. "This process was created for citizens to change the constitution," said Rep. James Marzilli (D-Arlington). "And we need to allow that process to happen." Finneran called a press conference Tuesday to push for his Rainy Day amendment, and invited area business leaders to help make his case. At that media event, the speaker said mandated universal health care is "an incredible economic weight for Massachusetts businesses to carry forward." ... A health care blank check Boston Herald Editorial, July 7, 2004 <http://news.bostonherald.com/opinion/view.bg?articleid=34643> Establishing the right to health care for every citizen in the Constitution is like that populist promise to voters of a "chicken in every pot." It sure sounds good, but no one has a clue about how to achieve it or, as important, how to pay for it. We remember all the balloons festooning the State House steps to celebrate the passage of the state's last universal health care experiment. And we remember the rush to repeal the measure almost as soon as the bills to pay for it landed on employers' desks. (Editorial Comment: The Dukakis employer mandate was passed but never implemented.) Proponents of the constitutional amendment guaranteeing health care for all want to avoid answering the nitty gritty questions now. But an issue as complex and costly as this one deserves more than sloganeering. It deserves a solution. The question before lawmakers at the Constitutional Convention today doesn't come close to providing one. City Council backs health care amendment to constitution Aaron Nicodemus, New Bedford Standard-Times, July 7, 2004 <http://www.southcoasttoday.com/daily/07-04/07-07-04/a07lo591.htm> New Bedford - The City Council has endorsed a proposed constitutional amendment that would require the state to make sure every one of its residents has access to affordable health care. The amendment does not require the state to provide health care coverage to every resident, explained Barbara Roop of the Healthcare for Massachusetts Campaign in Cambridge, which gathered 71,000 signatures in favor of the amendment. Rather, it would require the state to make sure there is a place for every resident to buy affordable health insurance. "We've identified $5.7 billion in savings, money that we already spend on health care in the state, that could be spent more efficiently," she said. ... Lawmakers debate proposed constitutional amendments Steve LeBlanc, Associated Press, July 7, 2004 <http://www.boston.com/news/local/massachusetts/articles/2004/07/07/lawmakers_ debate_proposed_constitutional_amendments> Boston - House and Senate lawmakers meeting in a joint session Wednesday to debate proposed amendments to the state constitution quickly defeated a proposal that would have abolished the eight-member Governor's Council. Lawmakers also postponed action on another proposed amendment that would require the state to guarantee affordable health care for every Massachusetts resident. ... The single-sentence amendment would require lawmakers to enact "such laws as will ensure that no Massachusetts resident lacks comprehensive, affordable and equitably financed health insurance coverage for all medically necessary preventative, acute and chronic health care and mental health care services, prescription drugs and devices." Supporters of the proposal say it is the only way to force lawmakers to come to terms with the lack of adequate universal health care. "If we could outlaw cancer, if we could outlaw heart disease, we could do it in a flash," said state Rep. Patricia Jehlen, D-Somerville, who said requiring universal health care is one step the state can take. ... Rainy day amendment gets initial OK Measure step closer to 2006 state vote Raphael Lewis, Boston Globe, July 8, 2004 <http://www.boston.com/news/local/articles/2004/07/08/rainy_day_amendment_gets _initial_ok> The Massachusetts Legislature overwhelmingly approved a proposed constitutional amendment yesterday to safeguard the state's rainy-day reserves by earmarking 1 percent of tax revenues each year for the fund, marking a major victory for its chief sponsor, House Speaker Thomas M. Finneran. ... ''I put this very high on the list" of career accomplishments, he said. ... Finneran exerted plenty of muscle to shepherd his pet bill through yesterday, including a prolonged effort to block a vote on an amendment measure that would require the Legislature to make sure that all citizens have access to health insurance coverage. Finneran, an opponent of the healthcare proposal, threatened to add a rider to that measure that would have effectively killed it unless backers agreed to allow for a vote on the rainy day legislation first. Backers of the healthcare bill agreed, but only after Finneran, his lieutenants, and Republicans promised not to interfere with a vote on the matter next Wednesday. The healthcare measure has more than enough backers to make it through to next year's constitutional convention, all sides agreed. ... Legislature approves health care coverage as constitutional right Jennifer Peter, Associated Press, July 14, 2004 <http://www.boston.com/dailynews/196/region/Legislature_approves_health_ca:.sh tml> Boston - Comprehensive and affordable health care coverage would become a constitutionally-protected right for all Massachusetts citizens under an amendment overwhelming approved Wednesday by a joint session of the House and Senate. If approved by lawmakers again during the 2005-2006 session, the question would go before voters in November 2006. If successful, the state would then develop a specific plan for providing and paying for health care. Under a change approved Wednesday, which made the amendment more palatable to some lawmakers, the payment and coverage plan would go back to voters for further approval, in November 2008 at the earliest. ... Mass. legislators approve universal health-care measure Boston Business Journal, July 14, 2004 <http://boston.bizjournals.com/boston/stories/2004/07/12/daily34.html> Massachusetts state legislators have overwhelmingly approved a proposed constitutional amendment that would require the state to create a mechanism to provide health insurance for every state resident. The 143-41 vote during the Constitutional Convention on Wednesday keeps the proposed amendment alive until a second legislative vote in two years. (Editorial Comment: The actual final vote was 153-41, since late-comers to the vote are allowed to ask to have their votes added to the tally.) Voters will be able to decide on the measure if the amendment survives that test. Only 50 votes were needed to move the proposed amendment to the second Constitutional Convention, so the margin represents a significant victory for the Health Care for Massachusetts Campaign, a citizens group that sponsored the measure. ... Health care lunacy hits Hill Boston Herald Editorial, July 15, 2004 <http://news.bostonherald.com/opinion/view.bg?articleid=35653> There are times when the fiscal irresponsibility of the Massachusetts Legislature is enough to simply take your breath away. Yesterday the House and Senate meeting jointly in Constitutional Convention voted overwhelmingly (143-41) in favor of a universal right to health care coverage for every man, woman and child in the commonwealth. The proposed amendment states that "it shall be the obligation and duty of the Legislature and executive officials ... to enact and implement such laws as will ensure that no Massachusetts resident lack comprehensive, affordable and equitably financed health insurance coverage for all medically necessary preventive, acute and chronic health care and mental health care services, prescription drugs and devices." Welcome to utopia, where politicians can promise all things to all people and heaven help us when the bill comes due. This newly invented right still needs another round of approval by a similar Constitutional Convention during the 2005-2006 session and then would go on the ballot in November 2006. And since it only needed 51 votes to make it through this round (the low number required by a citizen-initiated petition) it was pretty much a done deal. That allowed lawmakers to then join this little bandwagon with no real consequences - yet. Medicaid expenses continue to be a state budget buster. The funds needed to cover the so-called free care/bad debt pool for hospitals that serve the poor are increasingly problematic. And now we are one step closer to making universal coverage a birthright, regardless of need or income. Welcome to the land of fiscal lunacy where everyone is happy and healthy. Now let's see, who gets to pick up the tab? Lawmakers act on guaranteed affordable health care plan Thor Jourgensen, Lynn Daily Item, July 15, 2004 <http://www.thedailyitemoflynn.com/news/view.bg?articleid=6653> Lynn - Patricia Correa cannot afford her employer's health insurance plan, but that might change if a constitutional guarantee of affordable health care becomes reality. The state Legislature took the first step Wednesday on a four-year path toward implementing that guarantee. Lawmakers voted 143-41 to make comprehensive and affordable health care coverage a constitutionally protected right for all Massachusetts citizens. If approved by lawmakers again during the 2005-2006 session, the question would go before voters in November 2006. If successful, the state would then develop a specific plan for providing and paying for health care, which would again go before voters, in November 2008 at the earliest. ... Universal health insurance plan advances Jon Brodkin, MetroWest Daily News, July 15, 2004 <http://www.metrowestdailynews.com/localRegional/view.bg?articleid=73165> The state Legislature overwhelmingly voted to make health insurance a constitutionally protected right yesterday, paving the way for a potential statewide referendum on universal health care in 2006. Needing just 50 votes to advance, a proposed constitutional amendment guaranteeing all Massachusetts residents access to affordable health coverage was approved 152-41. "I feel that health care is a fundamental right and that government has a responsibility to provide acceptable and affordable health care to all its citizens," state Rep. David Linsky, D-Natick, said after yesterday's vote. The vote, which took place in a constitutional convention joining the House and Senate, was the first legislative test for the citizens petition drive to amend the state constitution. ... Legislators show support for affordable health insurance Cambridge Chronicle, July 15, 2004 <http://www2.townonline.com/cambridge/localRegional/view.bg?articleid=38402> The Constitutional amendment requires elected officials to reform, with stakeholder input, our health-care system to ensure access to affordable health insurance for all residents - the key to getting the high-quality care that will over time reduce costs. Reputable studies show these reforms can be paid for by redirecting money already spent on care for the uninsured and wasted on complicated and burdensome bureaucracies. These changes will mean getting better value for our health-care dollar by using current dollars for direct investments in the health and welfare of all Massachusetts residents and in the vitality of our health-care economy. ... Business leaders, small business owners and health-care providers have expressed support for the measure. Several small business owners testified at a hearing earlier this spring or have submitted testimony to the legislative committee reviewing the proposal, including Harold Hestnes, senior partner at Hale & Dorr; William Spring, chairman of the Youth Committee of the Massachusetts Workforce Investment Board; and Nick Littlefield, senior partner at Foley Hoag; They were joined by a cross-section of community leaders and health-care providers, including Peter Slavin, CEO, Massachusetts General Hospital; Rev. Richard Richardson, Black Ministerial Alliance; and Kathy (sic) Higgins, President, Massachusetts Nurses Association. Lawmakers give early approval to comprehensive health care ballot question Erik Arvidson, Fitchburg Sentinel & Enterprise, July 15, 2004 <http://www.sentinelandenterprise.com/Stories/0,1413,106~4994~2274143,00.html> Boston - Every Massachusetts citizen would have a constitutional right to access affordable, comprehensive health care under a ballot question given initial approval on Wednesday by state lawmakers. ... The language of the ballot question does not specify the details of how the state would implement a system that would provide health care to every citizen. It only makes it the obligation of the governor and the Legislature "to enact and implement such laws, subject to approval by the voters at a statewide election, as will ensure that no Massachusetts resident lacks comprehensive, affordable and equitably financed health insurance coverage." That means that if the ballot question were approved next year, it would go before the voters in November 2006. If the voters approve it, lawmakers would have to create a new health care system that would go before the voters again, in November 2008 at the earliest. ... John McDonough, executive director of Health Care For All in Massachusetts, said his organization was pleased the amendment passed, but was "not happy" that it required a final referendum by the voters after a system is created. "There already exists an ability for the voters under the referendum process to require an up or down vote on anything the Legislature does. This adds a rather significant obstacle to make it much harder to actually achieve the goals as proposed," McDonough said. McDonough added that there are "several paths to get to universal health care, some more expensive than others," but that the cost of not providing health care to all citizens was much higher. "The challenge is that none of us can be sure how real this is because it's subject to action not just by future legislators, but the voters, as well as further review by the courts," McDonough said. "There are too many hurdles to say how positively or negatively this will turn out." A health care ideal Boston Globe Editorial, July 19, 2004 <http://www.boston.com/news/globe/editorial_opinion/editorials/articles/2004/0 7/19/a_health_care_ideal> The Legislature gave preliminary approval last week to a sweeping constitutional amendment intended to guarantee health insurance to every Massachusetts resident. That's a worthy goal, but the state Constitution may not be the best vehicle to bring it about, and the amendment was reworded so that if it is eventually ratified, the issue will become entangled in the election process. The amendment still needs the support of at least 50 members in the next Legislature before it can be offered to the voters for ratification in 2006. Its language would instruct the Legislature to devise laws to ensure that no Massachusetts resident lacks "comprehensive, affordable and equitably financed" health insurance. The Legislature already has the power to expand insurance coverage, as it did in the 1990s, when thousands more children were protected. The main problems, as ever, are the cost and extent of coverage. The amendment is silent on both. Senator Richard Moore, Democrat of Uxbridge, inserted language in the amendment that would pass the buck to the voters. Any insurance plan devised by the Legislature and governor would have to go on the ballot for final approval. The wording leaves open the possibility that all laws to expand coverage, however modest, would have to pass the voters' muster. This would cede too much responsibility to the electorate. Independent of the constitutional amendment effort, the Blue Cross Blue Shield of Massachusetts Foundation has commissioned the Urban Institute in Washington, DC, to examine the hidden costs of the uninsured in Massachusetts and to propose ways to expand coverage. That work will be finished by next spring. Whatever the merits of the amendment, agitation for its passage should force the Legislature to take the plight of the uninsured more seriously. Even if the amendment becomes part of the Constitution, it will be years before a detailed plan is ready for the voters. Polling by the foundation suggests that while residents endorse the concept of universal coverage, support diminishes when cost is mentioned. Professor Wendy Parmet of Northeastern University contends that courts are unlikely to intervene to force an expansive health plan on reluctant voters. "The amendment is likely to be useful not to ensure the implementation of a radically new system," she wrote in an analysis for the advocacy group Health Care for All, "but to prevent the type of cutbacks and evisceration of existing programs that we have witnessed in the last few years." This protection would be a useful check on crisis budget-cutting. Health care advocates should not, however, let a distant goal distract them from pressuring the Legislature to extend health insurance to many more residents as soon as possible. Editorial Comment: One seriously has to ask, "What are the editorial writers at the Globe smoking?" Single Payer Study Torpedoed: Single Payer Study Passes Legislature Massachusetts Nurses Association, July 22, 2004 <http://www.massnurses.org/News/2004/07/single_payer2.htm> The MNA applauds the legislature for taking action today to approve a bill that mandates study of a single payer health care system to replace the current dysfunctional free-market system that has failed the residents of the Commonwealth. The MNA has long supported comprehensive and real reform of the health care system under a single payer model as the most efficient, high quality and cost effective approach to providing health care for all in Massachusetts. Senator Steven Tolman Announces Approval of Bill to Mandate Single Payer Health Care Study Commonwealth of Massachusetts, Massachusetts Senate Contact: Kate Regnier, 617.722.1280 Boston - Senator Tolman today announced that the House and Senate have approved a bill that mandates an analysis by the state of the effects of a single payer health care system. A single payer system would replace the current fragmented mixture of public and private health care plans with a single uniform plan. The bill requires that a study be made of, among other things, both the cost and the potential savings associated with the implementation of a single payer health care system. The bill further requires that a study be made of the impact on Massachusetts residents, the Commonwealth's budget, health care professionals and institutions, the Medicare and Medicaid systems, and state and federal laws and regulations. An interim study must be filed with the general court by December 1, 2004, with the final report due by April 1, 2005, along with relevant draft legislation if necessary. Massachusetts currently faces a crisis in its health care system, with studies indicating that approximately 1.5 million individuals under the age of 65 were uninsured at some point during 2002/2003. One of the primary arguments advanced by opponents of a universal health care system is the potential cost to the state. However, a comprehensive study of the costs as well as the myriad benefits (both financial and otherwise) has not previously been performed by the Commonwealth. ... The bill will now go to Governor Romney for his signature. Tolman announces approval of bill Cambridge Chronicle, July 29, 2004 <http://www2.townonline.com/cambridge/localRegional/view.bg?articleid=56354> Sen. Steven Tolman has announced that the House and Senate have approved a bill that mandates an analysis by the state of the effects of a single-payer health-care system. A single-payer system would replace the current fragmented mixture of public and private health-care plans with a single uniform plan. The bill requires that a study be made of, among other things, both the cost and the potential savings associated with the implementation of a single-payer health-care system. The bill further requires that a study be made of the impact on Massachusetts residents; the commonwealth's budget; health-care professionals and institutions; the Medicare and Medicaid systems; and state and federal laws and regulations. An interim study must be filed with the general court by Dec. 1, with the final report due by April 1, 2005, along with relevant draft legislation if necessary. ... Romney vetoes health care bill State House News Service, August 7, 2004 Governor Mitt Romney has vetoed legislation requiring the state Division of Health Care Finance and Policy to study the impact of creating a trust to administer a single-payer health insurance system for all Massachusetts residents. The bill had called for the agency to file an interim report by Dec. 1 and a final report, including necessary legislation, by April 1, 2005. In his veto message, Romney said the bill was duplicative of a study by Mercer Government Human Services Consulting and McDonell Consulting that is less than two years old. That study looked at the policy and cost implications of three reform models. The vetoed bill, which was advanced with a constitutional amendment on universal health care, imposes a "costly and unrealistic administrative burden," Romney said. Editorial Comment: Actually, Mercer and McConell were junior partners to LECG, the lead consultant hired by the Commonwealth following a deal worked out at 5:45 PM on July 6, 2000, at the State House between Mark Montigny, chair of Senate Ways & Means, and Paul Haley, chair of House Ways & Means, in the presence of representatives of four major health reform organizations, in an effort to bring down Question 5. In order to win single-payer supporters to the legislative compromise, a study would be commissioned to spell out how to achieve "consolidated financing" and "streamlined delivery" of health care in Massachusetts. And the pledge was given that the study would be completed and published early enough in 2002 to impact the elections. The final study did indeed detail three different approached to health care reform, but the one purported to be single payer wasn’t really, and the study grossly underestimated the cost savings of such a "single-payer" plan, while grossly overestimating the transition costs. And it was not published until December 31, 2002, long after the elections. The coalition backing Question 5, a far-reaching and multi-faceted health reform ballot initiative, split over the legislative compromise, but went on to win 48% of the vote while being outspent by the "not-for-profit" HMOs fifty to one. Ironically, if Question 5 had passed, the Legislature would have been bound to have come up with a universal health insurance plan by July 1, 2002. Mark Montigny sounded like he acknowledged the error of his ways as he testified in favor of the constitutional amendment on July 7, 2004. Romney administration rejects universal health care study Associated Press, August 9, 2004 <http://news.bostonherald.com/localRegional/view.bg?articleid=39169> Boston - Gov. Mitt Romney's administration has rejected a study that would assess the cost of providing health care coverage to all Massachusetts residents. Lt. Gov. Kerry Healey, acting on behalf of an out-of-state Romney, sent the bill back to the Legislature unsigned, which is the equivalent to a veto. The Legislature can only overturn vetoes during formal sessions, which have ended for the year. The bill called for a study of the feasibility of establishing a health care trust fund, which would cover the cost of health care provided to Massachusetts residents. The Legislature passed the bill during the last week of the session. ... Grocery Workers Hold Line on Health Care: Shaw's, union reach tentative agreement Boston Globe, August 6, 2004 <http://www.boston.com/business/articles/2004/08/06/shaws_union_reach_tentativ e_agreement> West Bridgewater - Shaw's Supermarkets and the union representing 6,000 workers reached a tentative four-year contract agreement late Thursday, setting the stage for a member vote Saturday on whether to ratify the deal. Union spokesman Peter Derouen declined to provide details, saying they would not be made available until the members of United Commercial Food Workers Local 791 vote on the pact. Employees at 25 Shaw's stores in Massachusetts and 14 in Rhode Island will vote on whether to accept the contract on Saturday in Mansfield. ... Shaw's union declares victory in healthcare portion of contract Kimberly Blanton, Boston Globe, August 7, 2004 <http://www.boston.com/business/articles/2004/08/07/shaws_union_declares_victo ry_in_healthcare_portion_of_contract> Workers at Shaw's Supermarkets won a key demand from the company in an agreement hammered out just minutes before their labor contract expired at midnight Thursday. New England's second-biggest grocery chain initially proposed new health insurance plans to cover the union's 6,000 workers in an effort to contain its soaring healthcare costs. But the union voted down the company-sponsored plans, offered as an alternative to the health plan overseen by the union. Local 791 of the United Food and Commercial Workers Union argued the company's health plans would expose its members to higher costs, because the union would have no say in administering them. The UCFW's win on healthcare, an issue that's been central to labor negotiations nationwide, could be key to whether workers approve the new, four-year contract in voting today at the Mansfield Holiday Inn. Last Sunday, members were on the verge of striking after they rejected the initial proposal to adopt the company health plans. ... Shaw's pact set for vote Greg Gatlin, Boston Herald, August 7, 2004 <http://business.bostonherald.com/businessNews/view.bg?articleid=38854> Union workers at Shaw's Supermarkets are expected to vote today on a four-year contract agreement reached yesterday, staving off a strike. Union leaders representing 5,700 workers in Shaw's Supermarket stores across Massachusetts and Rhode Island came to terms with Shaw's on wages, benefits and work conditions. Both Shaw's and Local 791 declined to reveal specifics. ... Shaw's workers ratify union contract Theo Emery, Associated Press, August 7, 2004 <http://www.masslive.com/newsflash/mass/index.ssf?/base/business-1/10919141412 78211.xml&storylist=massnews> Mansfield - Shaw's Supermarket employees at dozens of stores in Massachusetts and Rhode Island ratified a new contract on Saturday, ending the possibility of a strike after weeks of acrimony. "It's been a very long, tense and difficult couple of months of bargaining, with a lot of major issues on the table that needed to be addressed," said Peter Derouen, spokesman for the United Food and Commercial Workers Local 791. "We're just, obviously, glad that we were able to get a fair and equitable agreement for our members without having a labor dispute." Shaw's spokesman Terrence Donilon also praised the agreement, saying that it provides for "excellent wages and affordable high-quality health care." ... Shaw's is owned by Boise, Idaho-based Albertsons Inc., one of the nation's largest food and drug retailers. Memorials: Kate Maker & Gene Adams: Kate Maker, RN, Remembered Massachusetts Nurses Association, August 2, 2004 <http://www.massnurses.org/News/2004/07/kate_maker.htm> The Massachusetts Nurses Association and the nursing profession have lost a true champion and powerful advocate with the death last week of Kate Maker, RN, long time leader at the MNA, a powerful union activist and a passionate fighter for social justice. Below is Kate’s obituary from Sunday’s Worcester Telegram & Gazette, along with a tribute from her longtime friend and colleague, Kathy Logan. ... Kathleen C. Maker, 50 Worcester Telegram & Gazette, August 1, 2004 Webster - Kathleen C. Maker, age 50, of 120 Sutton Road, died Wednesday, July 28, 2004. She leaves her husband of 20 years, John F. Healey of Webster. She also leaves: 3 daughters, Sarah and Rebecca Maker, and Kelsey Healey-Maker, all in Webster; 2 sisters, Charlene Maker of Little Compton, RI and Janis Gay-Maker of Norfolk, VA; 2 grandchildren, Emily and Owen. She also leaves her mother, Esther Maker, of Charlton. She was born in Boston, daughter of Esther Porter Maker and the late John Maker. In 1984, she received her Bachelors in Nursing from Fitchburg State College, and was employed as an RN at UMass Memorial Health Care’s University Campus, in Worcester. Ms. Maker had a keen sense of social justice. From her high school years to the present, she participated in peace marches, rallies for reproductive freedom and union struggles. She supported and worked for progressive politicians and candidates, at every level. Though she advocated for various social reforms and legislation, such as Universal Health Care, her primary focus as an activist was with the Massachusetts Nurses Association (MNA). She both organized and marched in informational pickets and strikes for nurses at several of the Worcester hospitals. She was particularly effective at explaining the connections between such issues as: safe staffing levels of nurses, and patient safety. She was on the MNA’s Board of Directors, and served two terms as Chair of her Bargaining Unit at UMass. Memorial Health Care’s University Campus. For her efforts, in 1999, the MNA awarded her The Elaine Cooney Labor Relations Award. ... Dear friends and colleagues: Last evening, Kate Maker, passed away. Kate, a friend, a mentor, a wife, mother, grandmother, a nurse, has left a mark on the nursing profession and on the labor movement that can not be replaced. Kate has worked diligently for the quality of life for all; in the working force, socially, and for the patients that she delivered care to. It was the leadership of Kate Maker that allowed the nurses at the university campus to be afforded the same rights and benefits that they received as state workers when the hospital merged with Memorial. Kate helped negotiate the past several MNA contracts that gave the nurses at UMass improved working conditions, successor language, HIV insurance, and improved benefits. As a strong advocate for safe patient care, Kate was tireless in her efforts to improve the standards of patient ratios. Not only was Kate a visible force at the university, Kate worked on the state level, as a member of the MNA board of directors. Kate had a strong admiration for Elizabeth Stanton, who worked fearlessly for the rights of women and children. Like Ms. Stanton, Kate was fearless in her advocacy for human rights and the right for all patients to be provided quality care. Kate had large shoes to fill and she will be sorely missed. Kate Maker left this world too soon, she had "miles to go before she slept." Peace to Kate and her family. Kathy Logan, RN Editorial Comment: Kate, ever proud of her working-class roots, was a staunch revolutionary in our efforts to democratize and refashion organized nursing, the healthcare system in which we labor and this old republic. Rev. Eugene Adams, at 87; civil rights leader, minister Michael Busack, Boston Globe, August 16, 2004 <http://www.boston.com/news/globe/obituaries/articles/2004/08/16/rev_eugene_ad ams_at_87_civil_rights_leader_minister> The Rev. Eugene H. Adams, who rose from the boxing rings of New England to battle for civil rights not only in the Deep South but also in his adopted hometown of Medford, died Wednesday of cancer at a Cambridge hospice. The longtime leader of the First Universalist Church of Medford was 87. ''He really was someone who knew that he had to make sacrifices in life," said the Rev. Hank Peirce of Medford, who had worked with Rev. Adams for the past five years. ''He exemplified the role of the servant and everything that is meant by ministry to the people." Born in Boston, Rev. Adams moved to Portsmouth, NH, at an early age. Both parents died of tuberculosis when he was age 10, making him and his four brothers wards of the state. ... As a teenager, Rev. Adams became a boxer. He fought professionally under the name ''Red Adams," but his career ended by way of a knockout on the canvas of the old Boston Garden in 1938. ... By 1945, he had a master of divinity degree from the university. His first steps in the ministry, however, were staggers. At his first post, in Iowa in 1945, he lasted three days. A church member denounced his smoking, saying it would lead to drinking and fraternizing with ''wild women," said Rev. Peirce. Rev. Adams quit the post, not the habit. After a stint as a social worker, Rev. Adams joined the Unitarian Universalist Church of Binghamton, NY. This time, he lasted for three months, dismissed amid accusations that he was a Communist. From 1949 to 1954, Rev. Adams served as a chaplain to the merchant marines in New York City at the YMCA's seaman's house. He married his second wife, Caroline Brown, in 1956 in Cleveland. ... In 1961, Rev. Adams began serving at the First Universalist Church of Worcester and his social activism soared. A leader in the local civil rights movement, he embraced several other causes; for three years, he wore denim in the pulpit to show his support for migrant farm workers. In early 1965, Rev. Adams joined with local clergy and Worcester native Abby Hoffman to follow Dr. Martin Luther King Jr. in his historic and bloody march for voting rights from Selma to Montgomery, Ala. Rev. Adams remained active in civil rights as a member of the Medford branch of the National Association for the Advancement of Colored People, the Greater Boston Civil Rights Coalition, and the Medford Human Rights Commission. He also served as head of the city's Fair Housing Commission. ... He retired in 1987. ... A celebratory service is planned at 10 am on Aug. 28 in Unitarian Universalist Church of Medford. Editorial Comment: Incorporated into Gene’s lifelong battle for justice was his staunch support for safe staffing. He drove to MNA headquarters in Canton in 1995 to join the first united front meeting of the Statewide Campaign for Safe Care. He proudly held up his end of the Massachusetts Senior Action Council banner in Nurses Hall at the State House for the historic May 12th "rally for ratios." Gene was on Boston Common on June 19th for the Bridging the Gap in health care march and rally initiated by Jobs with Justice. Web Directory: AARN <http://www.aarn.org> Australian Nursing Federation <http://www.anf.org.au> California Nurses Association <http://www.calnurse.org> Canadian Federation of Nurses Unions <http://www.nursesunions.ca> CCDS <http://www.cc-ds.org> Committee for Health Care for Massachusetts <http://www.healthcareformass.org> Irish Nurses Organisation <http://www.ino.ie> Labor Party <http://www.thelaborparty.org> LabourStart <http://www.labourstart.org> Maine State Nurses Association <http://www.mainenurse.org> Massachusetts Ad Hoc Committee <http://www.MassDefendHealthCare.org> Massachusetts Green-Rainbow Party <http://www.green-rainbow.org> Massachusetts Nurses Association <http://www.massnurses.org> MASS-CARE <http://www.masscare.org> New York Professional Nurses Union <http://www.nypnu.org> New Zealand Nurses Organisation <http://www.nzno.org.nz> Nurses United (DC) <http://www.nursesunited.org> PASNAP <http://www.pennanurses.org> PNHP <http://www.p nhp.org> Québec Nurses’ Federation <http://www.fiiq.qc.ca> Revolution Magazine <http://www.revolutionmag.com> Saint Louis Area Nurses Coalition <http://www.slanc.org> Seachange Bulletin <http://www.seachangebulletin.org> Southern Arizona Nurses Coalition <http://SAZNC.homestead.com> UNAP (RI) <http://www.unap.org> Union Web Services <http://www.unionwebservices.com> Women’s Universal Health Initiative <http://www.WUHI.org> FAIR USE NOTICE: This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. 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