Kent Hospital isn’t on the battle line. Yet, what is happening at Kent is reflective of the challenges hospitals and their employees across the state face.

In the last two months, members of United Nurses and Allied Professionals (UNAP) Local 5008 have staged two informational picket lines on Toll Gate Road. The local’s contract expired in June, and the sides agreed to extend talks to Dec. 31, 2015. That date came and went, and although the sides continued to meet, nothing really happened. The union decided to make its position known – they are not prepared to take the 23 percent cut in pay and benefits they say the hospital wants.

The hospital, on the other hand, says it is faced with financial constraints. Care New England, which runs Kent, hasn’t laid out the specifics of its offer to the news media, nor what it would have the 900-member union sacrifice.

Hospital President and CEO Dr. Michael Dacey, in an interview last week, spoke in broad terms about the financial issues facing CNE and pledged not to cut salaries and benefits to the extent the union claims it is seeking.

“Twenty-three percent is not going to happen,” he vowed.

Dacey knows many of those who picketed. He has worked with them in the emergency department. He knows them by first name, and many of them knew his father, Michael Dacey Sr., when he headed human resources and crafted the benefit packages CNE is now looking to dilute. Kent was a hometown hospital then, run by a local board of trustees and with an incorporation whose members represented all sectors of the community from elected officials to educators, retailers, manufactures and automobile dealers.

That’s changed. Kent now comes under the wing of CNE that is also running Women and Infants, Butler and Memorial hospitals.

As Dacey defines it, the problem is “economics” – in other words, money. He said that hospitals across the country have seen a 25-percent decline in admissions over the last seven years, for a total of three million fewer patients. As a doctor, Dacey says that’s a good thing.

“That’s great for patients,” he said. He said people are “healthier,” that hospital stays are shorter, and that many procedures once done in a hospital aren’t now.

With fewer patients, however, hospital revenues decline. Yet, in many instances, hospitals can’t reduce costs to offset the loss. Rather, they look to increase the cost of medical care to balance the equation.

Dacey said Kent loses money on every Medicaid patient, and that reimbursement from Medicare is a “little closer” to covering costs. As a result, he said, hospitals turn to commercial health insurance to make up the difference. But, as Dacey points out, those higher costs can’t be passed on to the consumer, as the former state health insurance commissioner limited commercial insurers to a 2-percent increase in premiums annually. And 2 percent isn’t guaranteed, either, as hospitals have to show they are meeting certain quality standards to earn the full 2 percent. Even in Massachusetts, which is held as an example, commercial health insurance premiums have increased by 4 and 4.5 percent in the past year.

“In Rhode Island, it’s very, very hard. It’s an income problem,” he said.

Dacey said hospitals are lobbying to lift the 2-percent cap and that would help. “That’s a huge huge problem. It is hurting Rhode Island hospitals…2 percent is not sustainable” he said.

The union hears the argument, however, not all of it rings true.

“Kent was in the black,” said Jack Callaci, director of collective bargaining for UNAP, in an interview Friday.

That was the case – Kent ended the fiscal year ending Sept. 30, 2014, with a $3.2-million surplus. But not all hospitals in the CNE system did as well. Memorial lost $9.4 million for the same period. The system as a whole finished the year with an $8.5-million surplus, according to the CNE annual report.

Callaci acknowledges there’s no simple fix, although that’s what he says CNE is looking for from the “snot-nosed MBA kids” working for consulting companies retained to come up with the answers. He said consultants are recommending cuts in contributions to the pension system and pay. If implemented, he said the top pay for a nurse would drop from $43 to $38 an hour, putting Kent nurses below the market and forcing them to leave. The outcome would be a deterioration of services at Kent as the hospital could neither attract nor keep high-level employees, he said.

“You would think the people who run Care New England would get their own affairs in order,” he said. Instead, he adds, “They’ve taken a meat axe to pay and benefits.”

That’s of real concern to many who have worked a good part of their career at Kent. Trish Criner, who walked the picket line last Wednesday, is one of them. She’s worked at Kent since 1996 and is especially concerned by CNE’s proposal to reduce matched contributions to her 403-B pension plan from 11 to 3 percent of her pay.

“That’s a good chunk of my pension,” she says. “I’ll be working until I’m 70 if I want to live comfortably.”

Resentment over the use of consultants and the high pay of CNE executives runs high. There’s a feeling among union members that they’re being treated like units, not individuals, and the gap is growing between those interfacing with the patients – the nurses, nursing assistants, technical employees and other workers – and the CNE administrators.

Local president Rosemarie Desnoyers, RN, says CNE is cutting supplies, which is affecting how she and others can care for patients.

“Care New England could care less about what’s going on here,” she said.

That’s not the way Dacey sees it.

“We’ve had good relationships with the union,” he said. He called them part of the “team” who he has worked with and respects.

“There is not a single person I don’t respect,” he said. “We’re very committed to get this contract finalized fairly and we’re hopeful can make some progress.”

In a move that rarely happens in hospital/union talks, as hospital presidents leave talks up to a negotiating team, Dacey attended talks about six weeks ago. He said he thought it important for the union to hear from him the issues faced by the hospital.

“This is how personally committed I am,” he said.

From Desnoyers’ perspective, not much is happening, even though the sides continue to meet. Callaci is not surprised.

“The bargaining team [CNE] has their marching orders,” he said.

Dacey remains confident a fair agreement will be worked out. He recognizes that while Kent has lost some of its local control, as a member of a larger system it has gained, and that improvements such as the new emergency department would not have otherwise been possible.

Despite what appears to be a standoff, the sides are remarkably civil, if not cordial. They continue to meet.

Callaci acknowledges Kent has a workforce that is loyal to the community and to the hospital, with a lot of friendships and long-term relationships. He said there “is not the rancor” of other union battles.

“Everybody is being forced into a fight that nobody wants,” he said. He blames “the corporate office.”

He doesn’t see where it will lead. Desnoyers has said the local will strike if it has to, but that seems a way off at this time.

“I don’t disagree that they’re [CNE] facing significant financial challenges,” Callaci said. Yet he questions if hospitals are all facing the same challenges, how is it that Lifespan hasn’t moved to cut pension contributions for its employees and pays more in salaries and benefits than Kent.

Dacey said the aim is for Kent “to stay fair and competitive in the marketplace.”

The membership of Local 5008 will meet at the Crowne Plaza throughout the day on March 25. Callaci said it would be a “regular membership meeting” during which members would be given an update on negotiations and asked the question, “What do you think we ought to be doing?”