What's with TENET?

pickledpepperRN · May 6, 2003

Another thread about Tenet. Seems there are new developments but previous thread still important:

https://allnurses.com/forums/showthread.php?s=&threadid=33360

sjoe · May 6, 2003

Watch the CBS Evening News May 6th for more on Tenet.

pickledpepperRN · May 7, 2003

http://www.latimes.com/business/la-fi-rup6.4may06,1,1841754.story

IN BRIEF / LABOR

Nurses' Group Seeks to Overturn Tenet Pact

Ronald D. White

May 6, 2003

The California Nurses Assn. said it filed unfair labor practice charges with the National Labor Relations Board to overturn a labor agreement by Santa Barbara-based hospital chain Tenet Healthcare Corp.

CNA alleges that Tenet unlawfully forged a pact with two other unions, the Service Employees International Union and the American Federation of State, County and Municipal Employees.

The nurses' group said this allows the rival unions to improperly hold uncontested representation elections at Tenet hospitals and grants them preferential treatment in meeting with hospital employees. Tenet declined to comment.

pickledpepperRN · May 7, 2003

SEIU came to my house!

How did they get my address? I quit working there almost 2 years ago!

pickledpepperRN · May 7, 2003

The Associated Press State & Local Wire

May 5, 2003, Monday, BC cycle

9:21 PM Eastern Time

SECTION: State and Regional

LENGTH: 418 words

HEADLINE: California Nurses union files labor complaint against Tenet

DATELINE: LOS ANGELES

BODY:

The California Nurses Association said Monday it has filed charges with the National Labor Relations Board seeking to overturn an agreement reached between Tenet Healthcare Corp. and two labor unions.

Santa Barbara-based Tenet announced an agreement Friday with the Service Employees International Union and the American Federation of State, County and Municipal Employees that would allow nurses and other hospital workers wage and benefit increases of up to 29 percent over four years if they join the unions.

The deal would apply to employees at all of Tenet's 40 California hospitals, according to company and union officials.

The executive director of the California Nurses Association said Monday that the deal constituted an illegal "arranged marriage" between Tenet and the unions, and its effect would be to deny nurses the ability to make choices about compensation for their work.

"Basically Tenet Healthcare, which is already under investigation by a number of federal agencies, has decided to do what we find a kind of shocking back-room deal with the Service Employees Union, to essentially coerce and bribe registered nurses and other health care employees to join the Service Employees Union in order to get a raise," said Rose Ann DeMoro, executive director of the nurses group.

Federal investigations are under way into Tenet operations including the company's billing practices. Tenet acknowledged last fall having a pricing strategy, since changed, that triggered outsized payments collected from Medicare.

Tenet spokesman Steven Campanini said the company would have no comment on the allegations by the California Nurses Association.

Luisa Blue, president of SEIU's Nurse Alliance, which says it represents 35,000 nurses in California, dismissed the CNA's allegations as "disingenuous."

"What the CNA is calling a 'back-room deal' is, in fact, an extension of the raises and other provisions negotiated by other SEIU-represented employees in other Tenet hospitals," Blue said in a statement.

"It's outlandish to think that the CNA would call this bribery or that they would allege that anyone is being forced to join a union," Blue said.

The CNA says it represents 50,000 registered nurses, including 1,500 at five Tenet hospitals. DeMoro said the deal between Tenet and the two other unions was an attempt to thwart the CNA's organizing efforts at Tenet hospitals.

Phone calls to the National Labor Relations Board rang unanswered after hours Monday.

pickledpepperRN · May 7, 2003

Originally posted by sjoe
Watch the CBS Evening News May 6th for more on Tenet.

Wish I had seen it. I was working last night. (NOT at a Tenet hospital)

----------------------------------------

Contra Costa Times (California)

May 6, 2003 Tuesday

Legal

NURSES CLAIM: The California Nurses Association said Monday it has filed charges with the National Labor Relations Board seeking to overturn an agreement reached between Tenet Healthcare Corp. and two labor unions. Santa Barbara-based Tenet announced an agreement Friday with the Service Employees International Union and the American Federation of State, County and Municipal Employees that would allow nurses and other hospital workers wage and benefit increases of up to 29 percent over four years if they join the unions. Tenet had no comment.

City News Service

May 5, 2003 Monday

Tenet Healthcare

DATELINE: LOS ANGELES

An unfair labor practices complaint filed by the California Nurses Association alleges that Tenet Healthcare Corp. unfairly gave two other unions the chance to represent the hospital company's workers.

Tenet's agreement with the Service Employees International Union and American Federation of State, County and Municipal Employees could lead to unionization of nurses and other employees at all of the company's California hospitals.

SEIU officials said the CNA wanted to represent Tenet nurses exclusively and was therefore not included in the agreement, but the CNA contends nurses were not allowed to choose who they wanted to represent them.

"The RNs want a real choice, free of coercion or bribes, and we will do everything to assure they get it," said CNA President Kay McVay.

The CNA filed its unfair labor practice complaint late Friday with the National Labor Relations Board.

The CNA alleges that Tenet violated federal labor law by handpicking the SEIU and AFSCME and conditioning pay increases for workers on their joining the SEIU. Tenet also allowed the SEIU access to employees while blocking CNA organizers from talking to RNs, according to the CNA.

Tenet's Steven Campanini declined to comment on the CNA complaint, referring questions to the SEIU.

Lisa Blue, president of the SEIU's Nurse Alliance of Southern California, said in a written statement that "what the CNA is calling a 'back-room deal' is, in fact, an extension of the raises and other provisions negotiated by other SEIU-represented employees in other Tenet hospitals."

"It's outlandish to think that the CNA would call this bribery or that they would allege that anyone is being forced to join a union," she said.

Under the agreement, Tenet hospital employees in San Diego County and the company's RNs in Orange County will be able to join AFSCME's United Nurses Associations of California/Union of Health Care Professionals.

All other RNs and hospital employees in the state will be able to form a union with the SEIU and its affiliated Nurse Alliance.

RNs at Encino, Tarzana, Queen of Angels-Hollywood Presbyterian, Garfield, Irvine Regional and Lakewood Regional medical centers, and Garden Grove and Fountain Valley hospitals are already represented by either SEIU or AFSCME.

The agreement would allow nurses at 15 other Los Angeles County hospitals to join the SEIU through a special election process.

But any future elections could be set aside in light of its NLRB complaint, according to the CNA.

CNA officials said RNs at Brotman Medical Center in Culver City, Centinela Hospital Medical Center in Inglewood, Daniel Freeman-Marina Hospital in Marina del Rey, Los Alamitos Medical Center, Mission Hospital and Community Hospital of Huntington Park and Suburban Medical Center in Paramount filed petitions last Thursday, asking for secret ballot votes on whether to join the CNA.

--------------------------------------------------------------------

American Health Line

May 5, 2003 Monday

SECTION: EMPLOYER MARKETWATCH

TENET: REACHES AGREEMENT WITH TWO NURSES UNIONS

Officials from Tenet Healthcare, the nation's

second-largest hospital chain, on Friday announced an agreement

with two unions that will provide nurses and other employees of

Tenet hospitals in California and Florida with a 29% wage

increase over the next four years, Knight-Ridder/Orange County

Register reports (Wolfson, Knight-Ridder/Orange County Register,

5/3). Under the three-year agreement, nurses represented by the

Service Employees International Union and the American

Federation of Federal, State, County and Municipal Employees

will receive wage increases of 8% in the first year and 7% in

each of the next two or three years (Rundle, Wall Street

Journal, 5/5). The nurses represented by the two unions cannot

strike over the three-year period of the agreement

(Bloomberg/New York Times, 5/3). The agreement also will allow

nonunion employees at Tenet hospitals to vote to join the two

unions "without company resistance"; those who join one of the

unions will receive the wage increase included in the agreement,

Knight-Ridder/Register reports. The agreement covers Tenet

employees represented by SEIU and AFSCME at 40 hospitals in

California and two hospitals in Florida but not those at 72

other company hospitals nationwide (Knight-Ridder/Orange County

Register, 5/3). According to the Wall Street Journal, the

agreement should eliminate some of the "most contentious issues"

from future contract negotiations and allow Tenet to focus on

quality at a time when the federal government has launched

several investigations into the company, the Journal reports

(Wall Street Journal, 5/5). "Normally (Tenet) would want to

contest unionization, but they need good labor relations right

now. This is agreement is going to cost Tenet more money than

it would like, but peace with the unions is an intangible that

you can't put a value on," Nancy Weaver, an analyst for

Stephens, said (Associated Press, 5/3).

AGREEMENT HAS 'IGNITED A WAR'

The agreement may "soothe relations" between Tenet and the

two unions but has "ignited a war" between the unions and the

California Nurses Association, a third nurses union that

competes for members with SEIU and AFSCME, the Journal reports

(Wall Street Journal, 5/5). Tenet offered the same agreement to

CNA, but union officials rejected the agreement. According to

the Contra Costa Times, the agreement will provide SEIU and

AFSCME with a "strong advantage" in the competition for members

in California (Silber, Contra Costa Times, 5/3). CNA

spokesperson Charles Idelson said that SEIU officials have begun

to inform nonunion Tenet employees that they would lose a 29%

wage increase over the next three years if they voted to join

CNA. "It's a clear violation of labor law to be effectively

bribing employees with the promise of increased pay solely on

whether or not they will be joining SEIU or AFSCME," Idelson

said. He added that CNA plans to file a complaint with the

National Labor Relations Board (Wall Street Journal, 5/5).

pickledpepperRN · May 10, 2003

http://www.latimes.com/business/la-fi-molina4may04,1,4831243.story?coll=la%2Dheadlines%2Dbusiness%2Dmanual

HMO Criticized for High Profit From

Low-Income Patients

Some say Molina's hefty margins may come at expense of quality care. Supporters cite

diverse coverage for its success.

By Debora Vrana, Times Staff Writer

As an emergency room physician in Long Beach, C.

David Molina saw immigrant families come in for

everything from high fevers to ear infections because

they didn't have regular doctors. To help them, he

opened three small clinics in the city.

From those humble beginnings in 1980, Molina

Healthcare Inc. mushroomed into one of the nation's

largest-and most profitable-health maintenance

organizations serving low-income people on Medicaid.

With nearly half a million members in California and

three other states, Molina's earnings rose to $30.5

million last year, up from $2.6 million in 1998. Now it's

preparing to go public in a $115-million stock offering.

In regulatory filings, the HMO attributes its financial

success to providing medical care efficiently and to its

long experience serving culturally diverse communities.

Molina Healthcare employs a full-time cultural

anthropologist, and its Web site can be viewed in

Spanish, Russian, Hmong and Vietnamese.

"They seem to have the formula in place," said David Menlow, president of IPO

Financial .com, a New Jersey data service that tracks initial public offerings.

But according to some health professionals, consumer advocates and

independent reviews, Molina profits partly because its members don't see

doctors when they should and may not complain when they are denied care.

Reports from the state and a health-care analyst show, for example, that

Molina's pediatric patients in California and Michigan tend to have immunization

rates well below the statewide average. What's more, Molina and other HMOs

that serve Medicaid patients in California can and do readily shift care of acutely

ill children to state programs such as California Children Services, thereby

reducing their exposure to some of the most expensive cases.

Molina isn't the only HMO making handsome returns from government contracts

with Medicaid, called Medi-Cal in California. But it is among the most profitable

in the managed-care industry-Medicaid or otherwise-and consumer groups

say hefty margins are incongruous at a time regional HMOs have generally

struggled, budget-strapped states such as California are slashing funds for health

programs, and doctors and other providers are clamoring that they are losing too

much money serving Medicaid patients.

The size of Molina's profits is "shocking," said Jerry Flanagan, a director with the

Foundation for Taxpayer and Consumer Rights, a Santa Monica-based nonprofit

group. "HMOs that are serving the lowest-income population on the state's dime

are making huge profits. It's a great time to be an HMO investor but a bad time

to be a patient."

HMO Has Supporters

Molina executives declined to comment about any matters relating to the

business, citing the Securities and Exchange Commission's so-called quiet period

for companies preparing to go public.

"I just can't; I wish I could," said Dr. J. Mario Molina, 44, chief executive. He

and his brother, John C. Molina, 38, the company's treasurer, have been running

the Long Beach-based business since their father died in 1996.

The HMO has its supporters, among them Julie Olson, a director in the Utah

Department of Health. "Molina has done a good job for us," she said.

Olson was especially impressed, she said, when Molina moved into Utah's rural

Cache County, where some doctors were opposed to managed care.

"I really didn't think managed care would fly in that county," she said, but Molina

was able to work with doctors and others to successfully sign up new members

there. The HMO has more than 40,000 members in Utah.

"They are very good at looking at what is the most cost- effective solution for the

patient to get care," she said. "They will try some innovative things. They excel at

that."

Molina's mainstay is cater- ing to inner cities, focusing on Latinos, African

Americans, Southeast Asians and Russians. Nearly all its $644 million in revenue

last year came from Medicaid, which is supported by state and federal funds and

covers about 47 million people nationwide, more than half of them children. As

an HMO, Molina gets set monthly payments from the government based on its

Medicaid enrollment, not on the number of patients seen or services provided.

Wall Street likes such companies because the share of Medicaid members

enrolled with HMOs is expected to grow.

"These companies provide a coordinated system of care, and they are willing to

take the risk away from the states," said Thomas Carroll, an analyst at Legg

Mason in Baltimore. When Molina makes its stock offering, through underwriter

Banc of America Securities, it will join a few major Medicaid HMOs that have

gone public in recent years, including Virginia Beach, Va.-based Amerigroup

Corp. and Centene Corp. of St. Louis. "We're in the early stage of what I see

as a big growth period for these companies," Carroll said.

In California, some of the top commercial health insurers are going after the same

members. WellPoint Health Networks Inc., the Thousand Oaks parent of

Blue Cross of California, said its Medi-Cal membership grew to 1.2 million at

the end of 2002, from 830,000 the previous year. Company representatives say

this line is slightly less profitable than its overall business.

Keeping Costs Down

Like many HMOs, those specializing in Medicaid say their advantage is that they

keep costs down by streamlining operations and managing care efficiently.

Molina has said its employees work hard to get people to come in for checkups

with phone call reminders and by helping provide transportation.

Julie Alvarado, a 38-year-old mother of four in the Long Beach area, said

Molina often sends cards to remind her to bring her children in for exams or

shots.

"The doctor here is wonderful," said Alvarado, standing in front of Molina's clinic

in Wilmington, one of 21 the HMO runs in California. "I've had other plans, but

Molina has been the best."

Her comments don't square with California's annual performance report on

Medi-Cal managed-care plans. The report is based on a quality-measuring

system known as HEDIS.

The report showed that in some key categories, Molina ranks near the bottom of

the 22 Medi-Cal managed-care plans that had contracts with California in 2002.

During the year, 48.6% of the children who were enrolled with Molina had

received all the required immunizations by age 2. That compared with a

statewide average of 59.2% for Medi-Cal managed-care plans, and 79.3% for

the best performer in this category, Community Health Group, a San Diego

nonprofit.

The study also found that 34.4% of Molina Medi-Cal members who had babies

got effective postpartum care. That was just below what the state considered its

minimum level, and less than half the highest score achieved by Santa Barbara

Health Initiative, at 76.7%.

In response to its substandard results, the state noted, Molina started a

"Motherhood Matters" program, giving all pregnant members an infant car seat

and improving its data- collection process. The report also said that Molina had

"shown substantial improvement" in this area from 2001, when its postpartum

care score was 15.3%.

Molina's performance was stronger in some other categories-it ranked fourth

for well-child visits for members 3 to 6 years of age, with a score of 67.7% --

but the HMO didn't rank in the top three in any of the HEDIS measures for

Medi-Cal enrollees.

Lea Brooks, a spokeswoman for California's Department of Health Services,

said Molina has contracted with the state for more than 20 years. Company

reports show that Molina had 253,000 members in California at the end of

2002. Even so, Brooks said, no one at the department could comment on

Molina's HEDIS scores.

"Molina is meeting its contractual obligations and is particularly strong in serving

minority populations," she said.

Allan Baumgarten, an independent managed-care analyst who researches

HMOs, said his just-completed study of Medicaid HMOs in Michigan for the

year 2000 doesn't show Molina in the best of light when it comes to childhood

immunization rates and preventive tests such as mammograms for middle-aged

women. Molina, which also operates in Washington state, has about 33,000

members in Michigan.

Looking at Scores

"Based on these scores, it doesn't look like they are a strong health-care plan in

making sure their members are getting basic services," Baumgarten said. "The

states, by contracting with HMOs, are delegating significant responsibilities, such

as encouraging providers to call people and tell them to come in for their

six-month checkup."

Chris Perrone, director of the independent Medi-Cal Policy Institute in Oakland,

said it was difficult to speak to critics' claims about how much Medi-Cal

members are using services at Molina and other for-profit managed-care plans.

He said, however, that he believed many of these health plans were cutting

expenses by encouraging members to see doctors rather than making costly ER

visits and by doing a better job managing the length of members' hospital stays.

Most of the doctors interviewed for this story declined to comment on the

record, citing concerns about the effect on their contracts and patients. Some

said on the record that their experience with Molina had been mixed.

Ellis Beesley, a pediatrician whose Wilshire Boulevard offices are across the

street from Good Samaritan Hospital in Los Angeles, says that at least once or

twice a month he is called to visit a new baby at that hospital. But when he bills

Molina, Beesley says, it won't pay if the mother wasn't pre-approved to deliver

at Good Samaritan.

"Sometimes a patient goes into labor and she's not going to get on a bus to go to

the hospital she's approved for, so she delivers at the wrong hospital," said

Beesley, who is a contract doctor with Molina. "We're giving services in good

faith, and they deny it. I can't bill the patient, I can't bill the state. So I get

screwed."

Beesley said Molina makes money by underpaying doctors-a criticism

frequently made about the HMO industry. If Molina gets $40 a month from the

state for each member, the pediatrician said, he might get $10 to $12 a month

from Molina for each patient that has picked him for a doctor. That fee doesn't

increase, even during the flu season, when a child may come see him several

times a month.

"So where does that extra $30 go? They are making money because they don't

pay the physician properly," he said.

At the same time, Beesley said, Molina has never denied service when he has

requested treatments for his patients:

"They've always authorized everything I've asked for," he said.

If you want other stories on this topic, search the Archives at latimes.com/archives.

Click here for article licensing and reprint options

pickledpepperRN · May 10, 2003

http://www.kpmginsiders.com/display_reuters.asp?cs_id=65781

No Bonuses for Tenet Execs After Regulatory

Woes

NEW YORK, May 9 (Reuters) - Top

executives did not receive bonuses at Tenet

Healthcare Corp., the hospital operator whose stock plummeted after

regulatory difficulties, for June 1-December 31 last year, according to a

regulatory filing.

While Chairman and Chief Executive Jeffrey Barbakow's salary was

increased by four percent to $1.27 million annually effective September

1, he will not be eligible for a bonus that will be based on his

performance until 2004, the company said in the proxy statement to the

Securities and Exchange Commission.

Barbakow also did not receive any options for June 1-December 31

after receiving options for 1.5 million shares in the fiscal year ended May

2002. In that year, Barbakow was paid $1.20 million in salary and

received a $4.18 million bonus.

According to regulatory findings compiled by Equilar Inc, Barbakow was

the 12th best-paid executive last year, with total direct compensation of

$34.7 million.

From October through December, Tenet endured a wave of negative

publicity related to allegations it charged Medicare too much to treat

patients. It also lowered its earnings forecast and saw the resignation

of two executives.

The stock has fallen nearly 70 percent since late October.

The company filed a proxy statement because it is changing its fiscal

year to correspond with the calendar year. It will hold its annual

shareholders meeting on July 23.

Tenet has also named Robert Nakasone, former CEO of Toys R Us

Inc., and Ed Kangas, former chairman and chief executive of Deloitte

Touche Tohmatsu, to the board and will name two additional members

as it seeks an independent chairman.

Shareholders will also be able to vote on requiring all directors to stand

for election annually. They will also vote on defining what constitutes an

independent director.

BearingPoint, Inc., formerly KPMG Consulting, Inc., is an independent consulting firm and is

not affiliated with KPMG International or any KPMG member firm.

rights reserved.

KPMG Online Privacy Statement and Disclaimer

Pinky18 · May 12, 2003

Edited - spam - TOS violation.

pickledpepperRN · May 13, 2003

BY TIM MORAN

BEE STAFF WRITER

Published: May 13, 2003, 07:06:54 AM PDT

The California Nurses Association filed charges Monday with the National Labor Relations Board to force Tenet Healthcare to grant immediate pay raises to registered nurses and other employees.

The CNA complaint contends that a labor alliance announced by Tenet earlier this month, which promises employees raises of up to 29 percent for joining certain unions, is illegal.

Tenet Healthcare formed the alliance with the Service Employees International Union and the American Federation of Federal, State, County and Municipal Employees.

The nurses association is asking the labor board to seek an injunction in federal court forcing Tenet to pay the raises to employees whether they join the unions or not.

Tenet Healthcare operates 42 hospitals, 40 of them in California. Doctors Medical Center of Modesto and Doctors Hospital in Manteca are Tenet hospitals.

Steven Campanini, a spokesman for Tenet Healthcare, declined comment on the complaint.

"We have no comment on the CNA or this labor issue," Campanini said.

The CNA and the Service Employees International Union have waged intense organizing campaigns at Tenet hospitals throughout California.

Bee staff writer Tim Moran can be reached at 578-2349 or [email protected].

Contra Costa Times (California)

May 13, 2003 Tuesday

CNA bargains for San Ramon nurses

By Taunya English; CONTRA COSTA TIMES

DATELINE: SAN RAMON

When San Ramon Regional Medical Center and its nurses finally meet to negotiate salary and benefits, the California Nurses Association will represent their interests at the bargaining table.

The National Labor Relations Board certified the union's status as the nurses' bargaining representative Friday, nearly seven months after approval by a 119-93 vote.

A three-member, labor-board panel in Washington, D.C., rejected the hospital's claim that the election was invalidated because a pro-union nurse campaigned at the polling place and acted as an agent of the union.

The four-page ruling said the hospital failed to prove that Patricia Boiler caused a disruption that "impaired employees' exercise of free choice" or that she was a union representative.

The hospital sought a subpoena for documents to confirm that Boiler was an "agent of the union" but the panel called that petition a "fishing expedition."

The petitioner protesting to the vote must produce evidence to bolster its objections, the panel said. But, "the employer has asserted no facts and introduced no evidence that directly or inferentially supports its assertion of Boiler's agency status," the panel wrote.

CNA spokesman Charles Idelson said Tenet Healthcare Corp. -- the hospital chain which owns San Ramon Regional -- regularly uses legal machinations to stall negotiations. But now, Idelson said, "We are going to hope that they respect the law."

The association will represent nearly 250 registered nurses at the hospital. Tenet spokesman David Langness said company and local hospital officials will meet with the union. "We are glad to get this behind us and we look forward to bargaining," he said.

Theoretically, Tenet could refuse to sit down with the union, and eventually appeal the association's legitimacy to the circuit court. But one industry watcher said the hospital chain has been inundated with stockholder pressures and accusations of aggressive billing practices, so it may be less prone to spend energy on that battle than in the past.

Relations are icy between Tenet and CNA, which has long been a vocal critic of the for-profit chain's patient-care and labor practices. The union represents nurses at Doctors Medical Center San Pablo/ Pinole, who have been on strike for six months and recently rejected Tenet's latest offer.

Tenet has been touting a new partnership with the Service Employees International Union, which represents nurses at other California hospitals. The deal prevents strikes at those union-represented facilities and gives a hefty pay raise to the nurses.

"It think that shows that we can come to agreement with unions that are reasonable," Langness said.

Gary Sloan, San Ramon's new chief executive officer, was formerly the chief at Doctor's Medical Center, and was part of the team that held the line on the nurses' request for pension and retirement benefits beyond Tenet's 401(k) program.

Idelson said Sloan should use the upcoming negotiations to polish the hospital's "tarnished" reputation with its nurses and the public, after reports of health code breaches at the facility and nurses dissatisfaction.

"It's an opportunity for Gary Sloan to step up to the plate," Idelson said.

Reach Taunya English at 925-743-2216 or [email protected]

pickledpepperRN · May 13, 2003

Tri-Valley Herald

Regional's nurses union recognized

Hospital agrees

By Inga Miller

STAFF WRITER

Tuesday, May 13, 2003 - SAN RAMON -- Ending a seven-month standoff with organized labor, San Ramon Regional Medical Center will negotiate a union contract with nurses, company officials said Monday.

They received notice from the National Labor Relations Board earlier in the day certifying a union vote by nurses. The certification overturns objections to that election by the hospital.

"We're ready to sit down with CNA and negotiate," said David Langness, director of communications for Tenet Healthcare Corp., which owns the hospital.

All 250 registered nurses will be part of the California Nurses Association, said union spokes- man Charles Idelson. In October, about 56 percent of the 241 nurses then voted to join the association.

But in an appeal following the vote, Tenet accused the association of interfering in the election: being too close to the polling area and bullying nurses or promising them gifts. For its part, the union said Tenet interfered by offering better benefits shortly before the union vote and firing an employee.

Both sides disputed the accusations.

"It was a very close vote on the union. It involved a couple of hundred nurses -- and there was very small difference between the yeas and the nays. Still, the nurses at the hospital are not overwhelmingly in favor of a union. But because the majority are, we will sit down and negotiate," Langness said.

No date has been set for those negotiations.

But Idelson called Langness' announcement to negotiate "in the best interest of the San Ramon community."

"If that is their decision, to negotiate with the nurses, we certainly welcome it," he said. "We haven't heard anything officially, but we consider that to be a very positive response."

He said hospitals organized by his union have good patient outcomes and lower turnover among nurses.

For months, the nurses association has attacked practices at San Ramon Regional.

Publicizing a January health inspection at the hospital, the association pointed to findings by the California Department of Health and Human Services and the Centers for Medicare and Medicaid Services that hospital employees were not properly screening pediatrics patients, storing medications or adequately staffing surgical operating rooms.

Tenet said patient health was never jeopardized. And the hospital filed an action plan with the state to address situations described in the report.