UC Hospital Interns Can Unionize, Court Rules

The 4,500 medical interns and residents at University of California hospitals have the right to form unions and engage in collective bargaining, the state Supreme Court ruled Thursday.

The ruling affects university-run hospitals at Irvine, UCLA, San Diego, San Francisco and Davis, plus any other UC-affiliated hospitals that are not now covered by collective bargaining agreements.

In an opinion by Chief Justice Rose Elizabeth Bird, the court, by a 4-2 vote, held that a 1978 state statute that authorized collective bargaining by other university professionals applied to residents and interns.

The court dismissed as a “doomsday cry” the university’s claim that its educational mission would be undermined by allowing union organizing and that such a ruling would open the way for strikes.

Ranks Increase

With the decision, the number of residents and interns potentially covered by collective bargaining jumped dramatically. The 4,500 interns and residents at the five UC hospitals represent the bulk of the 7,500 interns and residents working at California hospitals.

Some county-run hospitals such as County-USC Medical Center, Harbor-UCLA Medical Center, Martin Luther King Hospital in Los Angeles and San Francisco General Hospital already have bargaining pacts with interns and residents. Collective bargaining at hospitals operated by counties is authorized under a different state law than covers university professionals.

Interns are first-year physicians; the more advanced residents are medical school graduates and doctors, but must complete at least a year’s training at a teaching hospital before receiving a license to practice. Many specialties require residencies of two to six years.

University officials refused to comment on the ruling. Lawyers for the UC Board of Regents had argued that they believe interns and residents have no right to organize because they are students and not employees.

A spokesman for UC Irvine residents lauded the ruling but said he does not foresee it bringing about drastic changes, such as a strike.

“This gives us an avenue to speak with the administration on a more equal basis. It brings about respect on both sides,” said Dr. Ted Okerson, a third-year resident in internal medicine who is co-president of Irvine’s House Staff Assn.

“We have no malicious intentions, no greedy intentions,” Okerson said. “Right now we’re all pretty happy.” But by improving working conditions, patient care can also benefit, he said.

“We’re predominantly responsible for patient care at the hospital,” Okerson said. “We’re concerned we get the best possible training and give the best possible care.”

Chief Justice Bird, concluding that residents are employees and not students, emphasized that they spend the bulk of their time working directly on patients without help from veteran doctors. The court cited one resident’s testimony that she never saw an attending physician during the three months she worked on an obstetric floor.

100-Hour Workweeks

The court pointed out that 100-hour workweeks are not uncommon for residents and that pay is relatively low. Interns and residents at the UCI Medical Center, for example, are paid $21,200 to $27,900 a year.

At the same time, while they attend some classes, residents do not receive grades, pay no tuition and are awarded no degrees upon completion, the court noted in concluding that they are not students.

State Court of Appeal Justice Campbell M. Lucas, appointed by Bird to fill a temporary vacancy, argued in a dissent that residents are students and have no bargaining rights. Lucas’ brother, Supreme Court Justice Malcolm M. Lucas, joined the dissent.

Campbell Lucas characterized Bird’s opinion as saying the “university has established its program as a device for procuring a cheap source of skilled medical labor to work in its hospitals.”

“That conclusion, of course, stands the whole idea of university teaching hospitals and residency programs on its head,” he wrote in an unusually long dissent--56 pages, 15 pages longer than Bird’s opinion--particularly for a temporary justice.

Teaching Program

Campbell Lucas pointed out that the university system created the hospitals “for the very purpose of enabling the university to conduct a postgraduate medical teaching program.”

The case began when the California Assn. of Interns and Residents asked the Public Employee Relations Board to force the regents to enter into collective bargaining. The board ruled in 1983 that residents could organize, in part because working conditions might improve and so the quality of medical care might increase.

Dr. Barbara Akin, a fellow at UC Irvine and president of the interns and residents group, said long hours will remain a “way of life” despite the ruling.

“I have no expectation that residency programs will become 9-to-5 jobs,” she said. “What I do hope is that working schedules can be assigned more fairly.”

Allan Brill, director of the group, said cuts in government spending on health care, coupled with neglect of indigent patients by private hospitals, have forced public hospitals such as those at UCLA and Irvine to treat “more and more patients with less and less staff.”

Brill discounted, as did Akin, the potential of strikes by interns and residents at the five hospitals, saying that most of the doctors in training view such action as “inappropriate except for the most dire of circumstances.”

Asked whether the residents will form a union, Irvine’s Okerson said,”I suppose it’s possible,” but that kind of decision would be made on a statewide level by representatives of the five UC institutions. Even if a union is formed, “I don’t think there will be any drastic action. There is no talk of strikes.”

Okerson said residents at UCI Medical Center work an average of 80 hours per week, a figure he does not expect will change. But there are differences in working conditions, vacationsand other benefits among the various specialties, which could be the subject of discussion, he said.

UCI has about 600 full-time residents, of whom about 235 are assigned to UCI Medical Center at any one time, with the remainder rotated to other local hospitals affiliated with the university, a spokesman said.

The Irvine residents’ group is not formally recognized now but a representative holds an ex-officio, non-voting seat on the hospital’s executive committee.

“We do have a voice, but right now it has no official weight behind it,” Okerson said.

Other Actions

The court also:

- Reversed by a 5-1 vote the death sentence of James Ratliff of Compton because the jury did not specifically find that he intended to kill a San Pedro gas station attendant during a 1980 robbery. The ruling was based on a 1983 decision that intent to kill must be proved before death can be imposed.

Malcolm Lucas dissented, repeating his stand that he opposes the 1983 ruling. The court has overturned 15 death penalty cases based on that decision. In all, the court has reversed 54 of 57 death penalty cases since capital punishment was reinstated in 1977, though the justices are rehearing three of those cases.

- Held that the owner of a defective manlift--a truck with a basket mounted on a ladder--could be found liable for injuries to another person even though owner Frank Uribe did not authorize the injured person to use the equipment and warned people that it was unsafe. Uribe had challenged a $200,000 jury award to Percy Ballard, who was hurt when the lift tipped over in 1975.

The ruling was based on cases that have said, for instance, that car owners may be held liable for injuries to others if they leave their keys in the ignition, the car is stolen and someone is later injured.

In other action Thursday, the court agreed to decide the legality of law enforcement roadblocks aimed at snaring drunk drivers by randomly stopping motorists. A Court of Appeal upheld the use of a so-called “sobriety checkpoint” set up by Burlingame police in November, 1984, even though the Legislature had not authorized the tactic. Voting to review the opinion were Bird and Justices Stanley Mosk, Joseph R. Grodin, Allen E. Broussard and Cruz Reynoso.

Times staff writer Marcida Dodson contributed to this report.