By Joshua Fernandez
Philadelphia City Paper

"I don't know how you're going to run a hospital without 1,500 people: 1,000 nurses and 500 technical and professional personnel."

Jacqueline Silver makes a good point. It's one that Temple University Hospital (TUH) probably doesn't want to consider. Silver, a TUH social worker, and her cohorts in the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP), are threatening that a strike may be imminent. Their contracts, after all, expired Sept. 30, and negotiations aren't going well. Many of the union's complaints are what you'd expect, and indicative of difficult financial times (though the hospital banked a $23 million net profit in fiscal year 2008, the unions says): wages, health care, fringe benefits, etc. But there's one point of dispute that may be of particular interest to potential TUH patients — the so-called "gag clause."

According to a complaint PASNAP filed with the Pennsylvania Labor Relations Board Oct. 30, the proposed clause within TUH's contract offer states that no employee will "criticize, ridicule or make any statement which disparages Temple, or any of its affiliates or any of their respective managers or medical staff members."

"It's a terrible clause," says PASNAP president Patricia Eakin, a TUH emergency room nurse. "I've been at Temple for almost 27 years, I've bargained a lot of the contracts, and I'm simply flabbergasted. I'm astonished that among the many terrible things they are trying to put in the contract, they are trying to insert this terrible gag clause that prevents us from saying anything to the public."

The union thinks that hospital managers want to silence their critics. What if Eakin wants to testify in Harrisburg about the dangers of low nurse-to-patient ratios, as planned? "How can I talk about that if I can't in some way reference my own workplace? They want to stifle our ability to advocate for things like that," she says. "Clearly, we've been documenting inadequate staffing at Temple — and [administrators are] claiming, 'We need to keep things internal, and away from the public.' They want to have it both ways. 'Stay within the hospital walls and we'll fix things.' But they don't."

This clause didn't pop out of thin air. In March, the union's newsletter — PASNAP @ Temple Systems News — published an issue with an article titled, "The Truth About Temple's Financial Condition." In that piece, PASNAP ties the hospital's record $73 million profits in 2003 to a Medicare scam.

In July, Temple University Health System sued. "PASNAP's statements, individually and collectively, impute to [the hospital] a lack of integrity ... that, if true, would adversely affect its fitness to receive and manage public funds and private donations," the hospital's complaint alleges. The case won't likely go to trial until 2011.

Jerry Silberman, a PASNAP staff representative for the Temple nurses, says the lawsuit is nothing but a scare tactic, designed to accomplish the same goal as the proposed "gag clause" — to keep the nurses quiet.

"Our position is that it's an obligation of a nurse, or any health-care professional who has an ethical and life responsibility of the patient, to advocate for them in whatever form is necessary," Silberman says. "You can't hold Temple, or any institution for that matter, accountable if you aren't willing to take criticisms outside the walls of the institution."

In other words, the nurses say, they need to be allowed to speak up, whether it's about the hospital's supposed underfunding of supplies or the alleged shortage of nurses, which union local chapter president Maureen May, a Temple nurse, contends is potentially dangerous.

The hospital brass maintains that the nurses should keep their grievances in-house. "The union is confusing the intent of the [clause's] language," says Sandy Gomberg, TUH's interim chief executive officer. "What it is, is a statement to the union itself, that the union or people representing the union can't say defamatory things about the hospital, or the people who work here, because that creates a defamation for the hospital. What it's not, it's not in any directed at any of our employees, it in no way stops any employee from speaking to whomever they want, whenever they want, about whatever they want." What's more, Gomberg continues, patient advocacy isn't the nurses' job: "It's the hospital's responsibility, working with its employees, to make sure that we are providing the best patient care possible, and with that, together we advocate for the patients. The union's job is to advocate for the employee ... in matters of bargaining. I think the union has confused these two points."

But if hospital employees don't speak out for their patients, Silberman asks, who will?

"If a nurse sees something wrong going on with a patient's care, it's his or her job to advocate," Silberman says. "You can't have the watchdog responsibility end with a report to your boss; they could have a motive for covering it up."