Mr. BATTORE. My name is Dr. Anthony Battore. I am executive secretary of the committee of interns and residents. I am accompanied by our counsel, Mr. Michael Horowitz.

We are here also to offer testimony about H.R. 11357, and our belief that it needs to be amended, specifically as nurses indicated, to clarify the position as to whether or not so-called supervisory personnel can join under the National Labor Relations Act.

Technically, we believe that interns and residents and nurses and related personnel should be related to more elaborate presentation of the type of amendment. Briefly let me state about what the committee is and my own qualifications.

I trained at Downstate Medical Center in New York City, graduated in 1966, and since then trained in California, San Francisco. The area of study which I have undertaken is predominantly labor relations matters as it relates to interns and residents.

The committee of interns and residents represents approximately 5,000 household interns and residents and clinical fellows at about 22 hospitals in the New York City area. It has been in existence since 1958.

STATEMENT OF ANTHONY BATTORE, M.D., EXECUTIVE SECRETARY, COMMITTEE OF INTERNS AND RESIDENTS, NEW YORK, N.Y. There are two aspects to H. R. 11357, which I think are essential with regard to interns and residents.

No. 1 is the ethical thing, to prevent strikes by hospital employees. This can be done through providing a framework for collective bargaining.

The second thing is humanistic aspect, to provide a situation, where house officers can have a humane type of training. There have been many instances where house officers have tried to effect improvements in their working conditions.

One such example is job action held in 1967 at Boston City Hospital. At that time, the wife of one of the officers was interviewed in the newspapers.

He had been working for 20 years in various schools. He was $10,000 in debt and the family qualified for food stamps at that time. The wife made a quote which I think is relevant. "I think if the fellows were able to make a decent living during this period, they would not be so conscious afterward. My husband is really an idealist, but sometimes when he is working over the bills, he will say something like, 'Oh, boy, wait until I have some money.'

I think it is very important that young physicians be given the same rights as other hospital workers, and that a framework be presented which would prevent the possibility of strike for recognition by a group of house officers, who would see porters and other groups. forming unions, but would be told they are so-called supervisory personnel.

The CHAIRMAN. Mr. Horowitz.

Mr. HOROWITZ. I am going to be as brief as I can. I think it might be somewhat significant to note the scope of intern and resident responsibilities. We are talking of some 50,000 young physicians in this country, who in the main bear the principle immediate health treatment responsibility at the hospitals of this country, particularly in major urban areas.

Some 18 to 20 percent of the practicing physicians dispensing health care in this country are young and not so young interns and residents. The committee of interns and residents, in our sense, it is reflective of the prototype health staff officer, just under 30 years old, is married, and has a fraction less than a child and is some $8,000 or $10,000 in debt.

We have had in the committee of interns and residents various collective bargaining agreements, fixed salaries for interns and residents, and I might indicate, Senator, that one of our witnesses at a proceeding was Margaret Mead, who is a physician herself, and perhaps the principal academic expert and otherwise on problems, generation gaps, in this country and elsewhere.

She described a problem with interns and residents as one of the most potentially explosive situations in this country.

In this country, we are not talking about schools, Senator. We are talking about family physicians for the sick poor, salaries of $4,000, $5,000, and $6,000 a year, working 100 hours a week, and who are told by hospitals that they have no right to form organizations to better their own circumstances.

Now, there is going to be a lot of testimony, and I have read the statements about the strike, the problem of strikes.

I think H.R. 11357 is mandated legislation, precisely in order to avoid strikes, because there is no way of holding down that explosive mix on circumstances where they have no alternative between confrontation on the one hand and submission on the other.

That is a terrible choice, which is proposed in the absence of meaningful legislation.

I can tell you just yesterday I received a call from some interns and residents in New York. I cannot mention the hospital at this point, in fact, because the protection afforded to interns and residents who undertake these kinds of efforts is such that they feel particularly exposed. But the need for that right of organization, meaningful statute, just is created precisely to avoid the kind of strikes which one can almost guarantee will take place, particularly if you are talking about people who are not very distance from campus settings themselves, where they have been in situations where confrontations have been used.

One can hardly describe a more dangerous mix, and it is the absence of legislation which provides them that alternative, which provides and moves the door for this situation, that creates the problem.

I want to comment on what Dr. Battore and Mrs. Munger said with regard to some technical modifications of the statute.

I cannot believe that there is anyone in the Senate or otherwise who would wish to decertify existing units of interns and residents in some communities. They are involved in various phases of bargaining in New York, in Minnesota; it is beginning to form in Pennsylvania; and there are some other States.

There are some very real risks attendant to the supervisory definition, in the legislative history and the House report, as it will indicate, for insufficient protection to those interns as well as those nurses.

May I say parenthetically, and here I claim limited expertise of being counsel to the New York State Nurses Association, as much as 30 percent of the nurses are involved in positions which might be in jeopardy in terms of collective bargaining if a rigid application of section 211, supervisors exclusion, were applied, and that could be

of extraordinary impact, of causing the very kind of recognition strikes which H.R. 11357 is meant to avoid.

So that we testify, and with some having dealt with this situation of seeing interns and residents not only in New York City, but elsewhere, feeling themselves in a situation of very difficult circumstance, committed not to training, undertake any kind of efforts, but in no position of having alternatives, and there is no legal recourse available to them.

So this Congress must pass, and pass pretty quickly, some legislation which provides a meaningful way for these people to solve their problems.

In terms of New York, over a course of a 20-year period, the salaries have gone from $70 a month to something around $12,000 a year. Not only that, it has been voting membership on medical boards from these young physicians in hospitals through collective bargaining. All of these things have taken place without confrontation within the context of the law, and it is precisely that which has to be preserved if 11357 is passed by permitting all residents to engage in bargaining.

I want to indicate, Senator, that I regard NLRB-would necessarily hold that interns and residents are supervisors, and I would say, however, from reading the decisions that the risk is substantial and enormous, and that some technical clarification is clearly needed if we are to avoid that decertification and the recognition strike.

I will just impose on your time, because I know there are additional witnesses coming, and I have read some of the statements, but we take no back seat to any of the witnesses in our parlance in strikes, in our desire to have a peaceable setting in hospitals. I heard the testimony of the gentleman from Chicago, and I can tell you from my own experience, that the difficulty of strikes-well, it is precisely that which is going to happen increasingly unless professionals who are now engaged in bargaining are permitted to continue to do so and unless hospital employees in States where there is no such ability to do so, are not; so that we do not-this is in the strike legislation, most fundamental.

Thank you very much.

The CHAIRMAN. Thank you very much.

It is very persuasive testimony. We appreciate your statement and your help in formulating this legislation.

Mr. HOROWITZ. Thank you.

The CHAIRMAN. Mr. David H. Hitt, chief operating officer, Baylor University Medical Center is the next witness.

STATEMENT OF DAVID H. HITT, CHIEF OPERATING OFFICER, BAYLOR UNIVERSITY MEDICAL CENTER, DALLAS, TEX., ACCOMPANIED BY WILLIAM J. EMANUEL, LABOR ATTORNEY, AND MEMBER, SPECIAL COMMITTEE, AMERICAN HOSPITAL ASSOCIATION OF LABOR RELATIONS AND PERSONNEL MANAGEMENT; AND LEO J. GEHRIG, M.D., ACTING DIRECTOR, AMERICAN HOSPITAL ASSOCIATION SERVICE BUREAU, WASHINGTON, D.C.

Mr. HITT. Mr. Chairman, I am David H. Hitt, chief operating officer of the Baylor University Medical Center, in Dallas, Tex. The CHAIRMAN. You are not a medical doctor, are you?

Mr. HITT. Pardon me?

The CHAIRMAN. Are you a medical doctor?
Mr. HITT. No; I am not.

With me are William J. Emanuel, a labor attorney from Los Angeles, Calif., who is a member of a special committee of the American Hospital Association on labor relations and personnel matters, and Dr. Leo J. Gehrig, who is acting director of the American Hospital Association's Washington Service Bureau.

I am here to testify on behalf of the American Hospital Association, which is an association of some 7,000 hospitals located throughout the United States.

I have a brief statement, and I would like to read it, if I may. The American Hospital Association strongly opposes H.R. 11357, which would remove from the National Labor Relations Act the current exemption for nonprofit hospitals.

Our opposition to the bill is based on our sincere belief that the provisions of the National Labor Relations Act should be not applied to hospitals or other health-care institutions because the basic elements in the collective bargaining process under the National Labor Relations Act; that is, strikes, picketing, and work stoppages, should not be tolerated in the life and death situation faced daily by hospitals.

We believe that it is clearly not in the interest of the American public to legislatively authorize such activities for general application in the environment where seriously ill persons must be treated. Certainly, hospital services are from society's standpoint at least as essential as fire protection and police protection, and must be available without any interruption.

In recognizing why hospitals and other health-care institutions should not be subject to the National Labor Relations Act, it is necessary to understand the essential nature of health-care services to a community.

Health care institutions really have no true analogy in industry. Health care institutions do not manufacture or sell products. Rather, they deal in the preservation of human life and the restoration of human functions.

The primary purpose of such institutions is the delivery of patient care services and, in providing these vital community services, often under emergency conditions, health-care institutions depend on the close coordination of many different professional, skilled, semiskilled, and unskilled workers.

In delivering patient care services, health care institutions are wholly dependent on their employees. In community hospitals across the country today there are almost three employees for each inpatient. The fundamental needs of sock persons cannot be met by machines.

Thus, around-the-clock availability of health care personnel working closely together as a team is an absolute requirement for health-care institutions to meet their responsibilities to patients and the community. Any interruption, interference, or delay in patient care services would result in increased morbidity or loss of life.

And if I can say parenthetically here-it is not in the report-that we are not just talking about the difficulty after you have got a strike and you are told to move the patient. We are talking about the weeks of anxiety among employees before a strike as well as those

who remain on the job during a strike, and then the animosity that might be present after a strike.

The CHAIRMAN. An economic strike or a recognition strike?

Mr. HITT. Either kind of strike, from the standpoint of the patient, is reflected in the same manner.

The report of the House Committee on Education and Labor on H.R. 11357 states that the American Hospital Association opposed passage of this bill but that "its New York and Massachusetts State Associations favored its passage."

We wish to point out to the committee that these two State associations recognize the serious deficiencies of the National Labor Relations Act as applied to hospitals which we are presenting in our testimony.

H.R. 11357 would amend the National Labor Relations Act by removing the current exemption of nonprofit hospitals from the provisions of that act.

The implications of such action must be carefully evaluated in light of the effects of applying the provisions of the act to the hospital field.

In two basic areas, the act is seriously deficient and inappropriate for applications to the health care field.

The first involves strikes, picketing, and impasses. The second pertains to the fragmentation and proliferation of bargaining units. Both of these areas have serious implications in regard to interference and interruption of patient care services.

Now, to discuss strikes, picketing, and impasses.

There are two different, distinct aspects to the problem of strikes, picketing, and impasses.

The first deals with work stoppages and picketing in situations not involving an impasse in collective bargaining.

Under the National Labor Relations Act, unions are permitted to engage in recognition strikes and recognition picketing.

For example, an institution in San Diego, that is covered under the National Labor Relations Act, recently went through an entire election campaign surrounded by a recognition picket line even though the union was granted a secret ballot election by the National Labor Relations Board.

Apart from recognition strikes and picketing, the National Labor Relations Act does not provide adequate protection from secondary boycotts and secondary picketing.

Moreover, when related to patient care, an additional deficiency is the National Labor Relations Board's inability to respond rapidly enough when a union violates the act's prohibitions against secondary boycotts, jurisdictional strikes, picketing and the like.

Because, under the act, an employer cannot obtain an injunction against illegal strikes or picketing from a Federal or State court, delays of 2 weeks or more are common while awaiting action by the National Labor Relations Board to obtain injunctive relief in the courts. In the meatine, the hospital's patients must suffer from the effects of these illegal activities.

The second aspect involves impasses in collective bargaining negotiations which in turn may lead to strikes and picketing.