The University of Vermont Medical Center’s proposal to build a new outpatient surgery facility is facing opposition from an unlikely source: its own employees.

The Vermont Federation of Nurses & Health Professionals — which represents 2,400 nurses, technicians and technologists at the UVM Medical Center — wrote to state regulators on Monday questioning the wisdom of expanding the hospital’s surgical capacity at a time when its leaders are “unable and unwilling” to safely staff existing operations.

The Green Mountain Care Board must soon decide whether to allow the Burlington hospital to start developing a plan for the new facility, which officials say would help reduce significant surgical backlogs and meet future demands.

But the union says that unless hospital leaders first commit to addressing existing staffing shortages, then the expansion will only exacerbate the current workforce crisis and further jeopardize the quality of care.

In a letter sent September 10, union president Deb Snell requested that the union be granted “interested-party status” so that it could weigh in on the project before regulators determine whether the hospital can proceed.

“Our members, more than Hospital executives, are undeniably the best voices to weigh in on safe staffing levels for current and future UVMMC patient population and whether this project will serve the public good,” Snell wrote.
Hospital leaders announced their desire to build a new outpatient surgery center this summer and requested a conceptual certificate of need from the Green Mountain Care Board so that they can begin a $5 million planning process. Hospitals must obtain conceptual certificates of need whenever they suspect the costs of a proposed project will exceed $30 million.

UVM Medical Center president Dr. Stephen Leffler said in a letter to regulators that the new surgical center would replace the hospital's now-shuttered seven-room outpatient facility at Fanny Allen, which was closed last year after a mysterious odor began sickening employees.

The expansion would also help the hospital to modernize, Leffler wrote, referring to a growing trend in medicine to shift surgeries away from more costly inpatient settings toward cheaper and more patient-friendly outpatient spaces.

He said the project is tentatively planned to be built on Tilley Drive in South Burlington, where the hospital already provides some specialty outpatient services, such as cardiology and endocrinology.
Leffler wrote that the hospital's review process should be expedited because of its “significant” surgical backlogs. The care board, which recently joined a state investigation into the problem of long wait times at Vermont hospitals, agreed, announcing on September 3 that it would forgo a public hearing on the proposal unless they received an interested party petition within the next five business days. The union’s request arrived just before the deadline.

To qualify as an interested party in Vermont's certificate of need process, petitioners must prove that they would be "substantially and directly affected" by a proposal. Snell argued that union employees clear this bar because they are the ones who will be asked to work inside of the center — and will therefore need to overcome any staffing-related challenges associated with it.

With more than 300 union job vacancies, the hospital would have no choice but to run the surgical center with “less than adequate staffing," Snell wrote, raising the chances of errors.

The hospital is currently making up for its staffing shortages by employing an army of travel nurses, who typically come from out-of-state and can make up to four times as much as permanent staff. A spokesperson told Seven Days last month that the hospital expected to spend roughly $40 million on travel employees this fiscal year.

Leffler has said that he hopes to reduce the use of these expensive temporary workers by hiring more permanent staff. But a growing shortage of healthcare workers across the country means that it could take years for this shift to occur.

“This overreliance on travel agencies can represent a waste of health care dollars, while doing little to stabilize safe staffing levels for the long term,” Snell wrote. She asked the care board to approve the union's request and hold a hearing, at which she hoped that the medical center would "make public commitments about its staffing and operational plans."
This isn’t the first time that UVM Medical Center employees have publicly questioned the hospital’s growth. The union also requested interested-party status six years ago, when the hospital sought a certificate of need to begin construction on a seven-floor, $187 million inpatient facility now known as the Miller Building.

Union leaders at the time questioned the hospital’s ability to finance the addition and how that might impact workers’ pay. The Green Mountain Care Board ultimately granted the union “amicus” status, a designation that allowed it to submit materials but prevented it from fully participating in the process — or appealing the final decision.

Regulators may be less receptive to the union’s latest request given that the hospital has only requested permission to begin planning the surgical center, not building it. The hospital would need to obtain a separate certificate of need before it could break ground. 

In a statement to Seven Days on Friday, Leffler said that he, like the union, is "critically concerned" with maintaining adequate staffing levels and reducing the hospital's reliance on travel nurses. He stressed that the care board's current review was limited to determining whether the cost of planning for the center was reasonable, and whether the proposed project met an "existing or reasonably anticipated need."

"Our ultimate Certificate of Need application will address staffing, which we are already working hard to address, and we look forward to receiving our employees’ input as part of the process," Leffler said.

Care board chair Kevin Mullin referred a request for comment to Susan Barrett, the board’s executive director, who said it would be inappropriate for regulators to publicly weigh in on a pending issue. The board must issue a decision by September 25.