Nurses upset with disability program

Sick days declining at Hamilton hospital

About two years ago, Hamilton Health Sciences realized it had a very high absenteeism rate and was fast becoming the worst hospital in Ontario for sick days, according to its assistant vice-president of HR.

The average number of sick days per employee for all Ontario hospitals in 2004-2005 was 10.8, while Hamilton Health Science’s average was 11.4. For the most part employees who were off sick were truly ill; however, some employees were bending the rules, said Gayle Holmes.

“We had seen that ourselves and it had been reported to us by other employees,” she said. “It was eroding morale and units in departments were working short.”

To bring the situation under control, the hospital contracted out the administration and adjudication of short-term disability to Cowan Wright Beauchamp, a Waterloo, Ont.,-based disability management company.

Once an employee has been ill for five consecutive days, her case is referred to Cowan. The disability management company then collects the employee’s medical information and, based on industry standards, determines what a reasonable length of absence would be.

Cowan requires all employees applying for short-term disability to have their physicians complete a detailed medical certificate of disability, something the Ontario Nurses’ Association Local 70, the union representing nurses at the hospital, takes issue with.

The certificate asks for full details about the diagnosis, any tests performed and therapies and medications prescribed. If all sections aren’t completed satisfactorily, the claim is denied and the employee will not receive benefits.

“You’re put under the gun. We have nurses who are sole breadwinners, raising children and they don’t have a heck of a lot of choice if they want to be paid. So their hand is forced into signing this form, having their doctor fill out the form and giving all of their medical information to this company,” said Pat MacDonald, president of the Ontario Nurses’ Association, Local 70.

The employer needs to know if an employee is able to come to work and, in the case of a nurse, can she lift and tug and perform the physical components of the job, said MacDonald.

“An employer (has) an onus to find us work within our abilities. But they’re not entitled to know our diagnosis and what medications we’re on,” she said.

When Hamilton Health Sciences first began considering using a disability management company, all of the companies the hospital spoke with had a similar medical form they required employees and physicians to complete, said Holmes.

However, all that information stays confidential, she said. The only information Holmes and the hospital receive about the employee is a recommendation regarding the short-term disability and any restrictions on the employee’s ability, she said.

Almost 95 per cent of short-term disability claims filed between January and October of this year were approved. Another 2.1 per cent were partially approved and 3.3 per cent of claims were denied, said Holmes.

Since contracting out to Cowan, the hospital’s average number of sick days per employee fell to 9.8 in 2005-2006, while the industry average was 10.3. However, the process hasn’t been completely smooth, said Holmes.

There have been complaints of nurses on leave being called incessantly at home, according to MacDonald. Some nurses have complained that Cowan calls them on a daily basis, sometimes two or three times a day, to find out if they can return to work sooner, she said.

“It’s demeaning, it’s degrading. Nurses are professionals. We know when we’re ill and when we shouldn’t be at work,” she said.

Mary Gingrich, manager of new business at Cowan, said that a case manager calls all employees on short-term disability once to explain the process and then there are followup calls throughout the leave, the frequency of which depends on the employee’s disability.

“It’s not every day and it’s not a couple of times a day,” she said. “There have been times where people didn’t answer the phone, so they might be called two times in one day, but it’s not that they were talked to two times a day.”

There were also problems with Cowan’s treatment of pregnant nurses who become ill. Cowan was recommending they either return to work or go on maternity leave early, said MacDonald.

“Our collective agreement does allow for a woman to be sick while she’s pregnant,” she said

Holmes said accommodations need to be made for these nurses. More nurses go off work in the last weeks of their pregnancies than women in other employee groups, she said.

“Maybe in the last weeks of pregnancy, 12-hour shifts aren’t the right thing to do. Maybe it’s shortened hours of work. Maybe it’s duties that don’t involve lifting heavy objects,” she said.

But there are many other problems with the new system, according to MacDonald. There was one instance of a nurse whose doctor was adamant that she wasn’t to return to work. Cowan insisted she could return to light duties at the hospital but her doctor refused, said MacDonald.

“Her doctor was a specialist,” she said. “Cowan bases all its decisions on industrial standards. So if you have a gall bladder issue you should be off for 6.2 weeks and if you’re off one minute longer, then they’ll be on your case, not taking into account your complications or other issues.”

And MacDonald worries about the possible breach of private information. Employees are being forced to share full medical diagnoses with an outside company with the potential of that information getting back to a supervisor, whether the employee wants it to or not, said MacDonald.

“We haven’t had a lot of open breaches of confidentiality,” she said. “But what they’re sending back to the hospital is far more information than we would have had to give our employer.”

Holmes said she’s not aware of that happening. Instead, it’s more likely an employee is sharing her medical information with her supervisor and when word gets out, other people assume the breach came from Cowan.

“Because we’re caregivers, sometimes the lines get crossed,” said Holmes. While a supervisor is an employee’s boss, she’s also a health professional and the employee might feel comfortable asking her for medical support.

“The roles get blurred,” she said.

Whether or not an employer, through a third party, can require an employee to share medical information is being disputed at arbitration with more than 20 nurses grieving the short-term disability process.

“The highest priority of the nurses at this hospital is that they retrieve their right to privacy,” said MacDonald.

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