Reflections From the Picket Line

We're trying to align this hospital with the market. - Care New England Health System

5/18/25, Providence, Rhode Island, Blackstone Boulevard:

My colleague, a union machinist, suggested I visit the Butler Hospital SEIU 1199 strike to "see if you like how it smells.” It was one of those New England May days when the outside couldn't decide if it wanted to rain. We are now on Day 4 of this open-ended strike. I knew I was near the picket line when I heard speakers blaring "Not Like Us,” the feel-good hit of last Spring in which one rapper accuses another of pedophilia. In our absurd, alternative-facts, Twitter-encrusted landscape, much of what we Americans call "political discourse" has devolved into this. The voices of the dedicated, hard-working employees of Butler Hospital spoke with a much more substantial message. 

We are dedicated to our patients. We'd rather be working.  We care deeply about Butler Hospital.  We are worth investing in.

Despite the seriousness of the striker's thoughtful demands, the event still retained a festive atmosphere. Hot dogs and hamburgers were handed out freely. Cars honked in support. It was American political action at its finest.  

I've been working here for 23 years. I get $24 an hour. - Ben Degnan, mental health worker, intensive behavioral unit. 

Despite the fact that I work in an adjacent field, in another state, all the demonstrators are open and welcoming to me. Before the day is done, I will be given a hamburger, my second of the day. I like America-flavored socialism. The workers introduced me to Ben Degnan, a longtime Butler Hospital mental health worker. He is also in nursing school. Ben was born and raised in North Providence. "My dad worked here. He started in 1974. He raised a family working on grounds. We didn't have a lot of money but we never felt it.” Ben and I spoke about how not too long ago, a person could own a home and raise a family without a college degree. "I fell into psych. I went to school for history but I didn't really have a plan. I started working here part time and just fell in love with the field. It's a very challenging job. You have to be fully committed.”

Butler is the only free-standing, non-profit psychiatric hospital in Rhode Island. Founded in 1844, Butler not only employs many Rhode islanders, but its location is essential for patient and family access. Our louder and significantly more well-to-do neighbor, Massachusetts, is the East Coast hub for healthcare. Rhode Island is often neglected, or worse, considered a forgotten, distant part of New York State when it comes to healthcare.

A hospital does not provide care in a vacuum. Despite the healthcare field's increasing monopolization, commercialization, and conglomeration, a tri-county or region's hospitals support one another like an ecosystem. It is impractical for one hospital to accommodate each form of medical specialty. It is not best practice to expect a hospital to serve every medical need. They have to communicate and make referrals to one another for the sake of their patients. "We get so much of the overflow in our emergency department from the other RI hospitals. They're just bursting at the seams." Emergency departments and psych hospitals in particular are often the entry point to services for people struggling with chronic homelessness, substance use, and severe mental illness. 

The general vibe from Ben and everyone else I spoke with was that not too long ago, Butler was a more rewarding place to work at. "For the longest time, Butler was seen as the pinnacle of mental health services in the region.  It's sad to see management no longer honor that.” Ben described the physical, mental, and emotional investment required to make Butler Hospital your career. Ben, his coworkers, and SEIU 1199 are asking that Care New England Health System return that investment. "If mental health is that important, you have to be committed to investing in it.” Care New England appears to be more interested in working against their employees. As we speak, a van with darkly tinted windows speeds off. The vehicle is full of scabs, flown in at a gross expense to undermine the actual employees. The strikers respond with powerful boos and a swarm of thumbs down. Like how you greet a Cybertruck. "This is unsustainable. This is not how you run a hospital,” Ben says. "Our patients are not commodities, they are not a product.” 

This is supposed to be a non-profit.  

Care New England Health System, the "non-profit" that owns Butler, has been turning in record profits for the past couple years. Despite this, Butler staff are increasingly asked to do more and more with less. CEO Dr. Michael Wagner enjoys a salary of $1.6 million. I wonder if he remembers what it's like to change a bedpan? 

All we have is each other. - Dan Camp, clinical access specialist

I'm approached by Dan, a mental health worker who is involved with union negations. A Butler employee for over a decade, he's been working here since he was 16. "I started in dietary in 2009. In 2022, I switched to detox. I was just at that time in my life in which I dropped out of college." Dan thanked a nursing manager who took a chance on him and guided his career. "I learned how to talk to clients and support them. I feel like I grew up working in the detox unit. My coworkers are like family." Dan now works as a clinical access specialist at Butler in their call center.

Dan describes the personal touch and careful consideration that he and other dedicated Butler employees in the dietary department utilize in their practice. "We served food a la carte, so the patients can choose what they like. It's part of the treatment.” Mentally ill persons, whether they agree to treatment or not, are often disempowered. Their ability to choose is often stymied by even the best practitioners with the best intentions. "It's not easy being on strike. We love taking care of our patients. We'd rather be working." Dan and an increasingly evaporating pool of long-term employees I spoke with all seemed to agree that Butler hospital corporate was more patient focused and employee invested in the past. 

When asked how corporate responds to employee bargaining, Dan tells me they say, "We're trying to align this hospital with the market.” Dan, myself, and anyone else in the healthcare field for the right reasons will tell you the market is a poor appraiser of the value of a human life.  He says their negotiations begin with the expectation that employees will accept drastic concessions. These concessions decrease the quality of care. Over 60% of Butler employees report struggling to make ends meet. Each year, assaults on staff by patients have increased significantly. Underpayment and dangerously low staff-to-patient ratios put everyone at risk. Butler corporate is also selective as to when they wish to listen to the "wisdom" of the market. They were unwilling to utilize data from market surveys during our recent bouts of extreme inflation. 

As I await my second hamburger of the day, I strike up a conversation with a mother and two of her sons. The Smith family has been working for or adjacent to Butler hospital for three generations. Mom is an RN and her younger son is in nursing school. Her older son is a high school teacher. "I like to tell my kids if they puke in class, they're going to fail for the year," he laughs. We discuss how Rhode Island does not have nearly as much industry as it used to, despite Slater Mill's pivotal role in the Industrial Revolution. Slater Mill in Pawtucket is often considered the birthplace of the American textile industry. "Most of the work around here are seasonal restaurant work or state jobs." Butler hospital is one of the few sources of employment where the workers can still exercise collective power.

Coalitions need to be built amongst other workers for human services. We need to fight back. The power is our numbers. They're not going to give it to us. We have to fight. - Ben Degnan

As cost-of-living increases and automation grow ever more inevitable, the force of our labor may the last remaining bargaining chip we have. It is one of the reasons why I, on a personal level, do not like using artificial intelligence. It's not to say it will never have a useful role. Never in my wildest dreams did I imagine that Facebook would be filled with pictures of Jesus Christ made out of shrimp. Witnessing surreal slop created by an AI trying to guess what will appeal to the mind of an American consumer is fascinating. However, I would rather see AI performing the tasks no one wants to do.  That way, we have more time to dedicate ourselves to labors of love. 

Every employee I spoke with at Butler is dedicated to their work. They would very much prefer to return to it. They are also willing to put themselves out there on the line for fair, safe worksite conditions and a living wage. Please lend them your support. Honk your horn in support, like a true American, if you see them on Blackstone Boulevard. Consider standing with them on the picket line. Tell your local Congress critter how important their work is. Feel free to visit Butler’s corporate office, a place where no one is healed ever, at 101 Dudley St., Floor 3, Providence. Maybe you can call corporate at 401-921-2715 and ask multi-millionaire Dr. Michael Wagner when was the last time he changed a bedpan?

William Sandler, LCSW