If employees at the former Hermann Hospital want to keep their basic medical coverage and qualify for good-health bonus programs, they're going to have to search their souls.
Starting July 1, a whole new system of medical insurance coverage goes into place for the Hermann part of the new Memorial Hermann Healthcare System. Employees had until May 15 to fill out an 81-page questionnaire that wades into territory more often covered in a doctor's office or on a psychiatrist's couch than on an employer's insurance enrollment form.
For instance: "Are you planning to get pregnant in the next year or two?"
"In the past two weeks, on how many days did you drink any alcoholic beverages such as beer, wine or liquor?"
"How often do you use drugs or medicines that affect your mood, help you relax, or help you sleep?"
The questions get tougher. "Have you or your partner had more than one sex partner in the last five years?"
And there's the check-if-true section:
"I've recently thought about ending my life."
"I tend to be more of a pessimist than an optimist."
"There is a handgun in my home."
It's the crescendo ending, though, that has some employees really upset. Questions 76 through 81 address the employee's religious practices. Employees are asked whether they "believe in a higher spiritual power," to what extent belief in a higher spiritual power influences their lives, how often they pray or meditate, how often they meet with others to share a spiritual experience and how well they think their current spiritual health or belief system is working.
Question No. 81 asks: "Would you like help or information on how to develop better spiritual health? Pick option (1) yes, or option (2) no."
"We wanted the option of saying not just 'No,' but 'Hell, no,' " one shaken employee said.
Unfortunately, that's not an option, employees say -- not if they want full health insurance. They must also submit to blood and urine tests (done after the merger in what some regarded as cattle-car fashion -- a group event in the hospital auditorium).
Employees found out about the questionnaire by way of an April 6 memo from Memorial Hermann system president Dan S. Wilford. A key, underlined sentence in the one-page memo read:
Your coverage will be limited to the catastrophic medical plan, with no other benefits coverage, if you do not return a completed form by the enrollment deadline.
Catastrophic medical plans are just what they sound like. They offer coverage only in the case of high-priced illness or dire damage to a human body. They provide no coverage for more routine medical matters such as pregnancy, a broken arm or the flu.
Unsurprisingly enough, all this has left some Hermann people fuming and not at all sure that last October's merger with Memorial was a hot idea. Many are filling out the forms under grumbling protest. A few aren't going to answer the questions, and are waiting to see what happens. Some consulted private attorneys, but no lawsuits have been filed. The kind of people who can afford paid lawyers are not among the rank and file who keep the records and clean the floors and cook the food and do the laundry at Hermann. These are people who aren't about to do anything to lose their jobs. In fact, none of the employees who talked to the Press for this article wanted their names used.
Out of the 81 questions, only four are marked "optional." You can decline to answer questions on your race, education level and family income, and whether you and your partner have had more than one sex partner in the last five years.
Despite being "optional," the question on sexual partners still infuriated several employees, who thought it had no place in the company questionnaire. Especially, they said, since files like these are very accessible.
As one employee put it, "Everyone knows everyone else's medical business here because we're all in the computers and we all have access to the same info." And if you're gay or have a variety of lovers or aren't religious enough, maybe everyone will know and maybe you won't have a job anymore.
Unless you lie, of course.
Dan S. Wilford, president of the not-for-profit Memorial Hermann Healthcare System, engineered this new approach to wellness and insurance coverage for Hermann. He comes from the Memorial side of the merger, where he was president of that system. The son of a Methodist minister, he studied at the University of Mississippi and played end on the 1961 Ole Miss team that went 91 and lost to Texas in the Cotton Bowl. As a hospital administrator in northern Mississippi, he moonlighted as an NFL lines official, flying around the country to pro games -- an activity he continued when he first came to Houston, quitting only when his knees gave out.
Wilford in conversation is likable, articulate, earnest and compelling. Getting a chance to have one of those earnest and compelling conversations with him is difficult; he seems to be in meetings all the time, working out details of the merger that's bringing together more than 11,000 employees and two disparate systems. He recognizes that his message isn't being received with open arms by the Hermann folks and seems genuinely puzzled by their reaction.
"We had a little of that [complaints] with Hermann with the merger," Wilford acknowledges. "In the three years before that [in Memorial], never."
Wilford insists the questionnaire is not meant to be intrusive, but is just carrying out the Memorial system's belief that many factors -- spiritual, psychological and social, as well as physical -- go into making a healthy human being.
"We make no apologies to say all this is important to well-being," Wilford says. "I would bet you that 50 percent of all the people who are here in the hospital got themselves here because they eat too much, they drink too much, they don't exercise or they have psychological, spiritual or social problems."
As part of the wellness program, employees who answer the questionnaire are eligible for up to $400 a year if they keep their blood pressure down and don't smoke.
"We 'incentivise' people," Wilford said, explaining that similar programs have prompted huge reductions in employee smoking.
The program is a self-insured one, operated jointly by the Memorial Sisters of Charity and the Memorial Hermann system. Those enrolled will see doctors in the Hermann Memorial System. Wilford insists there is no way that everyone in the hospital will be able to access the files. Files will go to the office of the doctor designated by the employee.
First, though, the forms are collected by the human resources office. Wilford maintains that no one gets into the files there, either.
Employees say otherwise.
"First of all, I think that the questionnaire violates federal law if individuals are required to answer these questions prior to being hired or as part of the hiring process," says Greg Gladden, president of the Texas branch of the American Civil Liberties Union. "Or if it's used for later discrimination among the employees of the hospital or the hospital system."
Gladden showed a copy of the questionnaire to a panel of ACLU lawyers and also passed it on to other lawyers specializing in employment law in Texas. Only one said he'd ever seen those kinds of questions asked on an insurance enrollment form.
"If there are benefits and incentives offered to certain employees because of the way they answered the questionnaire, that would also render it an illegal document," Gladden said. "If there is any attempt to coerce management-sponsored spiritual events, that would be a violation of the law."
Asked for his overall assessment of the questionnaire, Gladden responded, "This is obnoxiously intrusive to me."
One thing that puzzled Hermann employees was the declaration that the new wellness program had been developed by a committee of their peers, the human resources staff and managers. No one knew anyone who'd been part of any such group.
"We've asked everyone and we can't find anyone who was on that committee," two employees said.
Well, of course, as revealed by Wilford, any such committee would have been one formed at Memorial more than three years ago -- because that's when the program went in place over there. He says the program was transferred "pretty much in place" to Hermann.
In a system as large as the new Memorial Hermann, it's no surprise that communications don't always work well. Hermann employees got their first heads-up about the new insurance program by memo from R. Eugene Ross, the vice president for Human Resources, who wrote: "If you are healthy not just physically, but spiritually, psychologically and socially, you are likely to be happier, more energetic, and better able to contribute to your work, family life and community." That was followed a few days later by Wilford's life-altering April 6 memo.
That's how the old Hermann system worked, too: leadership by memo. As one employee put it, if she had been standing in the same room with one of the top hospital executives at the old Hermann, she wouldn't have known it. Executives never came out of their offices to talk directly to the troops. Employees didn't take their concerns to the top. Afraid for their continued employment, the complainers kept their comments to peers and immediate supervisors. Management never asked them what they thought about new policies, and staffers certainly weren't going to speak up to anyone who mattered. There seems to have been no conception among employees that anyone in mid-level management should be an advocate between the employees and upper management, that communications should be more than one-way, or that questions and concerns could be raised on a rational, polite level.
Wilford talks about meeting with employees. He said he does it. He does it at shift-change times to catch as many people as possible. He acknowledges at the same time that he can't go to all the meetings designed to answer employee questions. He can't be everywhere.
He said he's told employees since his April 6 memo came out that they really don't have to answer all the questions on the questionnaire to get insurance. He says he's gotten the word out on that.
Asked about that last week, one employee exploded.
"That's wrong. That's a lie. The questionnaire had been a big source of conversation. We have not been told that."
Wilford considered going into the ministry, but one memorable day, a friend of the family suggested that he and his twin brother should think about hospital administration as future careers. "That stuck with me," Wilford says.
He and his brother went into the medical service corps in the Army to see whether they liked being around medicine, and found that they did. Wilford went on to Washington University in St. Louis and earned his master's in 1966. His brother took a similar path and is now a hospital administrator in Dalton, Georgia.
In hospital administration, Wilford says, he can combine business interests with service to mankind. He finds it a challenging and rewarding profession, more challenging than it used to be. The merger, now well into its seventh month, has challenged him, though he says that overall, it's going well.
"It takes time for cultures to come together," Wilford says. "We need to respect each other's culture, appreciate the differences and take the best from both."
Until 1972, Memorial was a Baptist institution. That year it broke with the Southern Baptist Convention and became an interdenominational hospital. "We still train more chaplains than any other hospital system in the world," says Wilford.
Hermann doesn't have that tradition. It has mainly been known for its emergency room, Dr. Red Duke and its medical center location -- attributes that made it desirable to Memorial.
It didn't have teddy bear characters on employee badges, either -- not until Memorial showed up. The fact that some of the Hermann employees find the bear image disgustingly saccharine ("It's demeaning," one said) points up just one of the cultural divides.
According to some employees, the best people at Hermann are leaving, upset by the insurance forms, the bear badges and the shift to what some see as an overbearing, paternalistic culture.
Meanwhile, Wilford insists that nothing is designed to hurt or alarm anyone, or to limit any employee's access to full medical, dental and vision benefits.
Pre-existing conditions such as illness or pregnancy revealed by the insurance questionnaire will not affect hiring or promotions, Wilford says. "We have gay people in every hospital. We never discriminate against them. Hospitals sometimes attract those people. Because they are caring and want to help others.
"I've been here 14 years. I have never personally discriminated against anyone.
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"We think spirituality is a part of health. Jewish, Muslim, Buddhist -- we are trying to support that. We are trying to be an organization that supports."
The questionnaire asks whether an employee who feels he needs help at his home would like to talk to someone. Who would the hospital send? "Human resources people, social workers, chaplains," Wilford says.
"This is an added value. We are not trying to take anything away."
E-mail Margaret Downing at firstname.lastname@example.org.