Group Health Cooperative of South Central Wisconsin's East Side Madison clinic. (Photo by Erik Gunn/Wisconsin Examiner)

A union organizing campaign has turned into a contentious conflict at a Madison-based health care nonprofit.

The organizing drive at Group Health Cooperative of South Central Wisconsin has gotten mired in a mountain of litigation before the National Labor Relations Board.

There have been disputes over who should be included in a union representation vote as well as dozens of unfair labor practice charges that the Service Employees International Union (SEIU) has filed against Group Health management.

Most recently, the NLRB’s regional director has issued an order blocking the election after the union argued that the charges against the co-op would taint the outcome. Group Health is denying the charges, and co-op executives say they want a vote to take place as soon as possible.

The Group Health co-op was founded nearly 50 years ago as a health maintenance organization. Members, who include its employees, say the nonprofit’s focus on primary care and wellness has been central to its appeal. Those who support the union contend that the co-op’s response to the union drive is betraying its progressive roots.

“Everyone involved are gut-wrenched by the animosity that has developed,” said Susan McMurray, a former public employee union lobbyist and Group Health member for nearly 20 years. McMurray spoke at  a union rally outside Group Health’s clinic on Madison’s far East Side on June 20.

“There’s a multitude of reasons many of us chose a cooperative model over a for-profit shareholder model for our health care and insurance over the past almost 50 years,” said retired state employee Ruth Brill, a Group Health member, at a May 13 rally for the union.

“Some of our fellow GHC members have chosen to form a union. A union is like a cooperative in almost every way,” Brill said. “I’m calling on GHC to uphold the cooperative principles that it was founded on.”

In an interview, Marty Anderson, Group Health’s chief strategy and business development officer, rejected the accusation that the co-op has engaged in union-busting.

“GHC is not opposed to a union here at the cooperative,” Anderson said. “I think our position all along has been that we want our employees to have a voice — all of our employees, to have a voice in that choice.”

But Group Health co-op members who support the union see the management’s response — challenging the union’s proposal for who would vote as well as distributing messages to workers criticizing the union — more critically.

Paul Terranova, a community organizer, said he got involved in trying to persuade the co-op’s board to take a different approach earlier this year after a conversation with his Group Health doctor.

Terranova put together a group of members and asked for a board meeting in March.

“They gave us 20 minutes on the agenda to speak,” he told the Wisconsin Examiner. “It was just us making a presentation to them and them saying ‘thank you.’”

Terranova said his group asked the board and the management to “stop the anti-union messaging [and] anti-union activity” and to “get a second opinion” from other nonprofits that work cooperatively with union-represented employees.

“They refused to engage and they denied that there was any anti-union activity or messaging going on,” he said.

Terranova is also part of a member campaign that has endorsed, with the union, four candidates for the Group Health board in elections that concluded this week.

Update: All four were elected to the board. Election results were announced at the co-op’s annual meeting Thursday evening. 

Staffing struggles

The pro-union employees and SEIU filed a petition in December 2024 for a union representing Group Health clinic doctors, physician assistants, nurse practitioners and nursing staff in three departments: primary care, urgent care and dermatology. They also included physical therapists, occupational therapists and health educators.

According to union supporters, nearly 70% of the workers in those jobs and departments had signed cards asking for union representation.

Union supporters say that in those departments, issues including employee turnover and increased workloads prompted the campaign.

“We’re calling for equitable wages, safe provider-to-nurse ratios, meaningful ways to ease the crushing workloads we face and real strategies to improve retention,” said Dr. Ira Segal at the June 20 rally.

“There’s been a lot more turnover in our staffing, and that has increased over the years, which negatively impacts our ability to provide excellent care,” said Dr. Nisha Rajagopalan, a family physician. “The increasing turnover in our staff is unsustainable.”

Staffing crunches in health care have been widespread in the last five years, exacerbated by the COVID-19 pandemic.

“There just aren’t enough care providers and folks that assist those care providers within the [health care] system in total,” said Anderson, the Group Health executive. “We’ve had to flex with the changing health care environment.”

Julie Vander Werff, a physician assistant and union supporter, said she understands the health care workforce challenge. Despite that, she said, she’s experienced a shift in the co-op’s culture that is contributing to the problem.

“They used to be a very respectful employer, and they’ve really gotten off track in terms of how respectful they have been,” Vander Werff said in an interview. “And they’re being really punitive, and we’re losing staff as a result with high, high turnover rates.”

Who’s in, who’s out

The bargaining unit called for in the union’s original petition did not include other Group Health departments: optometry, behavioral health, radiology and pharmacy. It also did not include physical therapist techs, lab techs and interpreters, social workers, receptionists and maintenance staff.

Addressing the June 20 rally, Vander Werff explained that “other departments who are not under primary care leadership are happy with their jobs” and not interested in unionizing. “But primary care is not.”

From the start, Group Health challenged the bargaining unit described in the petition, according to a letter that employees leading the union drive sent to the Group Health board of directors on Feb. 10.

“Federal labor law says that to form a union, workers need petition only for ‘an’ appropriate bargaining unit — not ‘the’ most appropriate bargaining unit (however that would be determined), and certainly not the unit their employers would most prefer,” the employees wrote. “Rather than accepting a unit of GHC workers’ rightful choice, however, administration and counsel have chosen to contest our bargaining unit.”

Still at an impasse after two days of hearings before an NLRB hearing officer, the union amended its election petition to focus on a single Group Health facility, the Capitol Clinic on Madison’s near West Side. The employees wrote in the Feb. 10 letter that the change was made at the NLRB official’s suggestion.

Group Health challenged that, too. After an additional hearing, the Minneapolis-based NLRB regional director rejected the union’s petition for a single-clinic vote. The decision directed an election covering all clinical departments at Group Health — the bargaining unit that the co-op management sought.

Group Health’s position is that the bargaining unit the employees sought “didn’t include classes or employees that do go between our clinics,” Anderson said. “And because we are an integrated care delivery system, we need to make sure that all the appropriate employees are in the bargaining class.”  

While some Group Health members see the response to the union drive as a turn from the co-op’s roots, Anderson defended it. 

“We were formed by a vote of our members, our board is elected by our members, and I think this goes right along with our ethos as a cooperative to allow our employees the opportunity to vote,” he said.

Pro-democracy, or diluting support?

Employees involved in the union campaign and their allies among the co-op’s members argue that the management claim is disingenuous, however.

“While the administration claims they’re fighting us in order to give everyone a voice, this is a union-busting tactic to prevent workers from winning in a fast and fair election of our choosing,” the Group Health workers wrote. “Anti-union organizations do this to flood the unit with people that they hope will vote against our union.”

According to an NLRB report on union representation elections in 2023, 89% of employers didn’t challenge the workers’ proposed bargaining unit. 

Group Health member Paul Terranova rejected the idea that expanding the vote to include people in jobs and departments who weren’t interested in the union was “just trying to be democratic.”

 “If folks in Madison decided we wanted to put something on a referendum, and the state Legislature said ‘No, everyone in the state has to vote on it,’ everyone would know right away what they were doing,” Terranova said. “People would call BS. It’s the same thing here, right?”

“The right of workers to unionize and to decide what our union looks like . . .  doesn’t belong to administration,” Sarah Spolum, a physician assistant, said at the May union rally. “It doesn’t belong to lawyers. It belongs to us, the workers.”

Anderson said Group Health stands by its position. “We have no idea how our employees are going to vote,” he said. “That’s why we want to get to a vote — because we want that certainty and we want to know what our employees are feeling.”

Unfair labor practice charges

Throughout the campaign, the union has filed charges with the NLRB accusing Group Health management of numerous unfair labor practices. The allegations include changes in pay practices due to union organizing, surveillance of employees for union activity, prohibiting employees from displaying union-related materials, firing union supporters and a variety of other actions.

Group Health has denied all the charges.

After the co-op management’s bargaining unit petition was granted, however, the union petitioned the NLRB to block an election. The agency’s regional director granted the petition, ordering the election to be suspended until all the unfair labor practice charges are resolved.

The union, wrote regional director Jennifer Hadsall, “provided sufficient offers of proof which describe evidence that, if proven, would interfere with employee free choice in the election.”

Group Health, through its lawyer, has demanded a hearing on the allegations in the blocking charge, contending that it’s a smokescreen for diminished support.

At the union’s June 20 rally, Susan McMurray read from a letter she sent to Group Health’s CEO.

“Nothing good will come of this decision,” she said of the co-op’s stance during the union campaign. “It will in my view ruin GHC’s reputation in our community, cause irreparable harm to staff, as well as jeopardize patient care.

“And it didn’t and it doesn’t have to be like this,” she added. “In the past few weeks, I have communicated to management repeatedly that we could find a way through the strife and give everyone a graceful way out, a path going forward and something positive to announce at the annual meeting.”

This report was updated Friday, 6/27/2025, with the outcome of board elections at Group Health that were announced Thursday evening.

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