Health industry experts estimate that thousands of senior staff members -- workers with decades of service -- have lost jobs or their supervisory positions, often forcing them to scramble for health insurance and to search for new jobs.
Some quietly move on. Some swallow demotions and accept lower salaries. And some sue, citing slander or age discrimination. Indeed, complaints of age discrimination from health care workers to the federal Equal Employment Opportunity Commission have nearly doubled since 1989, from about 500 to nearly 1,000 in each of the last three years.
The phenomenon is nationwide and cuts across professional lines in the health field. Dozens of senior nurses at Mount Sinai Medical Centedical School professor, he was dismissed last year as director of the organ transplantation division at the New England Deaconess Hospital in Boston, just before the hospital merged with another Harvard-affiliated teaching hospital, Beth Israel Medical Center.
Monaco, who is 64 and who lost his vocal cords to cancer in 1994, quickly sued for age and disability discrimination.
"I think they felt because I was 64 going on 65, I would swallow this without any questions," said Monaco. Beth Israel Deaconess Medical Center called the lawsuit "totally without merit."
That has generated a spate of lawsuits and arbitrations, but at the same time, health economists note that hospitals fac incident to jettison an employee making more than $70,000 a year.
"I did my job and loved my job, but in the blink of an eye everything changed," said Ms. Reynolds, 46, who had two sons in college when she lost her job. "They took everything away: my job, my self-respect, my income."
Hospitals defend their disciplinary actions as fair and say cutbacks are necessary to streamline top-heavy managements. They add that some older professionals may find it hard adjusting to new demands that medicine be practiced more efficiently.
Whatever the reasons, a number of health experts say the exodus of experienced workers deprives sick people of the expertise that comes from years of practice, and robs young doctors and nurses of mentors.
"This is a quick-fix, shortsighted solution to a budget problem," said Anna Gilmore, director of labor relations for the American Nurses Association. "We're losing the history and knowledge that the older nurses and doctors have."
The numbera department chairman and one who ran a huge AIDS program. And she contends that the hospitals' actions represent age discrimination.
"I've seen a big rise in these cases in the last six months," she said. "Sure, what's driving this is a cutback of funds, but older workers are very vulnerable."
Most registered nurses and a few doctors are unionized and can be laid off only by seniority. Labor lawyers say hospitals, prevented by union contracts or the fear of bad publicity from dismissing senior employees, often demote them and cut their pay.
Supervising nurses may be transferred to floor duty. Senior doctors may have their salaries cut in half or their labs and titles taken away, or suddenly find themselves required to be on call every third night.
Fay Spragley, a nurse at Bellevue Hospital Center in Manhattan, had a senior position training new nurses until July, when cutbacks in the public hospital system "bumped" 500 senior nurses out of their jobs. She now runs a patienr-ranging repercussions.
"This certainly harms my ability to get referrals or to raise money," Monaco said, "and, of course, if I want a young associate, I can't offer him a job."
Monaco, whose division at the Deaconess does kidney and pancreas transplants, was first asked to step aside so the hospital could "consolidate" all transplant surgery under another doctor, whose division did liver transplants.
When the Deaconess and Beth Israel Medical Center merged last spring, the joint hospital developed an even more ambitious plan: to expand their transplant business by recruiting three liver surgeons from the New England Medical Center.
Officially, Monaco was dismissed for "disloyalty," after he advised one of those liver surgeons, a former student, that his career would be better served at a different hospital, like Massachusetts General, the Deaconess' archrival.
Monaco said his dismissal felt like a slap in the face, since he had recently orchestrated a huge reseatricians signed a petition last summer protesting Ms. Tomasino's dismissal. Several current and former doctors at the hospital said in interviews that the nurse had acted appropriately, and added that the hospital's stated desire to trim its nursing budget was partly to blame.
A spokesman for Mount Sinai, Mel Granick, said he could not discuss details of the case because of the arbitration, but he added that the dismissal "involved serious violations of hospital policy. It had nothing to do with her age, seniority or longevity at the hospital."
Ms. Reynolds, the nurse suing St. Luke's for slander, acknowledges an error in recording the antibiotic schedule. And the two nurses who relieved her after her shift acknowledge changing the paperwork to reflect the proper dosing and avoid future confusion. They were also dismissed and have joined her in suing the hospital.
In a letter to the hospital, Dr. Jeffrey Arliss, the patient's doctor, called the dismissals a "gross injustice."
adcom@aol.com">Internet AdCom Services.