Striking workers at Butler Hospital in Providence, Rhode Island, have delivered a resounding rebuke to management, voting by an overwhelming 98 percent to reject the hospital’s “last, best and final offer” and taking a stand against the ruthless dictates of profit-driven healthcare. This decisive vote, announced on July 30, comes amid what is now the longest hospital strike in Rhode Island history. 

The strike, which began on May 15, involves approximately 800 workers, including nurses, mental health professionals and support staff, fighting for basic demands: family-sustaining wages, affordable healthcare and safer working conditions.

The workers are members of SEIU 1199 New England (NE), a regional division of 1199SEIU United Healthcare Workers East (often referred to as simply 1199SEIU), which has a membership of nearly 450,000 healthcare workers across the Eastern US. While Butler workers have shown their determination to fight, the union apparatus has isolated their struggle and refused to mobilize the wider membership in protests and strike action to demand that strikers win their just demands.

Owned by the “non-profit” Care New England (CNE), Butler Hospital, the flagship facility for Brown University’s department of psychiatry, provides more than half of Rhode Island’s inpatient psychiatric care. For the duration of their strike, Butler workers have been vilified by management and the media for taking a stand in defense of both workers’ and patients’ rights. CNE and their media allies have blamed the workforce for the deplorable conditions facing patients at the facility.

Butler’s July 11 offer would detrimentally impact workers’ conditions in three key areas of concern:

• Wages: The Butler proposal offered dietary, clerical and housekeeping workers a starting wage of $18 an hour, which amounts to a paltry $37,440 a year before taxes. This is totally inadequate to cover basic expenses in Rhode Island, where the average rent for a one-bedroom apartment is $1,800 a month ($21,600 annually), and gas costs could range from $2,340 to $3,120 per year for commuting.

“No one can afford to survive in this economy for less than $20 an hour, especially if you have kids,” said Nutrition Associate Sean Seery, a 14-year veteran of the Dietary Department, quoted by NBC 10 News. He added that for some, the proposed 16 percent raise equates to less than 80 cents an hour, in fact, moving them backward when combined with higher healthcare costs

• Healthcare: The offer would substantially raise the deductibles for the BlueSolutions Health Savings Account (HSA) Plan, saddling members, particularly those with chronic health conditions, with medical debt. Butler stated it would continue to pay 100 percent of the premium for the individual HSA plan but proposed to phase out its contribution to the HSA from 25 percent in the first year of the contract to zero in the fourth.

• Workplace safety: The hospital seeks to eliminate the practice allowing employees on worker’s compensation to return to their same position after a year of service. This would force employees injured in workplace violence incidents to reapply to their positions, only retaining seniority and current wage if rehired, punishing injured workers for the violent conditions created by management. Nurses and mental health workers face a high number of assaults due to unviable staffing ratios, leading to physical and emotional exhaustion.

Butler Hospital and its owner, Care New England, have responded to the rejection of the contract with denunciations of the strikers. Butler President Mary Marran dismissed union claims of low wages, arguing that the $18-an-hour minimum wage is 20 percent higher than the state’s $15 minimum wage, itself a sub-poverty wage.

While aiming to keep Butler workers in destitution, CNE reported a $3.4 million operating gain for the first quarter of 2025. While Marran is paid over $575,000 annually, the hospital has frozen strikers’ healthcare benefits and wages and posted job listings to permanently replace striking workers.

The hospital has already spent over $2 million to hire replacement workers, while simultaneously closing 40 beds and several units, placing added stress on Rhode Island’s already strained behavioral health system. Workers who have been replaced will not get their jobs back after the strike is settled but will be placed on a “preferential hiring list.”

The role of the union apparatus in isolating Butler workers

1199SEIU, which covers healthcare workers across multiple states, has a track record of selling out workers’ demands. Weeks prior to the Butler strike, 1199SEIU called off a statewide nursing home strike in Connecticut, involving over 6,400 caregivers, after a deal with the Democratic Governor Ned Lamont that fell far short of workers’ demands. Similarly, a strike by hundreds of nursing home workers in western New York, also 1199SEIU members, was deliberately delayed, preventing it from coinciding with the Connecticut action. 

Prior to the Butler strike, SEIU 1199NE reached an agreement in December 2024 with Women & Infants Hospital Providence on a nearly three-year contract, averting a strike that had been authorized by staff over concerns about wages, staffing and working conditions. Since then, the staff have accused management at the hospital, also operated by CNE, of retaliatory layoffs, especially in the medical records and coding departments, denying entitled breaks and other contract violations. There has been no effort on the part of the union leadership to unite the struggle of Women & Infants workers with the Butler strike.

Healthcare systems in collapse

The struggle at Butler Hospital is part of a national and indeed global assault on healthcare workers and public health systems driven by capitalist interests and austerity. This crisis hits particularly hard in psychiatric care.

• UK NHS resident doctors’ strike: In England, 50,000 resident doctors are on strike against Keir Starmer’s Labour government to reverse the erosion of their pay and conditions. They are demanding a 29.2 percent pay increase to restore their wages to 2008 levels, but Labour Health Secretary Wes Streeting imposed a mere 5.4 percent award.

The Labour government claims it “cannot afford” the pay demands, which the British Medical Association (BMA) estimates at £1.73 billion, while simultaneously committing £13.4 billion more a year to military spending and maintaining tax cuts for corporations. The BMA leadership, like SEIU 1199NE, has actively isolated the resident doctors’ struggle, sanctioning only selective regional pickets and demanding the removal of other trade union banners.

• Nuremberg psychiatric ward shooting: In Nuremberg, Germany, a shocking incident occurred on June 1, 2025, when a 19-year-old patient was seriously injured by police gunfire in a psychiatric ward. This incident underscores the collapse of the healthcare system due to chronic underfunding and staffing shortages.

The acute crisis in nursing, with more than half of all psychiatric facilities in Germany failing to meet minimum staffing requirements, leads to inevitable escalations of violence. This horrific event highlights the desperate need for a massive investment in increased staff, better working conditions and fair pay.

• Australia’s psychiatrists: In New South Wales, Australia, public hospital psychiatrists have been in an ongoing dispute with the Labor government over pay, staff shortages and working conditions. Over 200 staff psychiatrists submitted resignations protesting years of worsening conditions and a state government’s refusal to grant their demand for an immediate 25 percent pay rise, opting instead for a paltry 9.5 percent over three years. Managers have explicitly told staff that they “can no longer provide best-practice care,” forcing trained professionals to lower their standards.

The government’s claim that the psychiatrists’ wage demand is “unaffordable” is a lie, as they spend more on temporary “locums” than it would cost to meet the demands of full-time staff. This mirrors the situation at Butler, where millions are spent on replacement workers with the aim of destroying jobs and conditions.

Build rank-and-file committees!

The overwhelming “no” vote by Butler Hospital workers is a courageous act, but workers’ demands cannot be won through isolated actions or appeals to the union bureaucracy or Democratic Party. The ongoing national and international struggles of healthcare workers reveal a harsh reality: workers’ jobs and conditions, as well as patients’ rights to affordable and high-quality care, are being slashed by the healthcare organizations, private and public alike, who demand that healthcare be subordinated to private profit.

Workers must overcome the betrayals of the union apparatus, which is fundamentally tied to the Democratic Party and pro-capitalist political establishment. The struggle to defend healthcare as a basic human right will intensify in the US as the Trump administration takes the axe to Medicaid and Medicare and boosts funds for war.

It is time to:

• Form a rank-and-file strike committee at Butler, independent of the union apparatus, to take control of the dispute and link up with other healthcare workers across New England and beyond.
• Fight for a livable wage for all workers, regardless of position, decent and affordable healthcare, and safe staffing to protect workers and patients.

Healthcare is a human right. The Butler Hospital workers’ fight is a critical battle not just for their wages and conditions but for the future of healthcare for all. Only genuine socialized medicine, in which services are provided based on human need, and not subordinated to the profits of the giant healthcare systems like CNE, can resolve the crisis in healthcare in the interests of the working class.