Oregon Health and Science University (OHSU) has abandoned its plan to acquire Legacy Health. But the merger may have one lasting result: a wave of unionization.
Legacy and OHSU, two of the largest healthcare systems in the region, announced on Aug. 16, 2023, that they planned to merge. By the time the pair called off the merger on May 5, 2025, more than 3,000 Legacy workers had unionized, from nurses and X-ray technicians to doctors and midwives.
In April, American Federation of State, County and Municipal Employees (AFSCME) filed election petitions to represent 500 support workers at four Legacy hospitals — Good Samaritan, Mt. Hood, Emanuel, and Randall Children’s Hospital. The new units include physical therapists, social workers, and other workers who serve hospital patients. Two of those votes concluded before the merger was called off, while two took place after. Support for the union ranged from 87% and 98%.
“We’re still motivated to be a part of this union because it gives us more of a voice and more certainty with where we’re going,” said Joseph Matter, a social worker at Emanuel. “Whether or not Legacy continues to operate as its individual system, or if it finds itself deciding to sell or look for an outside buyer, we’d still have some stability and support from the union,” Matter said.
Merger concerns weren’t the only reason workers wanted to unionize, but they were a major motivator for some groups.
“I think overall Legacy was a great place to work — and is a great place to work — and (the merger announcement) kind of unintentionally started this movement,” Matter said.
Sarah Zavala, a nurse at Emanuel and member of the union bargaining team, said finding out about the merger through the news, rather than from Legacy leaders, kicked union organizing into gear.
Nearly 2,300 nurses at three Legacy hospitals — Emanuel Medical Center, Randall Children’s Hospital, and Good Samaritan Medical Center — voted to join the Oregon Nurses Association (ONA) in February. Nurses at a few Legacy locations had joined ONA before the merger was announced, including the troubled Unity Center for Behavioral Health and Legacy Mt. Hood Medical Center, where Legacy abruptly closed its birthing center (and was later required by state officials to reopen).
ONA already represented more than 3,000 nurses at OHSU.
OHSU planned to absorb Legacy, which has struggled financially and lost $172 million in its last fiscal year before the merger plans were revealed. As a quasi-public institution, OHSU gets government funding and legal protections but also faces more transparency requirements. In recent years the academic health center has struggled through mismanagement and workplace scandals and now faces threats to federal funding for research. OHSU and Legacy did not give a reason when they announced the merger cancellation, beyond saying that after “careful consideration of the evolving operating environment,” they determined they would better meet community needs as separate entities.
Unions came out in favor of the merger
In September 2024, ONA, Oregon AFSCME, and Service Employees International Union (SEIU) Local 49 endorsed the merger after OHSU committed to recognizing existing union contracts with Legacy and improving job security, pay equity, and training and career development.
“We’re definitely disappointed that we don’t have those guarantees of things that were already bargained for us and that we’re kind of having to start again at the bottom,” Zavala told the Labor Press. “But we’re still focused on getting ourselves a fair contract that’s prioritizing workers and patients over profits, that’s ensuring patient safety (and) staff safety.”
The merger would have had to be approved by the Oregon Health Authority and the Oregon Department of Justice, which would have had to conclude it was in the public interest before allowing it. In April, a community review board unanimously recommended that Oregon Health Authority reject the merger.
With the merger canceled, Legacy employees bargaining their first union contracts don’t have OHSU’s assurances to look forward to.
Before they reached an agreement with OHSU, ONA, AFSCME, and SEIU Local 49 had reached an agreement about where each union would focus their organizing efforts within Legacy. Oregon AFSCME Executive Director Joe Baessler said that even though the merger has been called off, the unions are sticking to that agreement.
Roughly 200 doctors who work in Legacy hospitals voted in November 2023 to unionize with the Pacific Northwest Hospital Medicine Association, now known as Northwest Medicine United (NWMU), which is serviced by ONA. Though the vote came a few months after the merger was announced, organizing had already been underway.
Mikeanne Minter, an adult hospitalist and chair of the bargaining unit, said the hospitalists union organized to improve recruitment and retention and ensure physicians have sufficient time to attend to each patient.
The hospitalists have now been bargaining for a first contract for more than a year. So have 400 nurses at Mt. Hood; 45 physician assistants and nurse practitioners at Good Sam and Emanuel; and 38 nurse midwives at Legacy’s maternal-fetal clinics.
Other unionizations at Legacy in the past year include around 60 therapists at Unity, 57 physician assistants and nurse practitioners at urgent care clinics, and 175 clinic nurses, all represented by ONA; 34 pediatric specialty doctors and 84 adult specialty doctors who unionized with NWMU; and nearly 230 imaging medical equipment technicians, housekeepers, cooks, and other workers at Mt. Hood, who unionized with SEIU Local 49.
