🗞️ NLRB Single-Facility Bargaining Units in Healthcare: Westminster Clinic Decision

In Clinica Campesina Family Health Services, the National Labor Relations Board (NLRB) Regional Director applied the long-standing single-facility presumption to determine that employees at the Westminster Medical Clinic constitute an appropriate bargaining unit, despite the employer's operation of 14 facilities across Colorado. This case illustrates the application of principles established in Heritage Park Health Care, 324 NLRB 447 (1997), and Manor Healthcare Corp., 285 NLRB 224 (1987), which hold that single-facility units are presumptively appropriate in healthcare settings unless the facility has been so effectively merged or functionally integrated that it has lost its separate identity.

The Regional Director analyzed six critical factors following the framework established in Specialty Healthcare & Rehabilitation Center of Mobile (357 NLRB 932 (2011)):

1. Centralized Control vs. Local Autonomy: While the employer maintained some centralized policies regarding benefits and employee handbooks, the Westminster Clinic retained substantial local autonomy. The Clinic Director controlled day-to-day operations, initiated hiring, conducted local interviews, and handled most disciplinary matters in consultation with HR. Local supervisors directly managed most employees at the facility, demonstrating meaningful operational independence.

2. Employee Interchange: The employer failed to establish significant interchange between facilities. Only 1.6% of employee hours involved work at non-home clinics during a 13-week period. All permanent transfers were voluntary, and the decision cited New Britain Transportation Co., 330 NLRB 397 (1999), for the principle that voluntary interchange receives less weight in unit determinations. The Board has historically required a "significant portion of the workforce" to be involved in temporary transfers with direct supervision at non-home locations to overcome the single-facility presumption.

3. Functional Integration: The employer's primary evidence of functional integration was the "task box" system—an electronic tool allowing employees to assist with patient-related tasks across clinics. However, testimony revealed that 95% of tasks assigned to Westminster employees originated within their own clinic. The Regional Director found this insufficient to establish the "frequent contact" required under Budget Rent-A-Car Systems, 337 NLRB 884 (2002). Patients maintained home clinics and rarely transferred between facilities, further undermining claims of functional integration.

4. Similarity of Skills and Working Conditions: While employees in similar roles across facilities performed comparable work with uniform pay, benefits, and policies, this factor alone cannot rebut the single-facility presumption. The decision noted this commonality applied across all 14 facilities—not just the proposed five—which contradicted the employer's selective multi-facility approach.

5. Geographic Proximity: The facilities ranged from 2.4 to 21.8 miles apart with no geographic overlap in patient populations. Board precedent from Hilander Foods, 348 NLRB 1200 (2006), establishes that distances of 6-20 miles favor single-facility units.

6. Bargaining History: The employer had one existing bargaining relationship at the Walk-in Crisis Center—a single-facility unit. The Regional Director found this history of single-facility bargaining weighed in favor of approving another single-facility unit, following precedent from California Pacific Medical Center, 357 NLRB 197 (2011).

Healthcare-Specific Considerations

The decision reflects the NLRB's careful approach to healthcare unit determinations following the 1974 Health Care Amendments to the National Labor Relations Act, which extended coverage to nonprofit hospitals and established special protections for patient care. The Regional Director found that a single-facility unit would not create increased risk of work disruption or adverse patient care impacts—a critical consideration unique to healthcare bargaining units under Section 8(g) of the NLRA.

The case also demonstrates how the current American Steel Construction standard (reinstated in 2022) places the burden on employers challenging a petitioned-for unit to prove excluded employees share an "overwhelming community of interest" with the proposed unit. This standard makes it significantly easier for unions to organize smaller units in healthcare facilities compared to the 2017-2022 PCC Structurals framework.

Practical Implications

This decision reinforces that healthcare employers operating multiple clinics cannot automatically require system-wide bargaining units. The employer's acknowledgment that only 5 of 14 facilities should be included in any unit actually undermined its argument against the single-facility approach. The Regional Director directed separate elections for professional employees (nurses, nurse practitioners, physician assistants, physicians) and non-professional employees (medical assistants, case managers, behavioral health professionals), with professionals voting first on whether to join with non-professionals—a standard approach under Section 9(b) of the NLRA for units containing both professional and non-professional employees.

Key Points

• Single-facility presumption remains strong in healthcare settings absent compelling evidence of functional integration or loss of separate identity
• Local autonomy is critical: Even with centralized HR policies, the Westminster Clinic Director's control over hiring, discipline, and daily operations supported the single-facility unit
• 1.6% interchange is insufficient: Voluntary, temporary coverage at other facilities does not overcome the presumption; Board requires "significant portion of workforce" with regular supervision at non-home locations
• Task box system inadequate: Electronic collaboration tools do not establish functional integration without evidence of frequent cross-facility contact and substantial task completion for other locations
• Voluntary transfers receive less weight than mandatory interchange when evaluating employee integration across facilities
• Geographic distances matter: Facilities 2.4-21.8 miles apart with no patient population overlap favor separate units
• Selective multi-facility proposals undermine employer arguments: Proposing 5 of 14 facilities contradicts claims of necessary integration
• Healthcare protections preserved: Single-facility unit does not increase patient care disruption risk, satisfying healthcare-specific NLRB requirements
• Current "overwhelming community of interest" standard (reinstated 2022) makes smaller units more achievable than the 2017-2022 framework
• Professional/non-professional separation: Healthcare elections often proceed in two voting groups, with professionals deciding first whether to combine with non-professionals

Primary Author: Neale K. Sutcliff, Acting Regional Director, NLRB Region 27

Primary Source: Clinica Campesina Family Health Services d/b/a Clinica Family Health & Wellness, Case 27-RM-369131 (NLRB Dec. 23, 2025)

Primary Source Link: Decision available through NLRB Region 27, Byron Rogers Federal Office Building, 1961 Stout Street, Suite 13-103, Denver, CO 80294

Supplemental Links

• 1974 Health Care Amendments History
• NLRB Rules on Healthcare Bargaining Units (29 CFR § 103.30)
• NLRB Returns to Specialty Healthcare Standard (2022)
• Specialty Healthcare Decision Announcement
• Congressional Research Service: NLRB Bargaining Unit Standards
• Second Circuit Overturns Unit Determination - Constellation Brands Analysis
• Health System with 21 Clinics Defeats Single Facility Unit - St. Luke's Analysis
• NLRB Adds Three-Part Test - Boeing Co. Analysis
• Vorys Analysis: Park Manor Standard Overruled

This analysis is for informational purposes only and does not constitute legal advice. Organizations facing representation petitions should consult with qualified labor counsel.