This June, outside an East Village health clinic, several dozen middle-aged hospital workers marched in a ragged circle chanting civil rights slogans. An elderly man pulled up in a chauffeur-driven sedan, and two bodyguards helped him to a chair on the speakers’ platform. There he sat, kinglike, while politicians paid tribute both to him and to the embattled clinic, which had not long before been on a list of 27 clinics slated to be closed. “We say: ‘Stop the Russian roulette game with clinics,’” he thundered, when it was his turn to speak. “Health care is a right!”

The clinic stayed open; its survival, like that of New York’s entire public health system, depended in large part on the man on the platform. For 29 years, James Butler has been the most outspoken defender of a 200-year-old public hospital network whose scope and generosity are unparalleled in the rest of the country. As president of the public hospital workers’ union, Local 420 of District Council 37, Butler represents the non-medical staff in hospitals that care for 1.7 million patients a year, mostly uninsured New Yorkers who have nowhere else to turn.

To Butler, representing his members has always meant one thing: keeping the hospitals open. Budget cuts and short-staffing have crippled the city’s 11 public hospitals as well as its network of clinics and long-term care facilities, but thanks in part to Butler’s dogged resistance, Mayor Giuliani fell short of his goal of delivering the coup de grace to the city’s public hospitals. “He was out there representing not only his membership, but the public health system,” says Brooklyn City Councilmember Victor Robles, chair of the council’s Health Committee. “If there was no Jim Butler, I don’t believe we would have a public hospital system.”

But saving the public hospitals isn’t the only part of Butler’s job. Butler pulls down about $250,000 a year to make the city do right by some of its poorest public employees–the orderlies, nurse’s aides and laundry workers who do the grunt work in the city hospitals, earning $28,000 a year on average. Now, as this once-great labor leader presides over a union half its former size, he is confronting the ultimate insult: an insurgency among his own people. Furious at a proposed dues increase and a lack of financial accountability, they call him a free-spending autocrat and blame him for the job losses.

These overworked and undercompensated members, paying some of the highest dues in DC 37, were ready tinder for the blaze that erupted in June when Butler tried to raise annual dues from $754 to $819. “We’re working people trying to survive,” said Cynthia Patterson, a nurse’s aide at Coler Hospital. Early this summer, she stood in a swarm of angry workers congregating on the street outside the building where members had been meeting to vote on the dues increase. The meeting was so turbulent–and, according to observers, the dues hike vote so clearly likely to fail–that Butler adjourned the meeting without calling a vote. Added Patterson, “He wouldn’t even let us speak.”

Members are still smarting from a dues hike in 1995. That $78 increase passed in a disputed vote, at a time when union officials said they needed cash to open a new headquarters. Members say that when the vote favored the “nays,” Butler asked for a recount, declared that the “ayes” had it, adjourned the meeting and walked out. Six years and millions of dollars in loans later, a boarded-up shell of a building stands at the Harlem site. (The local’s attorney, William Sipser, says that the condition of the building is not a reflection of the amount of work that has been done.)

Drawing on the workers’ misery, a new group of members, led by independent vice-president Carmen Charles, is seeking to wrest control of the union. She and her allies charge that Butler has run the union as a personal fiefdom, tightly controlling information and booking expensive trips for officers and staff to the Caribbean and other warm climes for union events. High officer salaries and a new severance policy that will give retiring officers lump-sum payouts bigger than many members’ annual pay have added fuel to the fire. “We are just asked to dole out money,” Charles says. (Butler refused repeated requests for an interview. Sipser, however, has previously said that Local 420 keeps a careful watch over expenses and that the executive board is kept fully apprised of the union’s finances.)

With many of his allies retiring and his own health in decline–Butler has refused to step down or groom a successor–he’ll have to fight an organized group of union officers who have turned against him, saying he is more concerned with saving his presidency than with saving the public hospitals. “Mr. Butler has done a lot of wonderful things,” says Georgianna Neller, a longtime Butler supporter who is supporting the opposition slate in union elections next February. “Now he’s in it for the glory. He’s lost his sense of ideals. It’s become his dynasty.”


Three decades ago, Jim Butler was leading insurrections, not fighting them off. A former hospital aide from Savannah, Georgia, Butler was elected president of Local 420 in 1972, when the city’s labor unions were still a fearsome force. He quickly earned a reputation as a charismatic firebrand who would stand his ground against any politician who dared to go after public hospitals. A product of the civil rights movement in the south, Butler continues to trust in the power of the bullhorn, Christian symbolism, and the rhetoric of moral outrage.

His first big test came during the 1970s fiscal crisis, when Mayor Abe Beame announced plans to lay off thousands of hospital workers and close or privatize several hospitals. Butler responded by taking his members out on a three-day wildcat strike. In 1980, Butler worked with community groups to organize massive sit-ins and demonstrations at Sydenham Hospital in Harlem–one of four public hospitals that Mayor Ed Koch targeted for closing–to keep that facility open. They lost Sydenham, but they built a lasting political movement behind public health in the city, and many still regard it as his finest hour.

Forging alliances with the city’s poor communities and its black churches fit with Butler’s vision of the union as caretaker of its members’ hearts, minds and neighborhoods, as well as their paychecks. Asked why he was fighting so hard to save Sydenham Hospital when management promised not to lay off a single worker, he said at the time, “We are a very peculiar organization. Our concern is grievances and benefits, but also about our members once they get off work.”

Under Butler, Local 420 became a community-service organization that members could count on in times of need, whether to provide an emergency loan to a member facing eviction or to beg the boss not to fire an injured worker. “That man bent over backwards,” says one North Central Bronx Hospital worker, exhibiting her maimed hand. “I was out for a year and a half, and he saved my job for me.”

But even back in the day, Butler had his critics. Butler’s m.o., says Victor Gotbaum, the former executive director of DC 37, was “You can do anything you want, but you make sure that you take care of the members.” In the late 1970s, Gotbaum sent his lieutenants into city hospitals to campaign against Butler after the hospital leader proved too independent. When eight Local 420 members complained that Butler could not account for $20,000 in business trip expenses, Gotbaum sued the local and ordered an investigation. An AFSCME audit turned up no major misspending. The conflict deepened when Butler opposed Gotbaum’s bid to unseat the president of the national union AFSCME in 1980 elections, a battle that tore DC 37 apart.

The political war turned bloody at a Local 420 meeting one night, when a dissident union member began heatedly arguing with Butler’s supporters over the spending charges and was stabbed with a knife. No one was ever charged. “In the old days, Butler was surrounded by pistoleros,” says a union official who sided with Butler in that showdown. “He controlled through fear and muscle,” says Gotbaum, who reportedly had his own armed escorts at the peak of their feud to protect himself.

Butler was a wily political operator outside the union as well. Lilliam Barrios-Paoli, vice-president of human resources at the city’s Health and Hospitals Corporation (HHC) for 18 months in the mid-1980s, remembers Butler as a formidable adversary across the bargaining table. Butler sometimes sits in negotiating sessions with his eyes shut, flummoxing city officials who think that he must be asleep. They discover otherwise when his eyes snap open and he growls a rebuke when they say something that he doesn’t like.

“He’s a very smart man,” says Barrios-Paoli, now a vice-president of United Way. “He knows what he wants. People who underestimate him have learned the hard way.”


In late 1980, Butler and Gotbaum declared a ceasefire. Gotbaum dropped the lawsuit, and DC 37 agreed to pay Local 420’s legal fees. Butler moved the local’s offices up to Harlem, making 420 one of only two of DC 37’s 56 locals, which represent public employees from lifeguards to social workers, with an independent power base.

After the relatively quiet 1980s, in the next decade Butler found himself in a fight for the very survival of the public hospitals, thanks to the double-whammy of a new mayor intent on privatization and broader upheaval in the health care industry. Until the rise of managed care, municipal hospitals made ends meet by using Federal dollars left over from treating Medicaid patients–over 70 percent of their paying patients–to subsidize the treatment of the uninsured, for which the state reimburses only 25 to 50 cents on the dollar. That method of balancing the books fell apart when the city’s private hospitals, squeezed by HMOs, began siphoning away Medicaid patients.

In 1995, Giuliani announced that the city was selling Coney Island, Elmhurst and Queens hospitals. A year later, his blue-ribbon panel recommended that the entire system be dismantled. But in a landmark decision on Coney Island Hospital, the first on the block, New York State’s highest court barred the sale of entire facilities, ruling that HHC’s 1969 charter committed it to providing public health care. Undeterred, Giuliani turned to more covert cost-cutting, seeking to contract out or close the system’s central laundry, hospital cafeterias, community clinics, hospital security and school-based clinics.

Butler responded by revving up his protest machine. He organized rallies outside threatened facilities as well as prayer vigils at the homes of Mayor Giuliani, his budget directors and HHC presidents. With a mock coffin, the local’s “Freedom Bus” followed Giuliani on his trips outside the city during his aborted U.S. Senate campaign in 2000. It was a lonely fight. Few other labor leaders or politicians dared to challenge a popular mayor renowned for his vindictiveness. “He was absolutely alone at times,” says Ed Ott, director of public policy for the New York City Central Labor Council.

“He had very few allies, including within District Council 37,” agrees Ray Markey, president of the public librarians’ local and one of DC 37’s leading reformers. “There was no one willing to support him. He almost single-handedly fought against this tidal wave coming at him.”

The isolation proved near-fatal. In 1997, DC 37 chief Stanley Hill, Gotbaum’s hand-picked successor and a Giuliani supporter who ran the union from 1987 to 1998, left Butler’s people out in the cold. Their five-year contract excluded HHC employees from a guarantee that unionized city workers would not be laid off. Six hundred Local 420 members got the ax. (A criminal investigation later found Hill and his associates had rigged the vote to get the contract passed.)

While Butler’s brand of moral suasion paid dividends when a particular facility was in jeopardy, it accomplished little when the enemy was more nebulous. The union stood by helplessly as Giuliani drained the system of funding. The city’s direct contribution to the Health and Hospitals Corporation’s operating budget, which had never fallen below $350 million in the 1980s, plunged to $14 million by 1997. Meanwhile, cash-strapped hospitals set about whittling down their work force through attrition and early buyouts, slicing off 5,000 employees in 1994 and 1995 alone.

Butler’s members bore the brunt of this assault: In the last decade, their numbers dropped from 15,000 to 7,500. The city needed doctors and nurses to maintain the hospitals’ state accreditation, but non-medical staff could be laid off with impunity. “They were easy pickings,” says David R. Jones, president of the Community Service Society and a former HHC board member.

In the new climate, Butler’s refusal to compromise quickly turned into a liability. Barrios-Paoli recalls Butler’s response to a management proposal to combine two job titles–one a male housekeeping job and the other a female housekeeping job. Butler called the plan a return to “the plantation” that threatened the union’s hard-won job titles for different functions, says a union official who was privy to the talks. But in truth, the narrow job descriptions made workers more vulnerable to layoffs because it was harder to reassign them to different jobs. “Butler’s position was, ‘Brothers don’t dust, and sisters don’t mop,’” says Barrios-Paoli. “He wouldn’t budge. It was silly. What was the point?”

With their ranks now decimated, hospital employees who survived Giuliani’s cutbacks are putting in more overtime. Doing the work several people used to do, overworked staffers are forced to give assembly-line care. “Part of their job is to emotionally and intellectually stimulate these people, but instead it’s okay, get dressed, shovel food in their mouths. These people just sit there in their chairs. They don’t have anyone to talk to,” says Neller, who works at Sea View Hospital, a long-term care facility on Staten Island.

“People are trying so hard to make sure they don’t neglect anyone. They’re getting back injuries. They are calling in sick because they are burned out. It’s an impossible job.”


Butler’s critics hoped that an audit ordered by DC 37 Administrator Lee Saunders, as part of a major review of each local’s finances, would shed some light on the hospital union’s spending. But that never happened: While all the other locals’ presidents gave copies of their audits to fellow board members to take home, Butler gave his board less than 30 minutes to review the three mammoth volumes before whisking them away. DC 37 has refused to make copies of the audit public, saying that the documents are the property of Local 420.

Butler has his supporters. “He’s mighty among men,” says Rosa Lawrence, a former aide to Butler who now works for the think tank PolicyLink. “He never kowtowed to Giuliani. That’s what I respect him for more than anything.”

“It’s certainly not Butler’s fault that we didn’t win,” says Ott. “The difficulty is that he serves the poorest constituency and nobody gives a damn about the poor.” Indeed, no one thinks Local 420 could have emerged unscathed from the last decade. Even Gotbaum does not blame Butler for failing to stop the Giuliani juggernaut. “Privatization has diminished his membership,” says Gotbaum. “Not bad leadership.”

But other longtime supporters are starting to say that it’s time for Butler to move on. Says David Jones of the Community Service Society, a consistent ally, “This union needs an infusion of new people and ideas,” says Jones. “Jim fought brilliantly in the Sydenham controversy, but this is going to be a new time and it’s going to need new people coming up through the ranks to take leadership.” Other health care experts believe the union might have sustained less damage with a forward-thinking leader who could have contributed to a discussion of how to make public hospitals financially viable.

One thing is sure: No matter who wins Local 420’s February elections, they’re going to face the same fight Butler did. It is unlikely that the city’s financial contribution to the hospital system will go back to anywhere near what it was before Giuliani took office. If history is any guide, Butler is going to fight for his job just as hard as he’s fought for the hospitals. “Everyone knows that Jim Butler is not well at all, but he just holds on and holds on,” says Gotbaum. “When Sipser died not too long ago,” he says, referring to the local’s loyal old attorney, the father of its current lawyer, “I thought Butler would finally pack it in. My assumption now is that they will carry him out.”

Deidre McFadyen is a reporter for The Chief.