San Francisco Nurses Sue City Over Missed Breaks

Three nurses filed a class action lawsuit against the city and county of San Francisco last week, claiming they weren’t given legally mandated meal and rest breaks while working at the city’s public hospitals.

“Since January 1, 2023, the City has failed to provide meal and rest periods, and/or one additional hour of pay,” as required by law, the nurses stated in a class action lawsuit, filed on behalf of themselves and approximately 2,200 other city-employed nurses.

On February 6, the plaintiffs, Susannah Levy, RN, and Megan Green, RN, of the Zuckerberg San Francisco General Hospital & Trauma Center (SF General), and Aizelle Cunanan, RN, of Laguna Honda Hospital and Rehabilitation Center, filed the lawsuit in San Francisco County Superior Court, stating that both hospitals “regularly” fail to provide appropriate meal and rest breaks.

Levy has been a labor and delivery nurse at SF General for 28 years. She frequently served as a “charge nurse” and, in that role, coordinated staffing on her unit, per the lawsuit.

While each shift is supposed to have a designated “break nurse,” because of understaffing, there often aren’t enough nurses to assign any one nurse to that responsibility. As a result, during about 75% of all evening shifts there is at least one nurse who does not receive a full 30-minute break and two 10-minute rest breaks, the lawsuit noted.

“A nurse may spend her entire shift in a patient’s room while the patient is in labor, or in the operating room while the patient has a C-section — without being able to sit down, eat, or use the bathroom,” according to the lawsuit.

In addition, Levy worked “mandatory overtime shifts” longer than 10 hours, without any additional 30-minute meal break, or the required rest breaks.

“The lack of breaks contributes to medication errors and incomplete documentation. Nurses have no time to refocus and compose themselves,” the lawsuit noted.

Caitlin Gray, JD, is an attorney for Weinberg, Roger & Rosenfeld in Los Angeles, one of two firms representing the nurses. Gray said that due to hospitals’ low staffing levels, nurses sometimes worked 12-hour shifts without any ability to take breaks.

“The meal and rest break laws in California were designed to prevent that,” Gray said.

While private sector employers in San Francisco have been legally required to provide such breaks for years, a new labor code took effect in January 2023 that extended such privileges to public sector healthcare workers. The code was incorporated into a state Senate bill.

Specifically, the new labor law states that all “covered employees” are entitled to “one unpaid 30-minute meal period on shifts over 5 hours and a second unpaid 30-minute meal period on shifts over 10 hours.”

Employees are also entitled to rest breaks at the rate of 10 minutes for every 4 hours worked, the lawsuit noted.

Additionally, employers that fail to provide their employees with a meal or rest break are required to pay that employee “one additional hour of pay at the employee’s regular rate of compensation for each workday that the meal or rest period is not provided,” noted the lawsuit.

“Meal and rest periods are essential worker protections that reduce accidents, improve productivity, and promote employee well-being,” the lawsuit argued, emphasizing that worker “fatigue can adversely impact patient care.”

One wrinkle in the complaint is that the nurse plaintiffs and other city-employed nurses are represented by the Service Employees International Union Local 1021. The union and the city signed a collective bargaining agreement, or memorandum of understanding, that details the terms of nurses’ employment. That agreement holds from July 1, 2022, through June 30, 2024.

However, the agreement doesn’t align with the labor law, Gray said, because “it provides for rest breaks and it provides for first meal breaks, but it doesn’t provide for all of the meal breaks that would be required legally.”

Also, it doesn’t provide “the full premiums” mandated by California law when meal or rest breaks aren’t provided.

“If a break is missed … the law requires 1-hour pay as a premium wage — like an overtime wage to compensate the nurse for that working condition — but the collective bargaining agreement only provides 7.5 minutes of pay for a missed rest break, and does not provide any premium pay for a missed meal break,” Gray said.

The nurses in the lawsuit seek “full compensation for meal and rest periods that the City failed to provide; declaratory relief; reasonable attorney’s fees; and costs of suit,” according to the lawsuit.

MedPage Today was referred to San Francisco City Attorney David Chiu for a comment on the lawsuit by a spokesperson for the Department of Public Health Communications.

“Once we are served with the lawsuit, we will review the complaint and respond appropriately,” said Alex Barrett-Shorter, Chiu’s deputy press secretary, in an email to MedPage Today.