After the recent conflicts between the Catholic bishops and the Obama administration, one might be forgiven for thinking that the only thing the Catholic Church believes about employees is that they should not have employer-provided contraception. In fact, the church has elaborated a rich and admirable body of social teaching on labor, particularly on the right of workers to earn a living wage and to organize in trade unions. It’s also true that Catholic institutions, including hospitals, employ upward of a million Americans. The intersection of church-as-teacher with church-as-employer is the site of many arguments over who has the right-of-way and there have been more than a few collisions. With God on Our Side reports on one such collision, which occurred when health-care workers at Santa Rosa Memorial Hospital, run by the Sisters of St. Joseph of Orange, sought to form a union. As Adam Reich tells the story, the sisters decided to fight the effort, leading to a labor conflict that would last nearly a decade.

The background to the drama typifies institutional changes at Catholic hospitals generally. Though at one time the sisters had performed most of the work at Santa Rosa themselves, by the turn of this century they had delegated most of it to hired laypeople. In 2003, employees contacted the Service Employees International Union (SEIU), which represented employees throughout California’s two largest health care systems—Kaiser Permanente and Catholic Healthcare West (now known as Dignity). When nearly 70 percent of the employees quickly signed cards supporting the union, administrators were alarmed. The sisters reached for many of the same tools that secular, profit-oriented employers use to fight union organizing: hiring a law firm specializing in “union avoidance”; holding repeated “captive audience” meetings where employees were lectured on the deleterious nature of unions; and having supervisors meet individually with union supporters and accuse them of disloyalty.

A number of workers began to waver under the pressure, so the union retooled its strategy and turned to two lay activists, Fred Ross and Eileen Purcell. In the past Ross and Purcell had worked with social-justice committees, parish priests, and not a few of the Sisters of St. Joseph to advocate for causes like farm labor and immigration reform. Now they would seek to persuade the sisters that unions were as good for their health-care employees as they were for migrant farm workers.

The author is no disinterested observer. A doctoral candidate in sociology at Berkeley, and son of onetime Labor Secretary Robert Reich (who makes cameo appearances trying to mediate between the two sides), Adam D. Reich brings established labor sympathies to his work. Indeed, he served for a while as an organizer with the campaign. That said, it’s also clear that Reich—who describes himself as “a nonpracticing Jew whose religious experience was limited to bar and bat mitzvahs”—perceived better than most union organizers how different the sisters and their system were from conventional employers. The measures they adopted to cut operating costs and to fight the union may have looked like those of ordinary business enterprises, but the sisters had no interest in boosting profits to enrich themselves or their shareholders. Their “mission-driven” perspective, in an institution developed for charitable ends, differed significantly from that of a private, for-profit hospital.

As it turned out, the health-care workers themselves were motivated by their sense of mission as much as by any desire for improved wages and benefits. They were frustrated that staffing cuts driven by economic considerations were compromising their ability to care for patients. “Each side argued that it represented a vision of Catholic teaching in the face of impersonal market forces embodied by the other,” explains Reich. “Each subscribed to a view of the market as fundamentally immoral, yet each side identified the immorality of the market in the other.”

The campaign contained a few complicating subplots. Union supporters had to work around a concurrent national dialogue among the SEIU, the AFL-CIO, the Catholic Health Association, and the U.S. Conference of Catholic Bishops—a dialogue devoted to finding a more general labor peace. Even more disruptive was an increasingly fierce dispute between the national leaders of the SEIU and the officers of California’s SEIU healthcare local. The argument led to a split, with local leaders launching a competing union, the National Union of Health-care Workers (NUHW). Both groups devoted most of their attention to seeking the mandate of existing union members rather than organizing new ones, and for some time the Santa Rosa hospital workers were left largely to their own devices. In the end it was the NUHW that returned to pick up the pieces, winning representation by a vote of 283 to 263 in a December 2009 election.

The national dialogue between labor and church regarding Catholic health-care employees and their right to organize culminated in a 2009 document, Respecting the Just Rights of Workers: Guidance and Options for Catholic Health Care and Unions—a document more widely discussed than implemented. Some Catholic hospital systems are unionized and enjoy reasonably good labor relations; but many others are prepared to resist union initiatives among their workers every bit as fiercely as Santa Rosa.

Is it possible that in the course of the long organizing campaign at Santa Rosa each side learned that the other shared its commitment to the health-care mission? Perhaps. In April 2012—after publication of With God on Our Side—union members ratified their first contract at Santa Rosa. NUHW Secretary-Treasurer John Borsos reported that despite the long and bitter fight for recognition, the two sides had “very positive and amicable negotiations.” “We were both able to put a lot of acrimony behind us,” Borsos noted, “and start on a different kind of relationship.”