Pharmacy technicians at the University of Kansas Health System narrowly rejected a unionizing effort last week, as union organizers questioned why some ballots never arrived to be counted.

“The uncertified election results released today reflect disenfranchisement of pharmacy professionals on a staggering scale,” the IAM Healthcare Union said in a May 14 statement. “We need answers as to where the ballots went and why so many pharmacy professionals who voted have not had their votes counted.”

The health system rebuked the union’s concerns, saying the mail-in election had been conducted by the Kansas Public Employee Relations Board, part of the Kansas Department of Labor. 

“Disliking the results of an election objectively administered by an impartial state agency should not lead to baseless claims by the IAM Union intended to misinform employees and the public,” the health system’s written statement said in part.

According to a tally of ballots from the state, each of the two bargaining units was two votes shy of unionizing in the May 14 election, but less than 40% of eligible ballots were included in the final counts. 

• The larger bargaining unit, which includes the health system’s 39th Street main campus, voted 19-20 against unionizing. The unit had 105 eligible voters. Two ballots were voided.
• The second bargaining unit, including a specialty pharmacy in the Southlake Business Park in Lenexa, voted 9-10 against unionizing. That unit had 43 eligible voters.

The union said the list of employees whose ballots were counted did not include some people who have confirmed returning their ballots in plenty of time to meet the election deadline. The union did not provide a theory about why the ballots were missing, but said in a statement that it has “serious questions about the integrity of these razor-thin election results.”

The union filed an appeal with the state May 19. Union leaders said they hope to come to a remedy, which could include counting ballots if they do arrive, or redoing the vote, possibly through an in-person election.

Cheyanne Barker, a technician who works in the main hospital near 39th Street, said her ballot was one of those that did not show up in the count, although she mailed it a month before the deadline. 

Other technicians who had taken photos or videos as they mailed their ballots also were not among the names included among those who voted.

“It would be an understatement to say we were shocked,” Barker said. “It was not the outcome that we expected. We were definitely concerned about the amount of ballots that were missing. Right now our focus is on finding a resolution to make sure this election is fair so that everyone who did vote is counted.”

In its written statement, the hospital said the vote against unionizing shows that employees “believe they are better represented by their health system leaders here in Kansas City versus a union based more than a thousand miles away.

“Throughout this process, The University of Kansas Health System provided factual, timely information to our pharmacy technicians so they could make a well-informed decision. We support our employees and their right to decide. … Our focus remains on our employees and our patients, working to provide the highest quality experience for all.”

Pharmacy unionization movement

Pharmacy technicians began their unionizing effort 16 months ago, calling on the health system to schedule more technicians to work each shift and asking for reasonable workloads and a voice in pharmacy decision-making. They also want higher pay.

Pharmacy technicians work with pharmacists, typically helping to prepare medications for patients. That can include filling prescriptions, preparing drugs to be mailed, stocking medication and taking patient medication histories.

In recent years, and especially since the COVID pandemic, pharmacists and pharmacy techs have increasingly turned to unions for relief from what they claim were unsafe working conditions.

Changing buying habits, like people turning more to mail-order medicine, and low margins on some medications put financial pressure on retail pharmacies. That along with a shortage of pharmacists and technicians meant many pharmacies were trying to get by with a slim workforce. That got even worse during the pandemic, when pharmacies stayed open even as many doctors’ offices went virtual.

In 2023, a group of Kansas City-area pharmacists walked off their jobs at CVS-owned pharmacies to protest understaffing, low technician pay and burdensome workloads, helping spark a nationwide movement to unionize.

The Pharmacy Guild — part of the IAM (International Association of Machinists and Aerospace Workers) Healthcare Union — led that movement. KU’s pharmacy techs turned to it in January 2025 when their unionizing effort began. 

The union said it found strong support among KU’s pharmacy techs, but the effort to get a vote to unionize slowed down when the union and health system couldn’t agree on how the bargaining units would be structured. 

In October, the union and the health system entered settlement negotiations before eventually reaching a stipulated election agreement in March. That kicked off a seven-week election period when eligible employees could vote.

Previous complaints

According to National Labor Relations Board data, the overall participation rate in union elections last year was about 76%, nearly twice as high as the participation rate in the KU Pharmacy election. Rates vary widely across individual elections, however, and the data do not distinguish between elections conducted by mail and those conducted in person, which could affect turnout.

But the union may point to the low turnout rate in last week’s election as evidence that employees felt pressure from their employer.

The union has alleged that the hospital wasn’t playing fair leading up to the election. In an Oct. 28 letter to Bob Page, president and CEO of KU Health System, the union criticized the health system for interfering with the organizing efforts.

“Unfortunately,” the letter said, “we have documented multiple instances of intimidation, surveillance and misinformation that are in direct violation of the Kansas Public Employer-Employee Relations Act.”

The hospital hired lawyers from Littler Mendelson, a San Francisco firm with a reputation for helping companies fight union organizing efforts. Notably, the firm has represented Starbucks in that company’s aggressive push against baristas’ unionizing efforts.

KU Pharmacy technicians speaking on KKFI’s Heartland Labor Forum radio show in November said they had seen “union busting” efforts, too. Any flyers they posted — even in nonwork areas — would be taken down within a couple of hours, they said. Meanwhile, the health system used hospital resources to send anti-union messages, the technicians said.

In its written statement, the health system said that it had “provided factual, timely information to our pharmacy technicians so they could make a well-informed decision. We support our employees and their right to decide.”

Betsy Lawrence, an adjunct professor at the University of Kansas Law School, said employers have a right to launch a counter campaign and express their opinions about how a union would affect their organization. But they are legally prohibited from engaging in unfair labor practices that could impede a free and fair union election.

“That’s the line employers walk sometimes,” Lawrence said. “Many employers don’t want to just remain neutral, they want to be clear about their opposition. But they can’t do it in a threatening way.”

Under federal law, unions seeking to form a union at a private business must have at least 30% support from eligible employees before they can request a vote through the National Labor Relations Board. But unions typically wouldn’t proceed without the support of at least 50% of employees, Lawrence said, because once the counter campaign begins, some support will inevitably fall off.

The KU Health System, which is an independent, nonprofit academic medical center governed by an independent board of directors, falls under the jurisdiction of the state’s Public Employee Relations Board, which oversees labor relations for public employees.