Temple University Hospital v. NLRB ( 2022 )


Menu:
  •  United States Court of Appeals
    FOR THE DISTRICT OF COLUMBIA CIRCUIT
    Argued February 15, 2022                Decided July 8, 2022
    No. 21-1111
    TEMPLE UNIVERSITY HOSPITAL, INC.,
    PETITIONER/CROSS-RESPONDENT
    v.
    NATIONAL LABOR RELATIONS BOARD,
    RESPONDENT/CROSS-PETITIONER
    TEMPLE ALLIED PROFESSIONALS, PENNSYLVANIA
    ASSOCIATION OF STAFF NURSES AND ALLIED PROFESSIONALS,
    INTERVENOR
    Consolidated with 21-1124
    On Petition for Review and Cross-Application
    for Enforcement of an Order
    of the National Labor Relations Board
    Shannon D. Farmer argued the cause for petitioner/cross-
    respondent. With her on the briefs were Meredith Swartz
    Dante and Rebecca A. Leaf.
    Eric Weitz, Attorney, National Labor Relations Board,
    argued the cause for respondent/cross-petitioner. With him on
    2
    the brief were Jennifer A. Abruzzo, General Counsel, Ruth E.
    Burdick, Deputy Associate General Counsel, David S.
    Habenstreit, Assistant General Counsel, and Kira Dellinger
    Vol, Supervisory Attorney.
    Jonathan Walters argued the cause for intervenor Temple
    Allied Professionals, Pennsylvania Association of Staff Nurses
    and Allied Professionals in support of respondent/cross-
    petitioner. Claiborne S. Newlin entered an appearance.
    Before: SRINIVASAN, Chief Judge, HENDERSON and
    JACKSON, Circuit Judges.
    Opinion for the Court filed by Chief Judge SRINIVASAN.
    SRINIVASAN, Chief Judge: For more than four decades,
    labor relations between Temple University Hospital and the
    professional and technical employees working there occurred
    under the jurisdiction of the Pennsylvania Labor Relations
    Board. In 2015, however, the labor union representing those
    employees petitioned the National Labor Relations Board to
    exercise jurisdiction over its relationship with the Hospital.
    Over the Hospital’s objections, the NLRB granted the petition,
    asserted jurisdiction, and certified the union as the
    representative of an expanded unit of employees.
    Dissatisfied with that result, the Hospital refused to
    bargain with the union and eventually filed a petition for review
    in this court. Although the Hospital raised several arguments,
    we considered only one: its contention that the union was
    judicially estopped from invoking the NLRB’s jurisdiction
    because the union had previously insisted that the NLRB in fact
    
    Circuit Judge, now Justice, Jackson was a member of the panel
    at the time the case was argued but did not participate in the opinion.
    3
    lacked jurisdiction. Siding with the Hospital, we held that the
    NLRB had misapplied the relevant judicial-estoppel analysis
    and remanded for further proceedings. See Temple Univ.
    Hosp., Inc. v. NLRB, 
    929 F.3d 729
    , 735–37 (D.C. Cir. 2019).
    On remand, the NLRB again asserted jurisdiction over the
    Hospital after determining that principles of judicial estoppel
    are inapplicable. The Hospital continues to resist that result,
    and it renews the additional arguments we had no occasion to
    address in 2019. Because the Hospital identifies no error in the
    NLRB’s decision, we deny the petition for review and grant the
    Board’s cross-application for enforcement.
    I.
    A.
    The National Labor Relations Act, 
    29 U.S.C. § 151
     et seq.,
    guarantees employees the right “to bargain collectively through
    representatives of their own choosing.” 
    29 U.S.C. § 157
    .
    Section 8 of the Act bars employers from engaging in a host of
    unfair labor practices. Among them, an employer may not
    “refuse to bargain collectively with the representatives of his
    employees.” 
    Id.
     § 158(a)(5). Although the NLRA defines
    “employer” broadly, the statute specifically exempts “any State
    or political subdivision thereof.” Id. § 152(2).
    Under Section 9 of the Act, a labor organization or group
    of employees may file a petition with the National Labor
    Relations Board (NLRB or Board) alleging that a substantial
    number of employees wish to be represented for collective
    bargaining and that their employer has declined to recognize
    their representative. Id. § 159(c)(1)(A). Upon the filing of a
    petition, the Board must decide “the unit appropriate for the
    purposes of collective bargaining.”        Id. § 159(b).     A
    4
    representative becomes the exclusive representative of
    employees in a particular collective-bargaining unit upon a
    majority vote of the relevant employees and the Board’s
    certification of the results. Id. § 159(a)–(c).
    The Board has provided specific instruction concerning
    the appropriate composition of bargaining units in the health
    care setting since 1989, when it promulgated what has become
    known as the Health Care Rule. See 
    29 C.F.R. § 103.30
    ; Am.
    Hosp. Ass’n v. NLRB, 
    499 U.S. 606
    , 608, 615–17 (1991).
    Applicable to acute-care hospitals, the Health Care Rule sets
    out eight units as the “only appropriate units” for purposes of
    representation petitions filed under the NLRA. 
    29 C.F.R. § 103.30
    (a). Although units not described in the Health Care
    Rule are deemed nonconforming, 
    id.
     § 103.30(f)(5), the Rule
    provides that combinations of the enumerated units may be
    appropriate and excepts preexisting nonconforming units from
    its requirements, id. § 103.30(a).
    The Board, of course, is not the only labor relations
    authority in the country. Although the Board retains exclusive
    jurisdiction over activities “arguably subject” to the NLRA,
    state labor boards administer and enforce their own labor laws
    against entities outside the Board’s jurisdiction. San Diego
    Bldg. Trades Council v. Garmon, 
    359 U.S. 236
    , 244–46 (1959).
    Occasionally, the Board will exercise jurisdiction over a
    particular bargaining relationship previously under the
    supervision of a state agency. In such circumstances, the Board
    generally extends “comity” to the state agency’s elections and
    certifications, “provided that the state proceedings reflect the
    true desires of the affected employees, election irregularities
    are not involved, and there has been no substantial deviation
    from due process requirements.” Allegheny Gen. Hosp., 
    230 N.L.R.B. 954
    , 955 (1977). When it extends comity, the Board
    5
    accords the “same effect to the elections and certifications of
    responsible state government agencies” as its own. 
    Id.
    B.
    Our 2019 opinion in this case sets out the relevant factual
    background, see Temple Univ. Hosp., 929 F.3d at 731–33, but
    we recount the key points here. Temple University Hospital is
    an acute-care hospital located in Philadelphia, Pennsylvania.
    Acquired in 1910 by Temple University—a state-related
    university also based in Philadelphia—the Hospital initially
    functioned as an unincorporated division of the University.
    That changed in 1995, when the Hospital became a distinct
    nonprofit corporation. The sole shareholder of that corporation
    is Temple University Health System, a holding company the
    University created for its healthcare-related assets. As an
    independent corporate entity, the Hospital generally conducts
    its own collective bargaining and handles personnel decisions
    for non-executive employees. But the University and the
    Hospital nonetheless retain a number of close operational and
    budgetary ties.
    In 2005, the Temple Allied Professionals, Pennsylvania
    Association of Staff Nurses and Allied Professionals (the
    Union) filed a petition with the Pennsylvania Labor Relations
    Board (PLRB) to represent a previously certified bargaining
    unit of professional and technical employees—a unit that a
    different union had represented since the 1970s. In the ensuing
    proceedings, both the Union and the Hospital contended—over
    the then-incumbent union’s opposition—that the PLRB, rather
    than the NLRB, properly had jurisdiction over the Hospital.
    The PLRB agreed, and the Union prevailed in the subsequent
    election. It has represented the unit ever since.
    6
    Ten years later, in 2015, the Union petitioned the NLRB
    to assert jurisdiction over its relationship with the Hospital,
    notwithstanding the Union’s repeated prior invocations of the
    PLRB’s authority. The specific basis for the Union’s petition
    was its desire to add two classifications of unrepresented
    Hospital employees—professional medical interpreters and
    transplant financial coordinators, comprising a total of eleven
    individuals—to the existing professional-technical bargaining
    unit. The petition asked the NLRB to conduct an election in
    which the petitioned-for employees would vote on whether to
    join the existing unit.
    The Hospital mounted several defenses.            First, it
    contended that the Union should be judicially estopped from
    invoking the Board’s jurisdiction because of the Union’s prior
    representations that the PLRB, not the NLRB, had jurisdiction
    over the Hospital. Second, it maintained that the Hospital was
    a “political subdivision” of Pennsylvania and therefore exempt
    from the Board’s jurisdiction. See 
    29 U.S.C. § 152
    (2). Third,
    it argued that the Board should decline to exercise its
    jurisdiction on account of the close ties between the Hospital
    and the University. Finally, it submitted that the Board should
    not extend comity to the PLRB’s certification of the
    professional-technical unit.
    An Acting Regional Director of the NLRB ruled in favor
    of the Union. Rejecting each of the Hospital’s arguments, he
    asserted jurisdiction over the Hospital and extended comity to
    the PLRB’s certification of the professional-technical unit.
    The Union won the ensuing election among the petitioned-for
    interpreters and financial coordinators, and the Acting
    Regional Director certified it as the exclusive collective-
    bargaining representative of the newly expanded professional-
    technical unit.
    7
    The Board affirmed the Acting Regional Director’s
    decision. Seeking to contest the validity of the Board’s
    certification of the Union, the Hospital refused to bargain with
    the Union. The Union filed an unfair-labor-practice charge
    with the Board, which found that the Hospital had violated the
    NLRA. The Hospital then lodged a petition for review in this
    court.
    Although the Hospital briefed each of the four primary
    arguments it had pressed before the Board, we reached only its
    first contention concerning judicial estoppel. We agreed with
    the Hospital that the Board had misapplied the judicial-estoppel
    analysis prescribed by the Supreme Court. Temple Univ.
    Hosp., 929 F.3d at 735–36 (citing New Hampshire v. Maine,
    
    532 U.S. 742
    , 750–52 (2001)). We remanded the case for
    further proceedings.
    On remand, the Board again declined to estop the Union
    from invoking its jurisdiction. But its path to that result was
    different. Instead of assuming the availability of judicial
    estoppel in Board proceedings and nonetheless declining to
    apply it based on a balancing of the relevant factors, the Board
    this time concluded that judicial estoppel “is not available in
    proceedings . . . where the Board’s jurisdiction is in issue,”
    such that the doctrine’s application “could compel the Board to
    surrender its jurisdiction.” Supplemental Decision and Order
    at 1–2, J.A. 169–70. With judicial estoppel off the table, the
    Board reaffirmed its prior determination that the Hospital’s
    refusal to bargain with the Union violated the NLRA. Id. at 4,
    J.A. 172.
    The Hospital once again petitions for review, and the
    Board cross-applies for enforcement of its order. The Union
    has intervened in support of the Board’s decision.
    8
    II.
    The Hospital contends that the Board improperly asserted
    jurisdiction over this dispute and erroneously extended comity
    to the PLRB’s prior certification of the professional-technical
    bargaining unit. A court “must uphold the judgment of the
    Board unless its findings are unsupported by substantial
    evidence, or it acted arbitrarily or otherwise erred in applying
    established law to the facts of the case.” Novato Healthcare
    Ctr. v. NLRB, 
    916 F.3d 1095
    , 1100 (D.C. Cir. 2019). We find
    no error in the Board’s decision.
    A.
    The Hospital first argues that the doctrine of judicial
    estoppel should have foreclosed the Union’s attempt to invoke
    the Board’s jurisdiction. Judicial estoppel generally “prevents
    a party from asserting a claim in a legal proceeding that is
    inconsistent with a claim taken by that party in a previous
    proceeding.” New Hampshire, 
    532 U.S. at 749
     (quoting 18
    Moore’s Federal Practice § 134.30 (3d ed. 2000)). According
    to the Hospital, the Union’s prior insistence that the PLRB—
    and not the NLRB—properly had jurisdiction over the Hospital
    should estop the Union from reversing course in this case.
    Whether a nonjudicial tribunal such as the Board “may
    itself invoke judicial estoppel appears to be an issue of first
    impression.” Temple Univ. Hosp., 929 F.3d at 734. But we
    need not consider that question here, for the Board did not
    resolve it. Instead, the Board made a threshold determination
    that, while judicial estoppel might be available in certain Board
    proceedings, the doctrine is unavailable when its
    “application . . . could compel the Board to surrender its
    jurisdiction.” Supplemental Decision and Order at 2, J.A. 170.
    That is, the Board concluded that a party cannot rely on judicial
    9
    estoppel to prevent the Board from entertaining a matter that
    would otherwise fall within its statutory authority.
    As judicial estoppel is an “equitable doctrine” invoked by
    a tribunal “at its discretion,” New Hampshire, 
    532 U.S. at 750
    (citation omitted), we review the Board’s “decision . . . not to
    invoke[] judicial estoppel for abuse of discretion.” Temple
    Univ. Hosp., 929 F.3d at 734. In doing so, we confine our
    review to the adequacy of the reasons articulated in the Board’s
    order. Erie Brush & Mfg. Corp. v. NLRB, 
    700 F.3d 17
    , 23
    (D.C. Cir. 2012). The Board did not abuse its discretion in
    determining that judicial estoppel is unavailable in cases in
    which the Board’s jurisdiction is at issue.
    The Board centrally grounded that conclusion in “[f]ederal
    labor policy,” which, to the Board, “weighs heavily against
    allowing judicial estoppel to be used as a ground to limit [its]
    jurisdiction.” Supplemental Decision and Order at 3, J.A. 171.
    The Board located the relevant pro-enforcement policy in
    Section 10(a) of the NLRA. See 
    29 U.S.C. § 160
    (a). That
    provision “empower[s]” the Board “to prevent any person from
    engaging in any unfair labor practice (listed in [Section 8] of
    [the Act]) affecting commerce,” a power that “shall not be
    affected by any other means of adjustment or prevention that
    has been or may be established by agreement, law, or
    otherwise.” 
    Id.
    The Board reasoned that, if judicial estoppel were to apply
    here, the PLRB would have jurisdiction over all representation
    petitions and unfair-labor-practice charges brought by the
    Union against the Hospital and could issue rulings the Board
    would have no power to review. The Board declined to
    establish a doctrine under which “the power Congress endowed
    [the Board] with in Section 10(a) could be surrendered to the
    parties and the history of their petition-filing and litigation
    10
    choices over time.” Supplemental Decision and Order at 4,
    J.A. 172. “Even assuming Section 10(a) would permit this,”
    the Board explained, “the federal policy embodied in that
    statutory provision convinces us that we ought not do so.” 
    Id.
    The Board permissibly concluded that Congress’s broad
    conferral of statutory authority to prevent “any person” from
    committing “any unfair labor practice” affecting commerce—
    notwithstanding the existence of “any other” law—militated
    against enabling judicial estoppel to prevent the Board from
    exercising its authority in cases in which it could otherwise act.
    
    29 U.S.C. § 160
    (a) (emphases added). The Board “has the
    primary responsibility for developing and applying national
    labor policy.” NLRB v. Curtin Matheson Sci., Inc., 
    494 U.S. 775
    , 786 (1990). And we cannot say that the Board abused its
    discretion in determining that “plac[ing] [its] jurisdictional
    powers in the hands of litigants” would be at odds with
    Congress’s broad empowerment of the Board to enforce the
    NLRA in cases satisfying the Act’s jurisdictional prerequisites.
    Supplemental Decision and Order at 3, J.A. 171; cf.
    Hammontree v. NLRB, 
    925 F.2d 1486
    , 1491–92 (D.C. Cir.
    1991) (construing Section 10(a)’s “affirmative grant of
    authority to the Board” as providing that “no one other than the
    Board shall diminish the Board’s authority over [unfair-labor-
    practice] claims”); NLRB v. Reliance Fuel Oil Corp., 
    371 U.S. 224
    , 226 (1963) (“This Court has consistently declared that in
    passing the [NLRA], Congress intended to and did vest in the
    Board the fullest jurisdictional breadth constitutionally
    permissible under the Commerce Clause.”).
    The Hospital points out that the Board’s jurisdiction is
    discretionary and not mandatory. The Board, though,
    recognized as much, acknowledging that it “does not always
    exercise the power Congress granted it in Section 10(a).”
    Supplemental Decision and Order at 4, J.A. 172. The fact that
    11
    the Board may at times decline to exercise its jurisdiction is by
    no means inconsistent with its choice to avoid a regime in
    which the petition-filing practices of private parties—rather
    than the Board’s own discretionary decisions—could prevent
    it from hearing a dispute it would otherwise entertain.
    In addition to its reliance on federal labor policy, the Board
    also considered judicial precedent and its own decisions. As
    for the former, the Board observed that “federal courts have
    generally declined to apply judicial estoppel to create or defeat
    jurisdiction.” Id. at 3, J.A. 171 (citing City of Colton v. Am.
    Promotional Events, Inc.-West, 
    614 F.3d 998
    , 1006 n.6 (9th
    Cir. 2010); Whiting v. Krassner, 
    391 F.3d 540
    , 544 (3d Cir.
    2004); Da Silva v. Kinsho Int’l Corp., 
    229 F.3d 358
    , 361 (2d
    Cir. 2000)). As for its own precedent, the Board relied on two
    decisions in which it asserted jurisdiction over bargaining
    relationships notwithstanding the parties’ historically
    inconsistent positions on whether jurisdiction in fact existed.
    Id. at 4, J.A. 172 (citing Wyndham West at Garden City, 
    307 N.L.R.B. 136
     (1992) (advisory opinion); We Transport, Inc.,
    
    215 N.L.R.B. 497
     (1974)).
    The Hospital is correct that neither judicial nor
    administrative precedent compelled the Board to conclude that
    litigants cannot use judicial estoppel as a means of limiting the
    Board’s jurisdiction. But the Board did not suggest otherwise.
    It instead considered nonbinding judicial precedent only as a
    “preliminar[y]” matter, and it acknowledged that court
    decisions did not uniformly point in one direction. Id. at 3, J.A.
    171 (citing Sexual Minorities Uganda v. Lively, 
    899 F.3d 24
    ,
    34 (1st Cir. 2018)). And with regard to its own precedent, it
    recognized that the applicability of judicial estoppel in Board
    proceedings is an issue it “has not squarely addressed.” Id. at
    2, J.A. 170. At bottom, the Board permissibly reasoned that
    judicial and administrative precedent generally reinforced its
    12
    policy-driven decision to make judicial estoppel unavailable in
    the circumstances of this case.
    Contrary to the Hospital’s contention, the Board did not
    flout this court’s 2019 decision in this case. There, we
    remanded in part “for the Board to determine in the first
    instance whether judicial estoppel is available in NLRB
    proceedings.” Temple Univ. Hosp., 929 F.3d at 737. The
    Board could save that broader question for another day and
    determine that, even assuming judicial estoppel may be
    available in some proceedings, it cannot be used to defeat the
    Board’s jurisdiction.
    B.
    The Hospital next challenges the Board’s determination
    that the Hospital is not a political subdivision of Pennsylvania
    exempt from the NLRB’s jurisdiction. We see no basis to set
    aside the Board’s conclusion.
    Section 8 of the NLRA enumerates unfair labor practices
    that an “employer” may not perform, 
    29 U.S.C. § 158
    (a), and
    the Act defines “employer” to exclude “any State or political
    subdivision thereof,” 
    id.
     § 152(2). Although the statute does
    not further define “political subdivision,” the Supreme Court
    has upheld the Board’s construction of the term to mean an
    entity that is either “(1) created directly by the state, so as to
    constitute [a] department[] or administrative arm[] of the
    government, or (2) administered by individuals who are
    responsible to public officials or to the general electorate.”
    NLRB v. Nat. Gas Util. Dist. of Hawkins Cty., 
    402 U.S. 600
    ,
    604–05 (1971). An entity satisfying either prong of that test is
    not a statutory “employer” and falls outside the Board’s
    jurisdiction. Midwest Div.-MMC, LLC v. NLRB, 
    867 F.3d 1288
    , 1296 (D.C. Cir. 2017).
    13
    All agree that the Hospital was not “created directly by the
    state.” Hawkins Cty., 
    402 U.S. at 604
    . The sole question, then,
    is whether the Hospital is “administered by individuals who are
    responsible to public officials or to the general electorate.” 
    Id.
    at 604–05. Under that prong of the Hawkins County test, “the
    pertinent question is ‘whether a majority of the individuals who
    administer the entity . . . are appointed by and subject to
    removal by public officials.’” Midwest Div.-MMC, 867 F.3d
    at 1297 (alteration in original) (quoting Pilsen Wellness Ctr.,
    
    359 N.L.R.B. 626
    , 628 (2013)). In Midwest Division-MMC,
    the employer (also an acute-care hospital) offered no evidence
    that the members of the relevant peer review committee (the
    entity in question) were either appointed or removable by
    public officials. In those circumstances, the Board reasonably
    determined that the hospital committee did not qualify as an
    exempt political subdivision. 
    Id.
    The same reasoning controls here. As the Acting Regional
    Director explained, “no government entity has the authority to
    appoint or remove a Hospital board member, and no member
    of the board . . . is a government official or works for a
    government entity.”        Regional Director’s Decision and
    Direction of Election at 14, J.A. 82. The Hospital’s board
    members, rather, are “subject solely to private appointment and
    removal.” 
    Id.
     Because a majority of the Hospital’s board
    members are neither appointed by nor subject to removal by
    public officials (indeed, none are), the Hospital is not
    “administered by individuals who are responsible to public
    officials or to the general electorate.” Hawkins Cty., 
    402 U.S. at
    604–05.
    Invoking a non-precedential advice memorandum issued
    by the NLRB’s General Counsel, the Hospital points to
    additional factors purportedly establishing that it is an exempt
    14
    political subdivision. As the Board explained, however,
    “[w]here an examination of the appointment-and-removal
    method yields a clear answer to whether an entity is
    administered by individuals who are responsible to public
    officials or to the general electorate, the Board’s analysis
    properly ends.” Order Granting Review in Part at 2 n.2, J.A.
    147 (quotation marks omitted) (quoting Pa. Virtual Charter
    Sch., 364 N.L.R.B. No. 87, at *13 (2016)). The Hospital does
    not challenge that controlling standard—a standard that this
    court and numerous others have consistently applied. See, e.g.,
    Midwest Div.-MMC, 867 F.3d at 1297; Voices for Int’l Bus. &
    Educ., Inc. v. NLRB, 
    905 F.3d 770
    , 776–77 (5th Cir. 2018)
    (collecting cases); cf. Yukon-Kuskokwim Health Corp. v.
    NLRB, 
    234 F.3d 714
    , 717 (D.C. Cir. 2000) (“[T]he Board has
    long and reasonably preferred bright line rules in order to avoid
    disputes over its jurisdiction.”). The Board thus reasonably
    determined that the Hospital does not qualify as a political
    subdivision of Pennsylvania.
    C.
    The Hospital next contends that, insofar as the Board had
    jurisdiction, the Board should have declined to exercise it. It is
    true that the Board may properly decline to exercise
    jurisdiction if it concludes that “the policies of the [NLRA]
    would not be effectuated by its assertion of jurisdiction.”
    NLRB v. Denver Bldg. & Constr. Trades Council, 
    341 U.S. 675
    , 684 (1951); accord Temple Univ. Hosp., 929 F.3d at 732
    n.*. That decision, though, is inherently a discretionary one.
    While the Board may not act arbitrarily or cause an employer
    unfair and substantial prejudice, its discretionary determination
    to assert jurisdiction is otherwise “essentially unreviewable.”
    Hum. Dev. Ass’n v. NLRB, 
    937 F.2d 657
    , 661 (D.C. Cir. 1991)
    (quoting NLRB v. Kemmerer Vill., Inc., 
    907 F.2d 661
    , 663–64
    (7th Cir. 1990)). Indeed, we have long emphasized “the broad
    15
    scope of the Board’s discretion in determining whether an
    abstention from jurisdiction is likely to promote the objectives
    of the Act.” Herbert Harvey, Inc. v. NLRB, 
    424 F.2d 770
    , 782
    (D.C. Cir. 1969).       “[I]n the absence of extraordinary
    circumstances whether jurisdiction should be exercised is for
    the Board, not the courts, to determine.” 
    Id. at 783
     (quoting
    NLRB v. WGOK, Inc., 
    384 F.2d 500
    , 502 (5th Cir. 1967)).
    The Hospital nonetheless contends that the Board abused
    its discretion by exercising jurisdiction in this case. The
    Hospital emphasizes its close ties to the University, over which
    the Board a half-century ago declined to assert jurisdiction in
    light of the University’s “unique relationship” with
    Pennsylvania. See Temple Univ., 
    194 N.L.R.B. 1160
    , 1161
    (1972). As the Board explained, however, its more recent
    practice has been to “assert jurisdiction over an employer,
    despite its close ties with an exempt government entity, as long
    as it meets the definition of employer set out in Section 2(2) of
    the Act and the applicable monetary jurisdictional standards.”
    Decision on Review and Order at 2, J.A. 149 (citing Mgmt.
    Training Corp., 
    317 N.L.R.B. 1355
    , 1358 (1995)). The Board
    reasonably found both criteria satisfied, explaining that the
    Hospital “possesses sufficient control over its employees’
    terms and conditions of employment” and that there was “no
    dispute that the [Hospital] meets the Board’s monetary
    jurisdictional standards.” 
    Id.
    The Board also permissibly rejected the Hospital’s claim
    that asserting jurisdiction would substantially prejudice the
    Hospital by disrupting existing bargaining relationships under
    Pennsylvania law. As the Board reasonably determined, “[t]he
    stable bargaining relationship has been between the [Hospital]
    and Union, not between the [Hospital] and the PLRB.” Id. at
    3, J.A. 150 (quoting MCAR, Inc., 
    333 N.L.R.B. 1098
    , 1104
    (2001)). The Board explained that it has repeatedly exercised
    16
    jurisdiction even when a state agency such as the PLRB had
    previously asserted jurisdiction. 
    Id.
     And the Board reasonably
    declined to consider the Union’s purpose for invoking the
    Board’s jurisdiction, as well as the Hospital’s offers to add the
    petitioned-for employees to the existing bargaining unit under
    Pennsylvania law. While the Board could have afforded
    greater weight to such considerations, its decision not to do so
    evinces no abuse of discretion.
    D.
    The Hospital’s final contention is that the Board
    erroneously extended comity to the PLRB’s previous
    certification of the professional-technical bargaining unit. The
    Board, the Hospital maintains, should not have accorded the
    “same effect to the elections and certifications of” the PLRB as
    the Board’s own, Allegheny Gen. Hosp., 230 N.L.R.B. at 955,
    but rather should have required a new representation petition,
    held a federally administered election, and itself certified the
    bargaining unit upon a majority vote of the relevant employees.
    The Hospital contends that extending comity was
    improper for two reasons: (i) the PLRB-certified unit is
    inconsistent with the Board’s Health Care Rule; and (ii) the
    Board arbitrarily departed from its own precedent. Neither
    argument has merit.
    1.
    Under the Board’s Health Care Rule, two of the eight
    permissible bargaining units in acute-care hospitals are “[a]ll
    professionals except for registered nurses and physicians” and
    “[a]ll technical employees.” 
    29 C.F.R. § 103.30
    (a)(3)–(4).
    Any deviating unit is nonconforming—except that, as relevant
    here, the Rule allows both combinations of the eight units and
    17
    nonconforming units that existed at the time of the Rule’s
    promulgation in 1989. 
    Id.
     § 103.30(a), (f)(5). In this case, the
    Board determined that both of those exceptions applied.
    Specifically, the PLRB-certified unit was a “combination of
    two of the eight specified units”—i.e., professionals and
    technical employees. Decision on Review and Order at 4, J.A.
    151.     Alternatively, “even assuming the unit is non-
    conforming, it was and still is an ‘existing non-conforming
    unit[]’” within the meaning of the Rule because the unit was
    originally certified by the PLRB in 1975 and its composition
    “has largely remained the same” in the years since. Id. (quoting
    
    29 C.F.R. § 103.30
    (a)).
    We sustain the Board’s decision on that latter ground,
    which the Board made clear was an independent basis for its
    order. “We accord the Board an especially wide degree of
    discretion on questions of representation.” Rush Univ. Med.
    Ctr. v. NLRB, 
    833 F.3d 202
    , 206 (D.C. Cir. 2016) (quotation
    marks and citation omitted). The Board acted within its
    discretion in determining that the professional-technical
    bargaining unit was an “existing” unit at the time of the Health
    Care Rule’s promulgation.
    The Hospital correctly points out that the unit has changed
    in some respects since its original certification by the PLRB in
    1975. But the Board reasonably determined that the changes
    did not cause the unit to run afoul of the Rule. While the unit
    had a different collective-bargaining representative in 1975, the
    Board permissibly found that the mere change in representation
    did not divest the unit of its existing nonconforming status.
    Decision on Review and Order at 4, J.A. 151; see Crittenton
    Hosp., 
    328 N.L.R.B. 879
    , 880 (1999). As for adjustments in
    the unit’s scope, the Board reasonably determined that a unit
    whose composition “has largely remained the same” over the
    past half-century retains its identity as an existing
    18
    nonconforming unit. Decision on Review and Order at 4, J.A.
    151.     This court has previously upheld the Board’s
    understanding that the mere addition of new employees to a
    preexisting nonconforming unit does not instantly require the
    expanded unit to comply with the Health Care Rule’s strictures.
    See Rush Univ. Med. Ctr., 833 F.3d at 204, 207–09. And to the
    extent the 1975-certified unit contained some employee groups
    that are no longer part of the unit, the unit still represents
    professional and technical employees at the Hospital.
    2.
    The Hospital contends that the Board’s extension of
    comity in this case constituted an arbitrary departure from its
    decision in Summer’s Living Systems, Inc., 
    332 N.L.R.B. 275
    (2000). In that proceeding, the Board declined to extend
    comity to a unit certified by a state board that lacked
    jurisdiction at the time it issued the certification. According to
    the Hospital, if the Union is correct that the Board has
    jurisdiction over the Hospital, then the Board also had
    jurisdiction in 2006, meaning that the PLRB lacked jurisdiction
    at the time it most recently certified the unit. Under Summer’s
    Living Systems, the Hospital maintains, the Board could not
    extend comity to the PLRB’s purportedly invalid certification.
    The Board, however, adequately accounted for Summer’s
    Living Systems and reasonably distinguished that decision. In
    Summer’s Living Systems, the Board considered whether to
    extend comity to a series of certifications issued by a Michigan
    state labor agency. As Summer’s Living Systems explained, the
    Michigan Court of Appeals later determined that the state
    agency’s jurisdiction to issue the relevant certifications had
    been preempted by the Board’s jurisdiction. In those
    circumstances, the Board declined to extend comity to the
    19
    preempted state certifications. Summer’s Living Sys., 332
    N.L.R.B. at 276–77 & n.7, 286.
    The Board thus explained here that Summer’s Living
    Systems, unlike this case, involved an “intervening state court
    case” holding that the “state’s jurisdiction over various units of
    employees was pre-empted by the Board’s jurisdiction.”
    Decision on Review and Order at 4–5 n.7, J.A. 151–52. In light
    of those contrasting circumstances, the Board reasonably
    determined that Summer’s Living Systems “does not control”
    this case. Id. Comity to a state agency’s determination, after
    all, is a doctrine aimed at respecting not only the preferences of
    employees and employers, but also the administrative
    processes giving rise to the state agency’s decision. See
    Allegheny Gen. Hosp., 230 N.L.R.B. at 955. The Board could
    permissibly grant comity here while withholding it in
    circumstances in which a state court deems the state labor
    agency to have lacked jurisdiction to issue the certifications to
    which comity might otherwise extend.
    *   *    *   *    *
    For the foregoing reasons, we deny the petition for review
    and grant the Board’s cross-application for enforcement of its
    order.
    So ordered.