Besides the mutual display of hostility evidenced in the disputes, the Supreme Court case presented important legal issues in the untested field of hospital labor law. Since Congress's inclusion of the hospitals under the NLRA in the 1974 Health Care Act Amendments, any legal battle has helped to set precedents by which to judge hospital labor disputes. One legal issue centered around the intent of Congress in including hospitals under the NLRA. The hospital argued that Congress, because it enacted special strike provisions for hospital employees and evidenced concern for the special health care function of hospitals, other labor precedents set by the NLRB did not apply. The Board, however, while agreeing that hospitals are special cases, believed the burden of proof rested on the hospital to demonstrate special circumstances surrounding a labor dispute that would invalidate settled labor rights and practices.

Another issue centered on the so-called St. John's rule, a case decided by the NLRB which stated that in other than immediate patient care areas, the hospitals should allow union solicitation and distribution of literature. However, as the Tenth Circuit Appeals Court of St. Louis reversed this NLRB decision, the hospital challenged the Board's rationale.

The Supreme Court decision concurred on most counts with the union. The decision was unanimous, but two justices voiced stronger opinions directed at the importance of union organizing. Justices Blackmun, Burger and Powell agreed with the NLRB opinion in this specific case, but objected to the reasoning behind the other Justices' opinion. Justice Brennan states in the majority opinion, "Freedom of employees effectively to communicate with one another regarding self-organization on the job is essential." In his opinion, Brennan says that the Board's decision was consistent with the Congressional intent of the legislation, for Congress did not specifically make any provisions prohibiting solicitation and distribution. Brennan dismissed the hospital's argument of the Board's lack of expertise in health matters, saying the Board's expertise lay in labor relations and Congress gave the NLRB authority to administer hospital disputes.

The main reasoning behind the Justices' opinion seems to be the fact that comparatively few patients visit the Beth Israel cafeteria, and that the locker room area provides inadequate space for communication between employees about the union organization efforts. The opinion also stated the hospital "was unable to show any evidence" that distribution or solicitation had caused actual harm.

Justices Blackmun, Powell and Burger, however, stressed in their opinion that they believed hospitals should receive more consideration from the Board to protect the quality of patient care. For this reason, the union and the hospital disagree over how broad a precedent the case poses. "It's the first Supreme Court decision of this kind, and it is certainly clear in the case of Beth Israel, though there will probably be a lot more cases," says Shea. Chandler, lawyer for the hospital, says, "I don't think there's any question that this is not a broad decision, and does not set any precedents." Chandler adds he disagrees with the Court's finding of facts, because "hospital calculations show that at least 60,000 patients visit the cafeteria a year, and we don't find that an insubstantial number."

Although the union has won this round, service workers at Harvard's teaching hospitals remain unorganized into unions, and the prospect of future union organization looks bleak at best. Shea says Local 880 will concentrate its organizing efforts on non-Harvard local hospitals, such as St. Elizabeth's in Brighton. Chandler, for his part, says he expects other legal decisions in the future to corroborate Beth Israel's view that hospitals merit special consideration from NLRB because their primary function is non-profit patient care.