'Big victory for RNs and patient safety

U.S.A. California



May 26, 2004

Court Rejects Hospital Suit to Reverse Safe Staffing Law

'Big victory for RNs and patient safety,' says Calif. Nurses Assn.

Sacramento Superior Court Judge Gail Ohanesian today upheld California's historic law mandating safe registered nurse staffing in hospitals.

In a case watched closely across the nation, the judge issued a sweeping ruling against a lawsuit filed by the California hospital industry that the landmark RN-to-patient ratio law should not apply "at all times," an interpretation that, Ohanesian wrote, "would make the nurse-to-patient ratios meaningless."

"This is a searing indictment of the hospital industry's illegitimate attempt to deny patients safe care as required by the legislature, the Governor, and the Department of Health Services - and a huge victory for RNs and patients". said Rose Ann DeMoro, executive director of the California Nurses Association which sponsored the law and was an intervenor in the case.

"Once again California Nurses have shown their power by successfully mobilizing against this lawsuit. Our members should be very proud today," DeMoro added.

In her ruling, Ohanesian rejected a series of arguments made by the California Healthcare Association (CHA), the hospital industry lobbying arm, that hospitals need not comply with the ratio law while RNs were on meal or rest breaks. On one argument after another, the judge wrote the CHA contentions were "without merit."

Since the ratios went into effect in January, a sizeable majority of hospitals have been in compliance. Break coverage has been the leading violation, with "some hospital corporations and individual hospitals banking on a victory in court as their backdoor attempt to vacate the entire ratio law," DeMoro said.

In emphatic language, the judge ruled "the hospital must reassign the nurse's patients to another nurse and the reassigned patients must not cause the relieving nurse's patients to exceed the applicable ratios set forth in the regulation."

"This ruling slams the door shut and makes it clear beyond doubt that patients are entitled to safe care at all times," DeMoro said. "The industry should be embarrassed for their attempts to undermine the continuous standard requirement that placed in danger all safety regulations in hospitals. CHA wasted the time and resources of the state of California, infuriated RNs, CNA, and patients, and exposed the agenda of the hospitals they represent."

In the 12-page decision, Ohanesian dismissed CHA arguments that the "at all times" provision was an "interpretation" not found in the law or the regulations to implement the law, and that the industry was unaware of the requirement. The "petitioner (CHA) was on notice at all times during the rule making process that under the regulation nurses who were away from their assigned floors would not be counted for purposes of compliance with minimum ratios," she wrote.

Additionally, the judge reaffirmed provisions of California law that RNs are the foundation of nursing care and must not be assigned more patients than the specified ratios. Some hospitals have sought to use licensed vocational nurses, rather than RNs, to meet the ratio law.

Effects of decision will be heard across California and the nation

DeMoro said CNA will take the message of the ruling to RNs and hospitals across the state to assure that any hospitals continuing to violate the law "understand the unequivocal message - there can be no confusion or compromise when it comes to this law and patient safety."

She noted that hospitals and nurses throughout the U.S. have been watching the outcome of this case since the suit was filed last December 30, just hours before the ratios became operative. "This ruling should boost the efforts of RNs in several dozen other states who are pursuing similar ratio laws," DeMoro said.

California's law will continue to be the model for the nation, in providing genuine solutions for the current hospital care crisis and nursing shortage that affects many states.

Numerous studies document that safe RN staffing reduces preventable patient deaths, accidents, infection rates, and permanent injuries.

State data documents that the Safe Staffing Law is also helping to dramatically expand the number of RNs in California. Before the law's passage in 1999, the state was hemorrhaging RNs. But in the past three years alone, the number of actively licensed RNs in California has grown by more than 33,000, from 255,145 in January, 2001 to 288,491, as of April 30, 2004.

CNA conducted a 10-year campaign to win enactment of the ratio law, which included the largest rallies of RNs in state history in the Capitol. On the day of the court hearing in Sacramento May 14, about 500 RNs rallied outside the Capitol and marched to the courthouse.

Link to classes on promoting safe assignments:



4,491 Posts


Challenge to nursing ratio law tossed out

Industry group contends measure may hurt patients

By Leslie Berestein


May 27, 2004

A hospital industry challenge to a law that mandates nurse-to-patient ratios in California hospitals was thrown out yesterday by a Sacramento judge.

The law, which took effect in January, mandates that hospitals have a set number of nurses per patient on duty in all units at all times. The lawsuit, filed by the California Healthcare Association, a hospital industry trade group, sought to reinterpret the "at all times" clause to exclude periods when nurses were on break or otherwise away from their stations.

Sacramento Superior Court Judge Gail Ohanesian upheld the law as it stands, writing in her ruling that "staff ratios would be meaningless if not applied to break periods."

Her decision was applauded by proponents of the ratio requirements, who had argued that doing away with the "at all times" provision would essentially gut the law.

The California Nurses Association, a union representing 56,000 registered nurses, said it hoped the judge's decision would put an end to a long battle over the ratio requirements.

The hospital industry filed its lawsuit against the California Department of Health Services, the nurses' association and the Service Employees International Union, which also represents nurses. The suit was filed Dec. 30, two days before the ratios went into effect.

"I think that the hospital industry would have to be embarrassed to pursue this any further," said Rose Ann DeMoro, executive director of the nurses' association. "They tried this backdoor approach to essentially vacate the ratios. Essentially, they have lost in every venue."

The hospital industry isn't necessarily seeing the ruling as the end. Jan Emerson, a spokeswoman for the California Healthcare Association, said the industry would consider all options, including a possible appeal.

Emerson said having to reassign a patient to another nurse while a nurse takes a break "will jeopardize continuity of care to patients," and that hospitals without enough nurses to go around would have to resort to measures such as closing beds and delaying surgeries.

"We don't think that is in the best interest of patients," she said.

The hospital industry has also complained about the mandate's price tag, estimating it could cost California hospitals $422 million in additional staffing just for this year.

The judge, however, did not see merit in the hospital industry's arguments, including the argument of how patient care might be affected if hospitals are not permitted to allow nurses with a patient load to cover for others who are temporarily absent from their unit.

"This argument is really an attack on the ratios themselves," Ohanesian wrote.

Link to classes on promoting safe assignments:



3,905 Posts

Woo Hoo! I love this state. As always, thanks for the great links Spacenurse!



4,491 Posts

We are SO relieved. Although I wrote letters I didn't go to the rally I went to a folk festival.

Would have felt guilty if the judge had not seen the hundreds of nurses working for safe staffing.

The worst is having to take a patient to CT or MRI with the vent, ACLS, and all while worrying about your other patient. Thise "road trips" are stressful.

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