California Hospital Closes Due to Ratio Law

Published

From the L.A. Times:

By Stephanie Chavez, Times Staff Writer

"Santa Teresita Hospital in Duarte is shutting down its emergency room and acute-care facility today, closures that officials blame in part on the state's nursing shortage.

The hospital's 177-bed skilled nursing facility, outpatient surgery center and fertility clinic will remain open, said Sister Michelle Clines, chairwoman of the hospital's board of directors.

The hospital had slowly cut back on its acute-care beds, from a high of 150 in 1987 to fewer than 40 last year. Santa Teresita's emergency room saw about 12,000 patients a year who were not brought in by paramedics in ambulances and approximately 1,700 brought in by paramedics.

The closing of Santa Teresita's emergency room further strains the county's emergency medical services system. More than a year ago, St. Luke Medical Center in northeast Pasadena closed its doors.

"Every ER that closes in L.A. County puts greater pressure on our system, which is already overwhelmed," said Carol Gunter, acting director of the Los Angeles County Emergency Medical Services Agency.

At Methodist Hospital in Arcadia, about five miles south and the closest hospital to Santa Teresita, officials are preparing for a 25% increase in emergency room patients. "It will mean about one more person an hour, about 24 more patients a day," said Lynn Ingram, a spokeswoman for Methodist Hospital.

She said the hospital had been talking to members of the nursing staff at Santa Teresita in the hopes of hiring them.

Santa Teresita was founded in 1930 as a tuberculosis sanatorium by the Carmelite Sisters of the Most Sacred Heart. It became a fully accredited hospital in 1956, and its campus covered 14 acres in Duarte.

Many of its nurses have worked at Santa Teresita for 10 to 30 years because they are committed to working for a Catholic hospital, said the nursing supervisor, Mark Cline.

Although Sister Clines did not have figures on layoffs, she said many of the hospital's 475 employees would stay on because most of its operations are linked with its skilled nursing facility and other clinics. "

This may only be the beginning. The CEO was just on the news stating the new ration law is to blame.

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Yeah- it's so unfair to demand safe ratios. Better to keep the hospital open with unsafe ratios, huh? Typical propaganda from the administration- predicted by CNA (http://www.calnurse.org)

I wonder why they couldn't limit ER admits and divert the rest? Why take an all or nothing approach? Sounds like nurses are being blamed yet again for being reasonable. Yet we are FIRST to blame if something goes wrong with the patients due to unsafe staffing. If they can't operate their hospital with safe ratios, then maybe they SHOULD shut down!!!! :(

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Specializes in Psychiatry.

>

Amen

Kelly

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Originally posted by KellyMarie37

>

Amen

Kelly

(copy and paste of my reply in a similar thread)

I agree!

Also, I believe that any facility that makes itself into a good working environment for nurses, and actively tries to RETAIN and recruit nursing staff would not have any problem having enough nursing staff.

The "closing because of the ratios" is one tactic that lobbyists against the ratios have advised hospitals to use.

I'm sure the place had SOME nurses and could take care of a finite number of pts. They could just go on diversion or maybe get some administration "nurses" out onto the floor?

Maybe they could even chop a couple of hundred thousand dollars off of the CEO's salary and use that to pay the nurses they say they can't afford?

Come on!

I say good riddance to that hospital.

__________________

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No big surprise there. Its one of the industry's tactics to reverse the staffing ratio law by creating public panic. Hospital and healthcare corps (like Tenet) in California are conducting seminars all over the state to train hospital executives and management in how to evade and reverse the new staffing ratio law. The tactic you mention is right there in the "playbook" theyre giving out at these seminars. The hospital mentioned in that post is just following the playbook to the "T".

excerpt:

* 'Close beds and cry wolf'

Voluntarily close or downsize beds or units, citing an inability to "find" sufficient RNs to meet the ratios. The goal is to fan hysteria in hopes of softening public support for the ratios, winning regulatory exemptions to compliance, and generating political support for legislation to repeal or suspend the ratios.

* Delay elective surgeries, declare healthcare "emergencies," - both to force RNs on staff to work more hours and to engage in a PR war to subvert the ratios. To ratchet up public pressure, some hospitals may close units or suspend operations every day, and will meet with legislators to place the blame on the ratio law.The officials concede that hospitals may, in some cases, have difficulty receiving permission to reopen beds or units that have been temporarily or permanently shut down.

Seminar packets provide:

1. Detailed information on temporary and permanent closures of units and suspensions of beds

2. Sample letter to DHS requesting bed suspension

3. Sample letter to employees and medical staff announcing unit closures

4. Sample press release for participants headlined: "(Facility/System Name) Closes XXXX Unit Because of Lack of Nurses. Despite Recruitment Efforts, Hospital Unable to Hire Enough Nurses to Meet New State Law.">>

And youve just seen the first one to play the game as outlined in the "playbook", but it appears that lots of people (even nurses?) may be suckered into falling for it. You have to wonder what that hospital has been doing since 1999, when the law was first passed, to prepare for the day it would be implemented. If they waited until the last minute to take actions to meet the ratios, its seems THEY - not the law - would be to blame if their facility really had to close.

Full article: http://www.calnurse.org/102103/hospindustry.html

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Hope you all consider this. This could be the start of a domino effect for smaller hospitals. If they start closing floors or closing down entirely where will you work? If healthcare markets, i.e., hospitals (where most nurse are employed) are eliminated what will this do to pay? to benefits? When the larger more powerful hospitals or health care corporations (example: Tenet) are the only game in town to play with where will this leave the employees?

This was not an "evil" employer. It was a small religious-run hospital that served a community. As the nurses who spoke on the news said, "we're a family". To see the nuns and the nurses say that and see the tears in their eyes just made me very sad.

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Specializes in Oncology/Haemetology/HIV.
Originally posted by Gomer

Hope you all consider this. This could be the start of a domino effect for smaller hospitals. If they start closing floors or closing down entirely where will you work? If healthcare markets, i.e., hospitals (where most nurse are employed) are eliminated what will this do to pay? to benefits? When the larger more powerful hospitals or health care corporations (example: Tenet) are the only game in town to play with where will this leave the employees?

I'll take my chances. I will always prefer working in a hospital that has adequate staffing with professionals, rather than risking my license with understaffing.

Yes, it is sad, but the facility had more than adequate notice of what it was in for.

As for tears in eyes, if your loved one is harmed due to inadequate staffing (and there are studies to back this), how likely are you to forgive it with, "Well, they were a small hospital and a family so I guess it was okay"?

Somehow I don't think many will buy that excuse.

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It sounds like this hospital was in trouble regardless of the ratio law. How do you run an acute care hospital with only 40 beds anyway? It was bound to gobbled up (bought) by some larger health system and/or shut down anyhow. Too bad it will be blamed on the ratios.

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Where will I work?!!!:eek:

Are you suggesting that if small ineffictive hospitals close there will be no sick people that require nursing care.

My small hospital closed last year. It was sad. We were like family. I am happily employed. I had absolutely no problem finding work.

Nurses are not dependent on hospitals. You have it backward. They are dependent on us.

Just because you are in a small tight knit work setting does not make it the only desirable one. Life and nursing goes on after closure.

It is a given that these closures are political. Sorry even our dear catholic hospitals are not immune to politics. It is no secret that many CA hospitals have been planning closure to force the issue with the legislature if and when the law became effective.

Poor staffing issues is not justifyable even for tiny religious facilities. Being faith based does not excuse putting staff and patients at risk.

You post seems to suggest that larger hospitals are undesirable places and and will treat nurses worse and pay worse.

How can you even suggest this? The large facilities are the ones that have the $$, technology, and the expertise to care for sicker patients than tiny hospitals. Tiny hospitals like the one you describe must transfer patients because they do not have the equipment, skill, nor knowlege base to provide more than very basic routine care to non complex patients.

I understand the personal sadness. However, this is not ground for keeping this hospital open. It takes more than tear/emoations for safety and efficacy.

P. S. as to your question about pay and benefits. Mine improved greatly.

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Originally posted by Agnus

Where will I work?!!!:eek:

You post seems to suggest that larger hospitals are undesirable places and and will treat nurses worse and pay worse.

Sorry, you misunderstood me. I was not suggesting that larger hospitals are undesirable places to work. I was saying that monopolies can treat their employees however they wish. Right now in my area there are over 200 healthcare facilities (hospitals, sub acutes, nursing homes) where nurses can find employment. As those facilities close (again either beds or entire facilities) the choices for employment are decreased. Once you have a smaller number of employers it becomes an employers' market (much like the housing market becomes a sellers' market when there are more buyers than sellers) and employers can then set whatever pay and/or benefit they wish. Example: Tenet is imfamous for moving into an area, buying many hospitals in that area, closing what they consider the least profitable and moving whatever willing staff to other hospitals usually at lower pay grades and less benefits.

And, some nurses are still dependent on hospitals (or an employer) for jobs. You may be a Per Diem, or PRN, or traveler. You may think you set your own schedule and work only where the pay is great. But you should remember hospitals still set the rates and decide who they wish to employ. They can decide to stop using outside agencies or individuals. What will you do then?

You are also assuming that good care was not given at that hospital. That is not the case. Excellent care was given. But when the state mandates the number of employees per patients and the hospital sits down, does the math, and realizes it can't afford the 1:6 ratio (in M/S) but if they don't staff that way the state will come in and fine them (more dollars out the door) that's where the ratios come in as a negative.

The union (CNA) supported this law. Now they may find their membership pool decreasing as their members find it hard to keep or find jobs. We will just need to wait and see.

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In the early 1980s when we also experienced a huge nursing shortage, many hospitals had to close units down because of lack of nurses. They wouldn't run these units if they had no doctors, would they?

I agree that it will be tough for awhile, but in the long run it will be better for patient care, improve working conditions, and attract more nurses into the profession.

We have taken control of our Profession in California and I am very proud!!!

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Specializes in Med/Surg, Geriatrics.
Originally posted by -jt

No big surprise there. Its one of the industry's tactics to reverse the staffing ratio law by creating public panic. Hospital and healthcare corps (like Tenet) in California are conducting seminars all over the state to train hospital executives and management in how to evade and reverse the new staffing ratio law. The tactic you mention is right there in the "playbook" theyre giving out at these seminars. The hospital mentioned in that post is just following the playbook to the "T".

excerpt:

* 'Close beds and cry wolf'

Voluntarily close or downsize beds or units, citing an inability to "find" sufficient RNs to meet the ratios. The goal is to fan hysteria in hopes of softening public support for the ratios, winning regulatory exemptions to compliance, and generating political support for legislation to repeal or suspend the ratios.

* Delay elective surgeries, declare healthcare "emergencies," - both to force RNs on staff to work more hours and to engage in a PR war to subvert the ratios. To ratchet up public pressure, some hospitals may close units or suspend operations every day, and will meet with legislators to place the blame on the ratio law.The officials concede that hospitals may, in some cases, have difficulty receiving permission to reopen beds or units that have been temporarily or permanently shut down.

Seminar packets provide:

1. Detailed information on temporary and permanent closures of units and suspensions of beds

2. Sample letter to DHS requesting bed suspension

3. Sample letter to employees and medical staff announcing unit closures

4. Sample press release for participants headlined: "(Facility/System Name) Closes XXXX Unit Because of Lack of Nurses. Despite Recruitment Efforts, Hospital Unable to Hire Enough Nurses to Meet New State Law.">>

And youve just seen the first one to play the game as outlined in the "playbook", but it appears that lots of people (even nurses?) may be suckered into falling for it. You have to wonder what that hospital has been doing since 1999, when the law was first passed, to prepare for the day it would be implemented. If they waited until the last minute to take actions to meet the ratios, its seems THEY - not the law - would be to blame if their facility really had to close.

Full article: http://www.calnurse.org/102103/hospindustry.html

The [not-so] funny thing is that these tactics will work like a charm.

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