Showdown between California hospitals and nurses goes to judge

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Showdown between California hospitals and nurses goes to judge

By JIM WASSERMAN, Associated Press Writer

Posted: Friday May 14th, 2004, 6:35 PM

Last Updated: Friday May 14th, 2004, 6:35 PM

SACRAMENTO (AP) - With a statewide nursing shortage, hospitals and nurses battled in court Friday over new mandatory staffing levels that hospitals say are unrealistic and nurses say are necessary to protect patients.

Sacramento County Superior Court Judge Gail Ohanesian promised to rule quickly on a hospital industry challenge to new regulations requiring extra nurses to replace those who leave their station to transport a patient or take a break.

California Nurses Association Director Rose Ann DeMoro said outside court that there would be a "mass revolt" if the judge reverses rules that took effect in January.

The ruling is also expected to have an impact statewide and nationally, as the two sides battle over how many nurses are needed when they briefly leave their stations. A ruling supporting nurses would boost their campaign for more jobs in other states, while a nod favoring hospitals would help the industry contain costs.

The judge listened to 2 1/2 hours of arguments over the landmark law sponsored by the 57,000-member nurses association.

The Legislature passed the law in 1999 amid concerns over cost-cutting by hospitals and health maintenance organizations, but hospitals claim the state's regulations exceed the law by requiring additional nurses to cover for their colleagues.

"Our main concern is simply that nurses aren't available," said attorney Robert Leventhal, representing the California Healthcare Association's 400 hospital members.

The association sued the California Department of Health Services on Dec. 30, two days before the law took effect, arguing that the nation's second-worst nursing shortage makes compliance impossible. Hospital officials have argued the requirement could cause them to cancel surgeries, discharge patients earlier and turn away patients.

The court challenge is over a traditional hospital practice of assigning nurses to a specific number of patients at the beginning of a shift, and maintaining that nurse-to-patient ratio throughout the shift, even when nurses are on breaks. The new rules require staffing extra nurses on duty to keep up that ratio. No other state has such a requirement.

The new regulations require one nurse for every two patients in intensive care units, labor and delivery, and one nurse per patient in operating rooms and for trauma patients in emergency rooms. Next year it also requires one nurse to five patients in medical and surgery wards, up from one nurse to six patients now.

Attorneys for the state, the nurses union and the Service Employees International Union said the old rules threatened patient safety, leaving them in care of nurses agreeing to cover for them.

"The bottom line is, you can't be assisting someone, and let that person being assisted take a break or go to lunch," said Deputy Attorney General Janie Daigle, defending the state.

Daigle said the hospital industry is using its concerns about one part of the law as a back door to weaken its requirements for higher nurse-to-patient ratios.

Leventhal argued that new nurses briefly assigned to a patient are more likely to mix up medications and threaten the patient's safety.

"The concept makes no sense at all," he told the judge.

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http://www.calnurse.org/

Five hundred RNs from across California rallied in Sacramento May 14, and marched to a courtroom where a critical showdown was taking place that will affect the future of California RN ratio law and all safety practices in hospitals.

At stake is a hospital industry lawsuit that would throw out the requirement that hospitals must adhere to the ratio law "at all times." If the industry prevails in its case, decades of California law requiring "continuous compliance" with all safety regulations could be invalidated. On the ratios, the industry would have a green light to violate the law at will. As CNA attorney James Eggleston noted, "there is no way to have compliance with ratios that are sometimes in effect."

"RNs and patients across California may be assured the CNA will take strong action to protect patient safety regardless of the outcome of this case," said CNA President Deborah Burger, RN following the hearing.

A ruling by the judge is expected soon. Continue to monitor this website for updates on the court case.

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in guess no else has ever said it, i appreciate you keeping tabs on what is going on for nurses in california.

you rock!

topcat

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Sometimes I wish I lived in CA, just so I could join the CNA. They are awesome. Nurses everywhere owe them a debt of gratitude for standing up for NURSES!

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From a great nurse at Long Beach Memorial. Wonder if THEY think her a great employee?

http://www.calnurse.org/calnursefeb04/staffstandards.html

Staffing Standards Are Part of the Solution

'We are the first ones to see the devastating effects, the diminishing access to healthcare.' DeAnn McEwen, RN

On February 4, the state Assembly Health Committee & Senate Subcommittee on emergency medical services held a public hearing in Van Nuys on the subject: "California's Emergency Medical Services - Protecting Patient Health & Safety When Hospitals Change Hand: Tenet Healthcare to Sell 19 California Hospital."

The session came in the wake of the announcement by Tenet of its intention to sell 27 of its hospitals nationwide, including 19 in California, 14 of them in Los Angeles County. The hearing attracted widespread attention in the area and drew testimony from numerous public officials and representatives of community and healthcare advocacy groups.

The following are the remarks of DeAnn McEwen, RN, an acute care unit nurse at Long Beach Memorial Medical Center and chair of the California Nurses Association Joint Nursing Practice Committee.

First of all, for the sake of the public's interest we believe it is imperative that Tenet successfully sell its 19 hospitals. Registered nurses are on the front lines of healthcare. We are the first ones to see the devastating effects that the diminishing access to healthcare has on our patient population. Southern California patients deserve nothing less than access to hospital care that ensures safe, therapeutic and effective care no matter where they live or work. None of these hospitals can close! We must ensure that transfer of ownership and sale of these facilities is successful. We are committed to this for the sake of our patients and the communities affected.

Unfortunately sales, mergers and closures of hospitals in California is nothing new. While the prospect of Tenet's sale of 19 California Hospitals, almost all of which are in the Los Angeles area, is a potential healthcare disaster, it is also a symptom of a healthcare system completely at the mercy of market forces that have no commitment to the healthcare needs of communities. Unless there is systemic change that protects the public California will continue in this direction.

The University of California's Petris Center published a document in January of 2001 called "California's Closed Hospitals" that looked at closures from 1995 to 2000. 23 California general acute care hospitals closed between 1995 and 2000, 11 in the Los Angeles area. This trend must be reversed!

There are many reasons for hospital sales, mergers and closures: the capitation payment system that has driven doctors and other providers out of the system, California having the lowest MediCal reimbursement rates in the Country, and the practice of some hospital chains of buying up the nearby hospitals and then strategically closing them down. This eliminates their competition; more importantly, it also impacts the quality and accessibility of healthcare for the entire community.

I hope that no one will attempt to blame these long standing problems on the recently enacted Nurse-to-Patient Ratios, the only consumer law that will reduce mortality, reduce medication errors, decrease hospital malpractice liability, and retain current nurses while bringing others into the field. The recent LA Times investigative report on patient deaths at King Drew illustrate the absolute necessity of bringing all hospitals into compliance quickly with safe staffing standards. The good news is that the CNA hospital audit, released this morning shows that the majority of the hospitals surveyed are either meeting the nurse to patient ratio standards or are close to meeting them. Real problems require real solutions, not scapegoats.

L.A. county and many counties in California have watched their essential hospital services cut back while the population has grown. This is not the result of staffing standards; staffing standards are part of the solution.

As nurses and patient advocates, we have supported and fought for legislation to plan for essential hospital services, provide funding, and collect data from hospitals on ER usage so California can plan for ER needs and fund them. On each and every occasion, the California Healthcare Association (CHA), representing the hospital industry, has opposed and usually killed all such policies.

AB 421 (Aroner) 1998 to establish essential hospital providers in every county and fund ER services, opposed by CHA;

AB 1924 (Aroner) 2000 to collect hospital ER data to facilitate statewide planning for ER services, opposed by CHA;

AB 2103 (Gallegos) requiring an impact analysis each time a hospital closes an ER. Industry lobbyists amended the bill so that no agency has the authority to stop a closure, making the impact analysis almost useless in preventing closures. Last year, AB 910 (Diaz) which required healthcare companies that bought and closed hospitals to pay for the loss of service to the community and authorized the Attorney General to intervene on behalf of the community, was also opposed by CHA and stopped in committee.

California needs to look at a comprehensive overhaul of its healthcare system that will protect communities and patients from the competitive whims of the market place. That is why we support a Single Payer Healthcare system with a single, high-quality standard of care for everyone.

CNA also supports recommendations to fund services, protect the public safety net, force private hospitals to do their share and meet their community responsibility, provide adequate nurse training in community and state colleges, and advocate to the governor and legislature to adequately fund state and county medical services. These are solutions we should all be working on together.

Thank you for allowing me to address the Committees today. The California Nurses Association will be ready to work with you through out the year to address these issues.

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