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2003-12-31 -- Calif Healthcare Assn undermines nurse staffing law

(California Nurses Association responses below)


According to the Sacramento Business Journal, 12-31-03:

"The California Healthcare Association (a hospital trade group)
lawsuit asks the court to prohibit the state from enforcing the "at
all times" interpretation and to rule that it's OK for hospitals to
let on-duty nurses go on necessary breaks without jeopardizing
compliance with the new ratio law. An initial hearing in the case is
not likely until January, so Association president Duane Dauner
cautions hospitals to "comply, comply, comply" in the meantime.  "If
that means shutting down the emergency room, closing units or
canceling surgery -- do it," he said."

The CHA's hospitals would love to shut down their emergency rooms,
since the are the entry points for the small amounts of charity care
they do.




Hospitals sue over nurse law

San Francisco Chronicle, December 31 2003


California's hospitals sued Tuesday to challenge the state's strict
interpretation of a first-in-the-nation law to establish nurse
staffing levels, arguing that it will burden hospitals and threaten
health care.

The California Healthcare Association, which filed the lawsuit in
Sacramento County Superior Court, does not challenge the new law's
overall rules, but said rules for covering nurses on breaks would be
virtually impossible to satisfy and could backfire.

The law, which takes effect Thursday, requires one nurse for every six
patients in general wards, and a 1-to-5 ratio a year later.

The rules require a hospital to provide a nurse to fill in whenever
another nurse takes a break from patient care, so that the
nurse-to-patient ratio is maintained at all times.

"Because of the severity of California's nursing shortage, which is
the worst in the nation, there are not enough nurses to implement this
requirement, '' the Healthcare Association, which represents nearly
500 hospitals, said in a news release.

"This reinterpretation of how nurses are assigned to patients will
produce unintended consequences and result in patients being denied
care,'' said association president Duane Daumer. Unless the rules are
changed, the association said, hospitals may have to cancel elective
surgeries, discharge patients sooner and delay new admissions.

The California Nurses Association, which sponsored the law, said the
state is interpreting the law properly to promote patient safety.

Leaving a unit for sick babies, for example, "without what has been
determined to be adequate staffing just because it's lunchtime is
unconscionable,'' said the union's president, Deborah Burger. The
union also disputed the hospitals' claim of a nursing shortage.

The lawsuit contends, however, that the state Department of Health
Services misinterpreted the law, which was signed by then-Gov. Gray
Davis in 1999.

The suit seeks a court order changing the regulations so that
hospitals need not replace nurses who are taking breaks, eating, or
transporting patients to other units.

The hospital group will not seek to block the new rules immediately,
but it hopes for a court hearing on an injunction within 30 days, said
spokeswoman Jan Emerson.

E-mail Bob Egelko at begelko@sfchronicle.com.


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California Nurses Association Response:

Contact: Jill Furillo, RN 916-417-6203 / Liz Jacobs, RN 510-435-7674

MEDIA ADVISORY For Immediate Release
December 30, 2003

Nurses: Hospitals in 'Sneaky & Devious' Attack on New Patient Staffing
Law

Charging the California hospital industry with using every dubious
tactic it could muster to sabotage the state's new hospital staffing
law, the California Nurses Association termed the hospitals' latest
court action another "sneaky and devious" maneuver to that end.

The nurse-to-patient staffing ratios which were promulgated pursuant
to the enactment in 1999 of the Safe Staffing law are scheduled to go
into effect on Thursday in all general acute-care hospitals in the
state. On Tuesday, the California Hospital Association announced plans
to ask a Sacramento County Superior Court to enjoin state authorities
from enforcing the portion of the new CNA-sponsored nurse-to-patient
law that requires compliance during breaks and meal times.

The hospital industry is asking the court to approve RNs going on
breaks in circumstances that nonetheless leave hospital units in
non-compliance with the ratios.

"It probably should have been expected,' said CNA President Deborah
Burger, RN. "After all their other maneuvers to get around the ratios,
they turn to the courts on New Years eve with a specious argument
against the regulations that they could have - but chose not to -
raise at anytime over the three years since the law was enacted. It's
sneaky and devious."

CNA officials said today that the "at all times" language has been in
the regulations since June, inserted there by the state Department of
Health Services (DHS). It was done to align the new regulations with
the provision covering lunches and breaks in the present staffing
relations, which have applied to Intensive Care units since 1975.

CNA spokesperson Jill Furillo, RN said the effect of granting the
CHA's request "would be to roll back the clock and change how ratios
have worked for over 25 years in the ICU and Intensive Care
Nurseries."

"The ratio regulations speak for themselves. They comply with the law
as intended," said Burger. "Whether or not to leave a sick baby unit
without what has been determined to be adequate staffing just because
it's lunchtime is unconscionable. This is a serious matter for patient
safety and public health."

Burger said CNA and its attorneys have every intention to being
present in the courtroom to oppose any effort to scuttle any aspect of
the new regulations. "The hospital industry should not be allowed to
get away with this," she said.

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Parenthetically,  according to the Contra Costa Times, 12-29-03:

Kim Belshe, Schwarzenegger's secretary for health and human services,
said the regulations have been crafted carefully and she sees no
reason to tinker with them.

The administration could propose adjusting the rules, if necessary,
Belshe said. However, the concept of a minimum staffing requirement is
not new and has long been used in intensive care units.

Also, the hospital industry didn't contact the administration with
complaints until recently, she said. Belshe met for the first time
with Duane Dauner, president of the California Healthcare Association,
on Dec. 19.

"Unfortunately, hospitals didn't communicate the depth of their
concerns until two weeks before the regulations were going to take
effect," she said.


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An earlier California Nurses Association warning on hospital
association's undermining

For Immediate Release December 23, 2003

Contact:
Charles Idelson, 510-273-2246, 415-559-8991 (pg),
Jill Furillo, RN, 916-417-6203

Countdown to Safe Staffing - RN Ratios in Effect January 1,
Hospital Industry Lobby Continues Efforts to Undermine the Law,
California Nurses Assn. Warns

With just over one week to go before final implementation of the
nation's first mandated minimum staffing ratios for registered nurses,
some hospitals have made genuine progress toward compliance even as
the lobbying arm of the hospital industry continues efforts to erode
the law, said the California Nurses Association today.

As of January 1, 2004, all hospitals must be staffed in accordance
with the minimum ratios which include at least one RN for every six
patients in general medical and post-surgical units, one RN for every
four ER patients, and one RN for every four pediatric patients. The
law also requires hospitals to increase staffing for patients who need
additional care.

"The RN ratios should permanently alter the healthcare landscape after
January 1," said Deborah Burger, RN, president of the CNA which
sponsored the law. "Every major scientific study has documented that
safe RN staffing reduces preventable hospital death rates, infections
and accidents, and improves the therapeutic environment for recovery."

"Hospitals that fail to comply with the letter and spirit of the law
are placing their patients at risk," said Burger. "All patients
deserve safe care and should demand no less."

In recent months some hospitals have hired hundreds of RNs in
preparation for January 1. Among the larger systems, according to CNA,
the University of California medical centers, Catholic Healthcare
West, and Kaiser Permanente (Northern California) are either near
compliance or making progress to comport with the law at many of their
hospitals.

But some hospitals remain far from compliance, said CNA, citing Sutter
Health and Triad Hospitals, Inc. as examples. Sutter's Alta Bates
Summit Medical Center in Berkeley and Oakland, for example, is
assigning patients directly to licensed vocational nurses (LVNs),
increasing the work load of RNs, and failing to assure the hospital is
meeting the ratios during breaks creating periods of inadequate
staffing for patients.

Texas-based Triad's San Leandro Hospital is staffing well below the
ratio requirement on medical-post surgical units, and, like Alta
Bates-Summit, assigning patients to LVNs.

CNA said it is especially critical of the role of the California
Healthcare Association, the hospital's lobbying group. CHA has held
seminars for local officials offering tips on circumventing the law,
urged Gov. Schwarzenegger to delay or change the law, and is waging a
political campaign claiming the law will lead to closures and delays
in care.

Hospital industry 'questionnaire' continues attack on law

As part of its campaign, CHA is currently asking hospital members to
fill out one-sided questionnaires intended to provide the group with
materials for its publicity attacks on the law.

CHA is asking individual hospitals to provide details on alleged
ratio-caused emergency room diversions, waiting times for care,
closures of beds, units, or other services, cancelled surgeries,
failure to transfer patients in a timely manner, and to list units and
shifts on which the ratios were not always met.

"The obvious purpose of this questionnaire," said CNA Collective
Bargaining Director Mike Griffing, "is to link hospital decisions to
reduce care to the industry's political agenda - opposition to the
ratio law, and the hope it helps them to persuade the governor or
legislators to change the law."

"It's notable that the questionnaires do not once ask the hospitals
for examples of how safe staffing protects their patients or improves
overall patient care conditions. Apparently they don't want to know,"
Griffing said.

"CNA can only conclude that the CHA is more interested in continuing
to fight a law they've always disliked than in promoting safer
standards in hospitals," Griffing said.

Studies continue to show the importance of the law to public safety -
and how the advent of the law is already helping to tackle the nursing
shortage in California.

    * The Institutes of Medicine of the National Academy of Sciences
reported in November that "nurse staffing levels affect patient
outcomes and safety." Insufficient monitoring of patients, caused by
poor working conditions and the assignment of too few RNs, increases
the likelihood of patient deaths and injuries at a time when avoidable
medical errors kill up to 98,000 people in U.S. hospitals every year.
(IOM, November 4, 2003)

    * Inadequate staffing precipitated one-fourth of all sentinel
events - unexpected occurrences that led to patient deaths, injuries,
or permanent loss of function - reported to JCAHO, the Joint
Commission on Accreditation of Hospital Organizations, from 1997 to
2002. (JCAHO, August 7, 2002)

    * Data compiled by the state Board of Registered Nursing, the
agency that licenses RNs in California shows that overall California
today has over 30,000 more actively licensed RNs than the BRN
estimated the state would have at this date - six times the number the
state health department estimated would be needed for the ratios.

More information including the specific ratios can be found on the CNA
website, http://www.calnurse.org/finalrat/ratio7103.html