[Antiracism] [Workers Rights] More (better) Patient Safety Hearing Coverage

[WMass Jobs With Justice]

Still at odds, hospitals and nurses revisit staffing ratio debate
Catherine Williams, State House News Service, October 24, 2007

Boston - By 11 AM today, the state capitol's largest meeting space was
filled to capacity for an emotional Public Health Committee meeting where
nurses, hospital officials and lawmakers debated whether hospitals should be
required to employ mandated numbers of nurses.

At issue in Gardner Auditorium was a pair of bills designed to regulate Bay
State hospital nursing staff and which have fueled a longstanding dispute
within one of the state's leading industries, health care.

Citing concerns about patient safety, the Massachusetts Nurses Association
supports requiring hospitals to employ a set number of nurses working at Bay
State hospitals. If the bill is passed, patients suffering from chronic
illnesses would be required to get more nursing attention than patients with
minor injuries, say those in favor of the quotas.

Three hospital workers traveled from San Diego - despite the ongoing public
health and safety emergency caused by the state's wildfires - to testify in
favor of quotas, which are already in place in California.

But opponents of the quotas, including the Massachusetts Hospital
Association, say patients are guaranteed the best care when staffing
decisions are left in the hands of nurses and hospital staff on a
patient-by-patient basis.

"We need to put an end to this madness around fighting this issue. This is
getting in the way of other things including health care reform, rising
health care costs and workforce shortages," said Lynn Nicholas, CEO of the
Massachusetts Hospital Association, in an interview.

The Committee on Public Health, which is co-chaired by Sen. Susan Fargo
(D-Lincoln) and Rep. Peter Koutoujian (D-Waltham), is debating two bills
designed to regulate hospital nursing staff. One bill, (S.1244), would
require hospitals to publicly post nurse staffing plans and file staffing
plans with the Massachusetts Department of Public Health. If passed, the
bill, which is co-sponsored by Fargo, would also limit nursing work hours.

A second bill, (H.2059), requires hospitals to adhere to staffing levels set
by the Massachusetts Department of Public Health. If passed, the law would
also ban mandatory overtime. The first version of the bill appeared eight
years ago, said Rep. Christine Canavan (D-Brockton), a registered nurse and
lead sponsor of the quota bill.

The issue has long riled those on both sides of it. Early in today's hearing
Fargo banged the gavel several times to call the audience to order after
waves of applause broke out. "Remember this is not a rally. This is a
legislative hearing," said Fargo.

At the suggestion of Sen. Dianne Wilkerson (D-Roxbury), who testified in
favor of an oral health bill, the audience began waving their hands in the
air silently to show support for speakers testifying before the committee.
The trend continued throughout the hearing.

Emotions hit a high point during the testimony of Pembroke resident John
McCormack, who testified in favor of nursing quotas because his 13-year
(sic) old daughter Taylor died in 2000 after what he called poor care at
Children's Hospital Boston.

"I am a father with a broken heart," said McCormack. A medical malpractice
law, known a Taylor's Law, was passed in 2004 after the death of Taylor
McCormack.

Meanwhile, legislators testifying in opposition to the quotas included Sen.
Richard Moore (D-Uxbridge), who is the lead sponsor of the nursing reform
bill.

"We need to be very careful that we balance politics with good health
practice and that's never an easy process," said Moore.

Lawmakers testifying in favor of the quotas included Sen. Harriette Chandler
(D-Worcester).

"I believe if this bill is passed it will address the problems facing
nurses, including fatigue, and ensure patients will get the quality care
they deserve," said Chandler.

Nurses on both sides of the issue attended the hearing.

Three (sic) Quincy Medical Center-based nurses, including 42-year nursing
veteran Mary Ryan, attended the hearing in support of the quotas. Ryan, a
critical care nurse, supports the ratios because she believes it protects
patients and resembles the teacher to student ratios required at daycare
schools.

Rose Brisson, a clinical nurse manager at St. Luke's Hospital in Fall River,
attended the hearing with two other nurses from the South Coast Health
System and said she is concerned that imposed ratios would prevent her from
doing her job.

"My fear is if we had ratios then it would minimize the nursing team," said
Brisson.

Nurses presented new evidence that Massachusetts patients are unhappy with
the care they are receiving.

The Coalition to Protect Massachusetts Patients released a survey of
Massachusetts hospital patients that determined 28 percent of hospital
patients and their families say their safety, or a family member's safety,
was directly compromised by nurse understaffing. The coalition said that
"translates into" 235,000 patients a year feeling their "safety is
compromised" by a lack of available nurses. The Cambridge-based research
organization Opinion Dynamics Corp. conducted the statewide survey. The
results also indicate that 49 percent of those surveyed felt they would have
received better care if their nurses had fewer patients.

Meanwhile, there is some common ground between the opposing sides. Both
nursing bills include funding for nursing scholarships and nurse training.

However, lawmakers and nursing and hospital advocates have debated the
staffing quota issue for almost a decade. A previous version of the
Canavan's quota's bill passed in the House with 133 votes in favor and 20
votes in opposition last year. But the bill failed to move forward in the
Senate before formal sessions ended in July.

It's unclear why the Senate failed to take up the bill. And until the House
takes up the new bills the fate of hospital nursing staffing regulation is
up in the air.

HYPERLINK
"http://www.massnurses.org/News/2007/10/Patient_Safety_Act.htm"http://www.ma
ssnurses.org/News/2007/10/Patient_Safety_Act.htm

Patient Safety Advocates of all Ages Urge Passage of “The Patient Safety
Act” at State House Hearing
Hundreds Come Together to Expose Dangers of Hospital Understaffing.
Cite New Survey Showing Almost One-Quarter of A Million Massachusetts
Patients Per Year Feel Their Safety Has Been Compromised in Bay State
Hospitals.
Alex Zaroulis, Fifield Strategies, October 24, 2007

Boston – Armed with new statistics on patients’ increased concern over
quality care in Massachusetts hospitals as well as evidence linking disease
and deaths to poor patient oversight, hundreds of elderly Massachusetts
residents, mothers and children, nurses, and other consumer and health-care
advocates from across the state converged on the State House this morning to
urge passage of The Patient Safety Act, House Bill 2059, at a hearing before
the Joint Committee on Health Care. The Bill would set limits on the number
of patients a nurse can be forced to care for at one time.

For more than a decade, bedside nurses in Massachusetts have been sounding
an alarm that patients are being harmed because nurses are being forced to
care for too many patients at one time. A version of the safe staffing
legislation was first introduced in 1994. Since the bill’s initial
introduction, hospital-acquired infections and medical errors have soared,
with the Centers for Disease Control (CDC) now reporting that 2,000 people,
or 6 people per day, are dying because of them every year in Massachusetts.
Nationally, 2 million people are harmed by hospital-acquired infection and
medical error, and nearly 100,000 of them die each year. As of today, more
patients are killed each year by hospital-acquired infections than by AIDS
and breast cancer combined.

A statewide survey conducted by Opinion Dynamics Corporation (ODC) and
released in conjunction with the hearing indicates that more than
one-quarter (28 percent) of Massachusetts hospital patients and their
families say that their safety, or a family member’s safety, was directly
compromised by nurse understaffing, Based on the total number of hospital
stays in the Commonwealth as tabulated by the state’s Department of Health
Care, Finance and Policy, this translates into more than 235,000
Massachusetts patients annually whose safety is compromised by a lack of
available nurses.

In addition, nearly three-quarters (73 percent) of past patients agree that
the overall quality of patient care in Massachusetts hospitals is suffering
because nurses are forced to care for too many patients at once. And more
than one-third (35 percent) of these past patients and their families say
that their nurse had too many patients to care for during a recent hospital
stay.

“Massachusetts patients are saying loudly and clearly that they are
concerned about the impact that the persistent understaffing of nurses in
Massachusetts hospitals is having on the safety of their care during their
hospital stay,” said John McCormack, the co-chair of The Coalition to
Protect Massachusetts Patients, which comprises more than 120 leading
health-care and consumer organizations. “My baby daughter, Taylor, died in
2000 at the age of two in a Boston hospital because she didn’t get the care
she needed. When I carried her to the hospital morgue, I promised her that I
would fight my hardest so that this wouldn’t happen to another child.”

The elderly and the parents of young children have coalesced around the
issue of setting safe limits on nurses’ patient loads because those
populations (seniors and children) are most at risk of contracting
hospital-acquired infections.

John Bennett, president of the Massachusetts Senior Action Council, is
disturbed by the fact that so many of the state’s elderly are at risk for
injury or harm in the hospital as a result of understaffing.

“As an older citizen and leader of a grassroots organization of seniors, I
have been continually hearing complaints from our members about problems
they and their family members have experienced as a result of nurse
understaffing,” Bennett said. “Members of my own family have been
hospitalized and over the years I have watched the care they received
deteriorate – not because nurses don’t care or aren’t working hard, but
precisely because they are working too hard, running from patient to patient
to doing what they need to do. The suffering the lack of nursing care causes
is unacceptable.”

A number of studies link the rise in hospital-acquired infections and other
medical complications to understaffing of nurses, including one published in
the July issue of the journal Medical Care that found that safer RN staffing
levels could reduce hospital acquired infections by 68 percent.

“The hospital industry’s mantra every year for more than a dozen years has
been, ’Leave it to us to fix this problem. We know best’,” said Karen
Higgins, co-chair of The Coalition to Protect Massachusetts Patients. “
While we have waited for the hospitals to ’fix it,’ thousands of patients
have died and continue to die throughout the Commonwealth. The time for
waiting is over. The Commonwealth’s hospital patients and their families
can’t afford to wait any longer.”

The Patient Safety Act (HB 2059) would improve hospital conditions by
setting a rational, safe limit on the number of patients a nurse can be
forced to care for at one time, while also creating initiatives to increase
nursing faculty and nurse recruitment. Similar legislation to set safe
patient limits was passed in California and was implemented in 2004.
Testimony about the bill’s success in California was presented by a panel of
frontline nurses from California and by Karin Berntsen, RN, BSN, a
California nurse administrator and one of the nation’s leading patient
safety experts.

Leading National Patient Safety Expert and California Nurse Administrator
Endorses Mass Staffing Bill

Contradicting assertions by the hospital industry that the bill is
inflexible and the wrong approach to improving patient safety, Karin
Berntsen testified about the success of the California law and said that the
Patient Safety Act introduced in Massachusetts is even better than the
California legislation.

Ms. Berntsen, the author of the books The Patients Guide to Preventing
Medical Errors and Fatal Care, testified that she observes a “Massachusetts
understaffing crisis,” and that Massachusetts hospitals “approach is
counterproductive and dangerous to patients.”

“One of the nation’s leading organizations on patient safety, the Agency for
Healthcare Research and Quality, examined over 90 studies on nurse staffing
and reported that reducing the number of patients a nurse cares for at one
time is associated with reduced hospital mortality and reduced adverse
patient events,“ she said. “Furthermore, The Patient Safety Act has been
well thought out and builds in the principles of improved safety and
efficiency, including a balanced approach to nurse staffing, ramping up of
the staffing requirements, and supporting nurse recruiting to assist with
the bedside nursing shortage,” Ms. Berntsen added. “The legislation is
flexible, and promotes staffing plans that are balanced for all hospitals,”
she concluded.

Evidence Presented at Hearing Calls the Hospital Industry’s Solutions Into
Question 
 
At a time when patient safety is being increasingly endangered by RN
understaffing, the state’s hospitals continue to post record profits of
nearly a half-billion dollars for the first six months of 2007 – a 35
percent increase over the previous year’s second quarter profits. If the
trend continues, the hospital industry is poised to record its third
straight year of profits in excess of $1 billion.

Instead of investing in safer nursing care, the Massachusetts hospital
industry’s response to the mounting death toll has been to create a
“Patients First” web site that posts proposed nurse staffing “plans” with no
guarantee that the staffing plans are accurate, and with no uniform standard
of care that patients can expect in all hospitals.

The patients who responded to the ODC survey said the web site is of little
or no value to them. Nearly 90 percent of recent hospital patients report
that they did not have the time to research staffing levels prior to their
hospital visits. In fact, only 14% were aware of the web site, and only 4
percent used it.

Audrey Heath, a senior from Worcester, said she was insulted by the
assumption that she would be able to check a web site to safeguard her
hospital stay. “You think I have time to look at a web site when I’m on my
way to the hospital? Most people my age are in serious condition when they
arrive at the hospital. They’re not thinking about the internet.”

The Patient Safety Act is co-sponsored by State Senator Marc Pacheco
(D-Taunton) and State Representative Christine Canavan (D-Brockton).

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