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The San Francisco Chronicle
Nov 05, 2004 - 01:00 AM

by Sabin Russell, Chronicle Medical Writer

State moves to freeze nurse-patient ratio

In a post-election blow to powerful nursing unions, the Schwarzenegger administration moved Thursday to ease some requirements of the state's first-in-the-nation law telling hospitals how many nurses they must have on hand to care for patients.

Under proposed emergency regulations sought by hospitals and filed by Department of Health Services Director Sandra Shewry, the state will put off until at least January 2008 -- instead of two months from now -- a rule that would have lowered from six to five the number of patients to which each nurse in a general medical floor could be assigned.

The reduction had been scheduled for Jan. 1 as part of the implementation of the pioneering nurse-to-patient ratio law signed by Gov. Gray Davis in 1999.

The ratios were first set at six patients per nurse at the beginning of this year. The California Healthcare Association, an organization of the state's 500 hospitals, has been seeking relief ever since.

The hospital group has battled the California Nurses Association since the union first proposed nurse-to-patient ratios in 1992.

"This is a step in the right direction," said Jan Emerson, spokeswoman for the hospital organization.

Since the ratio law went into effect in January, Emerson noted, eight hospitals -- including San Jose Medical Center -- had either closed or announcedplans to shut down, and four other hospitals shut down units, citing difficulties complying with the law.

"We've been having conversations with the administration for nearly a year about the overall fragile state of our health care system," Emerson said.

In addition to delaying the scheduled reduction in the nurse-to-patient ratio, the state health department would also grant hospitals flexibility in the number of nurses required in emergency rooms, and strict rules governing coverage when nurses are on restroom breaks or taking telephone calls would be eased.

The regulatory changes sought by Shewry will take effect in 10 days, if approved by the state Office of Administrative Law. Subsequently, there will be a 45-day public comment period and a single public hearing.

"I am outraged," said Deborah Burger, president of the California Nurses Association. "The governor is putting patients' lives at risk to bow to the pressure of the hospital industry."

Burger said that Gov. Arnold Schwarzenegger was "emboldened" by the defeat of Proposition 72, which would have required businesses with more than 50 employees to provide health insurance or pay a tax to cover the costs of state coverage for them.

She said the revised version of the emergency room rules was "so vague that they can do virtually whatever they want."

But Shewry, in a news release, said the proposed changes represented "common-sense flexibility for hospital emergency departments and clarify language in the current regulations."

Brenda Klutz, deputy director of the Licensing and Certification Program in the state health department, said the law requires evaluation of the new rules, and the proposed changes will provide the time to do it.

Klutz denied that politics had anything to do with the decision.

The state was concerned that hospitals would have to hire 1,900 nurses by Jan. 1 to meet the scheduled tightening of the ratio, during a time when trained nurses are hard to find.

Jamie Court, president of the Foundation for Taxpayer and Consumer Rights, said the timing of the decision was no coincidence. "This is pure political payback for the governor's biggest contributors -- this from a governor who said he would not be beholden to special interests," Court charged.
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E-mail the author Sabin Russell at srussell@sfchronicle.com




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