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Contra Costa Times (California)
Nov 05, 2004 - 01:00 AM

by Judy Silber

State backs off on nurse levels

Responding to complaints that hospitals are closing because of a law that took effect this year, California's health department on Thursday said it will ease nurse staffing requirements.

The Department of Health Services said it will delay increasing the number of nurses required on medical-surgical units until 2008, instead of Jan. 1, 2005, as was originally planned. In addition, it will allow emergency rooms to deviate from the state's requirements if they have a sudden influx of patients.

"It's certainly a step in the right direction," said Jan Emerson, spokeswoman for the California Healthcare Association, a hospital industry group. "It doesn't solve the entire problem, but it is a first step and addresses the areas where we've been the most concerned about."

The California Healthcare Association claims that the state's staffing requirements have contributed to the closures of 11 hospitals. All are in Southern California with the exception of San Jose Medical Center, which in September announced its intention to shut its doors.

In addition, several hospitals have had to scale back the number of patient beds. They couldn't find enough nurses to staff them, Emerson said.

The California Nurses Association criticized the changes.

"We're furious that Gov. Arnold Schwarzenegger has bowed to the pressure of the hospital industry in weakening patient protections for the citizens of California," said Deborah Burger, president of the CNA.

Burger said the ratios did not cause the hospital closures. "The hospitals were in financial trouble four, five, six years before the ratios even took effect," she said."

California became the first state in the nation to require specific nurse-to-patient ratios at hospitals when it passed a law in 1999 over the loud objections of the California Healthcare Association.

Just before it was to take effect on Jan. 1, the hospital group began lobbying newly sworn-in Gov. Arnold Schwarzenegger. But Schwarzenegger refused to change the regulations crafted by the Department of Health Services. According to those rules, medical-surgical wards must have a minimum of one nurse per every six patients. The ratio was to have decreased to one nurse per every five patients in 2005.

By softening the staffing requirements, health care advocate Jerry Flanagan accused Schwarzenegger of caving to a special interest group. On Feb. 11, Kaiser Permanente, a dominant player in California's hospital industry, donated $150,000 to the Yes on Proposition 57 and 58 campaigns, measures on the March ballot that were considered critical for Schwarzenegger's nascent political career.

But Brenda Klutz, deputy director of licensing and certification for the California Department of Health Services, argued that the new rules make more sense.

The Department of Health Services decided to delay the stricter ratios until 2008 because it wants to know that they won't have unintended consequences , Klutz said. To evaluate the ratios and their effects, the department will undertake a two-year study.

Nursing homes have complained that the ratios have worsened the nursing shortage, making it hard for them to hire. It's also heard that some hospitals have delayed patient transfers because accepting facilities feared being out of compliance.

"We really believe that the minimum ratios we've had in place since Jan. 1 are really good for patient care," Klutz said. "(But) when we start to hear these signs and symptoms, we really have an obligation to slightly pause."

The new rules also reverse a requirement that said hospitals must replace nurses on bathroom breaks. The California Healthcare Association had sued over this point but lost. Now, nurses will be considered on duty if they step into the bathroom or make telephone calls, so long as they are physically located on the ward.

The changes to the ratio rules will become law if approved by the Office of Administrative Law as expected. The OAL has 10 days to reject or accept them.




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