California Healthcare Association Files Suit Against State Over New Nurse-to-Patient Ratio Rules
The California Healthcare Association on Dec. 30 filed a lawsuit in Sacramento County Superior Court against the Department of Health Services over concerns that California hospitals cannot meet the requirements of new state nurse-to-patient ratio rules that took effect on Thursday, the Oakland Tribune reports (Vesely, Oakland Tribune, 1/1). Under the rules -- the result of a law signed by former Gov. Gray Davis (D) in 1999 -- nurses will not have to care for more than eight patients at a time. The rules also call for one nurse per five patients in medical-surgical units by 2005, as well as one nurse per four patients in specialty care and telemetry units and one nurse per three patients in step-down units by 2008. In addition, the regulations state that licensed vocational nurses can comprise no more than 50% of the licensed nurses assigned to patient care and that only registered nurses can care for critical trauma patients. The rules also require at least one registered nurse to serve as a triage nurse in emergency departments (California Healthline, 12/4/03). The lawsuit alleges that the state is "misrepresenting the intent" of the 1999 law because the new nurse-to-patient ratio rules require "additional nurses to fill in anytime a nurse is temporarily away from patients" for bathroom and meal breaks, the Tribune reports. CHA spokesperson Jan Emerson said that the lawsuit does not seek to delay implementation of the rules or a repeal of the law but seeks an expedited hearing within 30 days to examine state interpretation of the law (Oakland Tribune, 1/1). DHS spokesperson Lea Brooks said that she could not comment on the lawsuit (Silber, Contra Costa Times, 12/31/03). According to DHS, California hospitals have had two years to increase staff to comply with the rules (Berestein, San Diego Union-Tribune, 1/1).
Several newspapers recently published articles that examine the efforts of California hospitals to comply with the new nurse-to-patient ratio rules. Summaries of the articles appear below.
Contra Costa Times: The Contra Costa Times on Dec. 29 examined the appeals made by hospital officials to Gov. Arnold Schwarzenegger (R) to reduce the requirements of the rules. Hospital officials have expressed support for the rules in principle but have said that they oppose their "stringency," the Times reports. Kim Belshe, secretary of health and human services for Schwarzenegger, said that the rules were "crafted carefully" and that she "sees no reason to tinker with them," the Times reports (Silber/LaMar, Contra Costa Times, 12/29/03).
Los Angeles Times: The Los Angeles Times on Dec. 31 reported that although the rules would take effect on Jan. 1, "it's far from clear how many of the state's approximately 500 hospitals will be in compliance." Hospital officials have said that they "simply hadn't been able to find and hire enough nurses to meet the demands" of the rules, the Los Angeles Times reports. According to hospital officials, the rules are "impossible to manage" and leave them "vulnerable to state sanctions and legal action if they are out of compliance for even a few minutes," the Los Angeles Times reports (Vrana, Los Angeles Times, 12/31/03).
Oakland Tribune: The Oakland Tribune on Dec. 29 examined efforts by hospitals to comply with the rules, which represent "a statewide experiment -- the first in the nation -- on whether more nurses caring for fewer patients means less staff burnout and better patient outcomes." The Tribune highlighted the efforts of Kaiser Permanente of Northern California and of private and public hospitals in the Bay Area to comply with the rules (Veseley, Oakland Tribune, 12/29/03).
Sacramento Bee: The Sacramento Bee on Jan. 1 examined whether certain hospital chains were prepared to comply with the rules. A number of hospitals in the Sacramento area have offered signing bonuses, increased salaries and benefits, retrained employees to serve as nurses, donated funds to nursing schools and recruited nurses from abroad to comply with the rules (Rappaport, Sacramento Bee, 1/1).
KPBS' "KPBS News" on Tuesday reported on the nurse-to-patient ratios. The segment includes comments from Melanie Bruce, director of staffing for Tri-City Medical Center; Joy Gorzeman, Tri-City's chief operating officer; Geri Jenkins, a registered nurse and a member of the California Nurses Association Board of Directors; and Marry Middleton, associate director of patient care systems at University of California-San Diego Medical Center (Goldberg, "KPBS News," KPBS, 12/30/03). The complete transcript of the segment is available online. The complete segment is available online in RealPlayer. This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.