Los Angeles Times Examines Hospital Closures
The Los Angeles Times on Friday examined the increasing trend of hospital closures in California. According to the Department of Health Services, 60 hospitals have closed while 26 have opened in the last 10 years. Some officials contend that the hospital industry "could benefit from some pruning or consolidation," but communities affected by hospital closures "decry the loss of nearby emergency services and secure jobs," according to the Times. The Times reports that some hospitals, especially those in isolated or rural areas, do not have enough patients to support themselves, while hospital finances have been further affected by the migration of procedures such as biopsies and dialysis from hospitals to outpatient clinics; "paltry" Medi-Cal and Medicare reimbursements; "pinched" managed care pay rates; and increasing technology costs.
In addition, "two costly state laws" governing nurse staffing and seismic retrofitting of public buildings could accelerate the trend of hospital closures, according to the Times (Hymon et al., Los Angeles Times, 1/16). The new state nurse-to-patient ratio rules, which took effect Jan. 1, require that nurses 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, 1/15). In addition, California law requires that all hospitals guarantee by 2008 that their buildings would not collapse in a significant earthquake, or by 2013 if the buildings are expected to remain in use 30 years from now. By 2030, hospitals must be able to withstand a major earthquake and continue functioning immediately afterward (California Healthline, 11/21/03). The nurse-to-patient ratio rules were the "dagger through the heart" in the closure of Santa Teresita Hospital in Duarte, the Times reports. In addition, hospitals are calling the seismic standards an "unfunded mandate" because the state will not help pay for the hospital retrofitting or new construction.
Sister Michelle Clines, chair of Santa Teresita, said that the hospital closed because "[w]e didn't want to stand around and wait for the penalties to come in for being in noncompliance with the [nurse-to-patient ratios] law." Bob Reed, chief financial officer of the Sutter Health system in Northern California, said, "There is no question in my mind that the smaller hospitals will have to close programs or close their doors because they won't have the money to meet the law and serve their patients." However, Charles Idelson, a spokesperson for the California Nurses Association, said claims that the nurse-to-patient ratio rules are bankrupting hospitals are part of "a heavy-handed campaign by the hospital industry to sabotage California safe staffing law." The Times reports that David Hammer, counsel for Trinity County, which runs Trinity General Hospital, said that hospital officials "aren't even thinking about the seismic retrofits" because the county "doesn't have the funds to make payroll even today." However, according to Gerald Kominski, an associate director of the University of California-Los Angeles' Center for Health Policy Research, hospital profits are as high as they have been in the last 10 to 15 years. "This is, relatively speaking, a relatively profitable time," Kominski said, adding, "It doesn't mean individual hospitals are not struggling. It also doesn't mean the regulations aren't causing hospitals to be squeezed more than they would be otherwise. To say this is causing the industry severe financial threat sounds to me like an overstatement" (Los Angeles Times, 1/16).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.