Tentative Superior Court Ruling Would Place Injunction on Delay of Nurse Staffing Rules
Sacramento Superior Court Judge Judy Hersher on Thursday "tentatively ruled" that the administration of Gov. Arnold Schwarzenegger (R) "overstepped its authority" by delaying changes to state nurse staffing rules, the San Francisco Chronicle reports (Gledhill, San Francisco Chronicle, 3/4).
Under current state law, nurses may care for no more than six patients at one time. Schwarzenegger in November 2004 delayed until January 2008 the implementation of a law -- passed under former Gov. Gray Davis (D) and scheduled to take effect this month -- that will require nurses to be responsible for the care of no more than five patients at one time (California Healthline, 2/3).
The California Nurses Association in December 2004 filed a suit alleging the administration illegally bypassed the Legislature by unnecessarily calling for the emergency regulations that delayed the nurse staffing changes. The Department of Health Services has said the delay was necessary to avoid fiscal emergencies at hospitals. The administration currently is working to make the delay permanent.
In Hersher's preliminary ruling, which can still be changed, she wrote that "considerations of nursing shortages and economic impacts are outside the scope of the rulemaking because such considerations are inconsistent with the fundamental purposes of the statue to ensure that nurses be 'accessible and available to meet the needs of patients.'"
Hersher stated that there was no evidence to support the administration's use of emergency rule-making, adding, "The determination of 'emergency' is arbitrary and capricious and entirely lacking in evidentiary support" (San Francisco Chronicle, 3/4). Hersher stated that CNA "has shown a high probability of success on the merits" of its arguments that the emergency regulation "exceeds the scope of authority" of the administration and was "both an abuse of discretion and not adopted in the manner required by law" (Wasserman, AP/San Francisco Chronicle, 3/3).
In addition, Hersher stated the administration had failed to convince her of a "substantial risk of harm" if she finalized the injunction against delaying the new staffing rules, noting that about half of hospitals already had implemented the one-to-five staffing ratio (San Francisco Chronicle, 3/4). Hersher said the state did not present any "data to support or refute these and other claims that have been made about problems caused or exacerbated by the current nurse-to-patient ratios."
According to the Los Angeles Times, Hersher "appeared sympathetic" to hospitals' financial situations but noted that factors including inadequate Medi-Cal reimbursements and the rising number of uninsured residents have contributed to rising medical costs (Salladay/Chong, Los Angeles Times, 3/4).
Hersher wrote that she likely will decline CNA's request to block the administration's efforts to make the regulation change permanent, saying such a ruling would be "premature" (Benson, Sacramento Bee, 3/4).
Lawyers for the state and CNA will present oral arguments Friday, when Hersher is expected to deliver her final ruling. The Contra Costa Times reports that the "strong language of the preliminary ruling indicates the judge will likely rule in favor of the nurses."
According to the Contra Costa Times, if finalized, the ruling "would be a major political victory for labor unions" and the "biggest legal setback to date for the Schwarzenegger administration" (Silber/LaMar, Contra Costa Times, 3/4). The ruling could immediately require hospitals to conform to the stricter ratios that were initially supposed to have taken effect at the beginning of this year (Sacramento Bee, 3/4).
Health and Human Services Agency Secretary Kim Belshe said in a statement on Thursday, "We are disappointed by the tentative ruling issued by the court this afternoon but look forward to having the opportunity to present the state's case at tomorrow's hearing. If the court's final ruling is consistent with today's tentative ruling, [DHS] intends to pursue all legal remedies" (Sacramento Bee, 3/4). Belshe added that the "state's regulatory action on nurse-to-patient staffing ratios is based on a solid legal foundation and is consistent with the administration's priority of protecting patient safety while ensuring access to care" (Los Angeles Times, 3/4).
DHS chief counsel Robert Tousignant said he hoped that during Friday's arguments, attorneys for the department "will be able to persuade [Hersher] that her ruling is incorrect."
CNA President Deborah Burger said, "Arnold overstepped his authority," adding that the lower ratios should go into effect immediately. "Then nurses will be able to provide safer patient care, which was the intent of the law all along," Burger said (San Francisco Chronicle, 3/4).
CNA Executive Director Rose Ann DeMoro said the ruling "is monumental news for all California patients and families who need hospital care" (Los Angeles Times, 3/4). She said the ruling "clearly says that all the arguments used by the governor and hospital corporations to revoke the staffing laws are null and void" (Contra Costa Times, 3/4).
DeMoro added that if the administration enacts a permanent regulation postponing the ratios, "we would file another lawsuit or go to court to try to have it overturned" (Sacramento Bee, 3/4). DeMoro said, "This order should send a strong signal to this governor to end his flagrant efforts to accumulate power at the expense of the Legislature and the public. ... It's time for this governor to start respecting the constitution" (San Francisco Chronicle, 3/4).
Sen. Deborah Ortiz (D-Sacramento), chair of the Senate Health Committee, said, "It is the right thing to do. It's better for patient care, but it is a challenge. We have failed to have enough nursing programs. We haven't supported the profession enough" (Los Angeles Times, 3/4).