Predictions that managed care would significantly reduce the number of patients in Massachusetts hospitals have not come true, creating crowding that concerns nurses and causing some hospitals to postpone elective surgeries.
In at least one case, a hospital was so full it sent patients to a rival.
After examining what had happened on the West Coast, consultants figured managed care would cut sharply into patient loads here, leading many area hospitals to reduce their number of beds.
"Hospitals maybe rushed to judgment as to what they should do and downsized," said Barbara Cooke, a nurse and administrator at Brockton Hospital.
She said nurses at some hospitals have been told to work consecutive shifts or to take eight hours off and then return for another shift.
"There is not ample time for rest. It creates concerns as to whether the worker can do the best job she should be able to do, she said.
David Schildmeier, a spokesman for the Massachusetts Nurses Association, said it is unsafe and inappropriate to have nurses work shifts like that.
"The decline in (hospital admissions) has never taken place to the degree they said it would. However, they have staffed the hospitals on those projections," he said.
Elective surgeries were postponed for a couple of days in January at the University of Massachusetts Medical Center in Worcester because all beds were taken, an official said.
Some surgical patients were kept in recovery rooms longer because there was no space in regular rooms.
The 388-bed hospital was recently 95% full.
A spokeswoman for 400-bed New England Medical Center in Boston said it has 12% more patients than last year, and its bone marrow transplant unit has admitted 50% more patients than during the comparable time last year.
The Lahey Clinic in Burlington added beds in recent years and was 79% full this February, compared with about 70% in February 1997.
Pam Bush, a spokeswoman, said the figure would be higher but the hospital changed its scheduling of tests so patients don't have to stay as long.
Stays also are shorter because technological advances have made surgery less traumatic, she said.
Beverly (Mass.) Hospital, running between 95% and 100% occupancy in recent months, has been cooperating with Salem Hospital, a nearby rival.
"We had no choice . . . we had to find the best place to put the patients," a spokeswoman said.
Also adding to hospital patient loads were the strong economy leading people to undergo procedures they might otherwise delay; baby boomers' need for more care as they age; and a bad flu season.