California lawmakers are considering two separate measures that would enforce the state's controversial nurse-staffing law and create unannounced hospital inspections when the nurse-to-patient ratios go into effect in 2004.
The pieces of legislation, backed by the Service Employees International Union and the California Nurses Association, were approved last week by the state Senate's Health and Human Services Committee and the Assembly Health Committee. The legislation now heads to the appropriations committees in both chambers and could make it to Gov. Gray Davis' desk this fall.
The Senate bill, introduced by Joseph Dunn, a Democrat, calls for enforcement of staffing ratios during regular inspections by the state Department of Health Services, unannounced hospital inspections by the DHS and investigations of urgent complaints within 24 hours and routine complaints within 10 days. The act would create follow-up procedures to ensure hospitals fix problems and meet deadlines for compliance or face fines of up to $50 per patient per day when patients face risk.
The ratios, set to go into effect Jan. 1, 2004, would require hospitals to staff one nurse for every six patients in medical-surgical units. A 1-to-5 ratio would be required 12 to 18 months after the law goes into effect. Intensive-care units would operate with a 1-to-2 ratio."Without effective enforcement of new nurse-to-patient ratios, unsafe staffing that endangers patients in many of California's hospitals will continue to put patients at risk," said Glenda Canfield, policy director of the SEIU's Nurse Alliance, which supports Dunn's legislation.
The Assembly bill, introduced by Darrell Steinberg, a Democrat, and backed by the nurses' association, also calls for unannounced inspections but creates heftier fines of up to $5,000 per day for hospitals that do not meet the nurse-to-patient ratios.
Enforcing the ratio law will be costly for hospitals that cannot meet the minimum nurse-to-patient requirements, said Rob Fuller, executive vice president and chief operating officer of 199-bed Downey Regional Medical Center. "They are going to effectively shut down hundreds of hospital beds across the state because we don't have the labor and can't afford the fines," he said. "It is an unfunded mandate."
Downey Regional is 40 nurses short of complying with the state ratio law, Fuller said. In the hospital's 36-bed definitive-observation unit, which will require a 1-to-4 ratio, the hospital could be fined up to $1,800 per day under the Senate measure, he said. "That gets to be a very expensive proposition," Fuller said. "It is very clear we would be shutting down beds."
The unannounced inspections, which already take place in nursing homes, should give the health services department a candid picture of hospitals, SEIU spokeswoman Beth Capell said. In the past when hospitals were informed of upcoming inspections, hospitals would hire cleaning crews and double the number of staff workers, she said.
"Six months is a long time to tidy things up," Capell said. "Having routine inspections of hospitals unannounced will give you a real inspection instead of a dress inspection."
Kay McVay, president of the California Nurses Association, said enacting Steinberg's legislation "would send a clear message to hospitals and the public that the state will not tolerate unsafe staffing."
The California Healthcare Association, which represents 500 hospitals and health systems, is opposed to the legislation, saying that nothing is needed yet because the mandated ratios are not in effect.
"It is a solution to a problem that doesn't exist," CHA spokeswoman Jan Emerson said. "After the ratios are released and if there is a problem that hospitals are not abiding by the law, then it might be appropriate. But that is several years down the road."
The DHS held three public hearings last year on the ratios and is reviewing testimony before issuing final ratio regulations later this year. Currently, the department has no options to enforce the ratio law, Canfield said.
"There are no built-in enforcement mechanisms," she said. "How are we going to enforce ratios and protect patients if we don't have teeth in the law?"