A California law that limits the ratio of hospital patients per nurse continues to spark public and sometimes bitter disputes between healthcare unions and hospitals, one of the most recent erupting in Los Angeles County last week.
Local 660 of the Service Employees International Union, which represents nearly 5,000 nurses, filed two complaints with state regulators Oct. 25, charging L.A. County's Health Services Department with repeatedly violating the 10-month-old state law that limits how many patients a nurse may care for at any one time.
In a complaint to California health officials, SEIU Local 660 said the county needs an additional 1,200 nurses in its five hospitals to comply with the nurse-patient ratios. A second complaint filed with California's attorney general alleges the county wrongfully disciplined nurses who objected to handling more patients than are permitted by law.
The law requires one nurse for every six medical-surgical patients and staffing ratios narrow for patients with more severe illnesses. In January 2005, the medical-surgical ratio will fall to one nurse for every five patients. California's Health Services Department is responsible for enforcing the law during routine inspections or in response to a specific complaint. There is no penalty or fine for ratio violations, however, said a spokesman for the state department.
To date, the state has completed 28 investigations of 78 complaints about alleged nurse-patient ratio violations, the spokesman said. In 15 cases, investigators confirmed the violations. The remaining 50 cases remain under investigation. In addition, 68 hospitals have self-reported violations, he said. Of those, investigators have wrapped up a dozen investigations, nine of which have found hospitals to be noncompliant.
John Wallace, director of planning and policy for the county's Health Services Department, confirmed that the county needs to boost its nursing staff by 25%, or about 1,190 nurses, to fulfill the law's requirements, but stressed that L.A. County's handful of hospitals aren't alone in failing to comply with mandates amid a national nursing shortage. Wallace cited a survey of 300 hospitals by the California Healthcare Association, a trade group representing the state's hospitals, that found 85% of hospitals fell out of compliance at some point from January to June.
Last December, the California Healthcare Association sued unsuccessfully to have a judge relax a provision that requires ratios be enforced "at all times," which the trade group said would put many hospitals out of compliance during lunch or bathroom breaks.
Exacerbating the problem, L.A. County and nurses have negotiated unsuccessfully to replace a contract that expired 13 months ago.
Mark Tarnawsky, a union spokesman, said the county's decision to discipline or suspend, nurses who object to accepting additional patients violates state laws protecting whistle-blowers. Wallace defended the disciplinary action against nurses who have objected to accepting new patients, saying its hospitals would not compromise patient safety.