Local Hospital Leaders Say Impact Would Be Catastrophic If Question 1 Approved
By Sophia Eppolito
Boston University Statehouse Program
BOSTON -- Local hospitals are coming out against the upcoming nursing ballot initiative, saying that it would have catastrophic financial implications that could reverberate throughout local communities.
Lowell General Hospital, Emerson Hospital, and Lahey Hospital and Medical Center all oppose ballot Question 1, which would set limits on the number of patients assigned to hospital nurses. The initiative would mandate patient to nurse ratios and would require hospitals to pay a $25,000 fine to the government for every additional patient assigned to a nurse.
The Massachusetts Nurses Association, the largest nursing labor union in the state, is sponsoring the initiative, saying the mandated staff levels are designed to ensure patient safety. The MNA says hospital executives are grossly exaggerating the costs to implement the initiative, and that hospitals can easily afford to ensure safer staffing with limits on nurse’s patient assignments.
Between the three hospitals, this initiative would cost a total of $33 million. Lowell General would lose $15 million while Emerson and Lahey would each lose $9 million. Executives opposed to the ballot initiative have cited a study by Mass Insight Global Partnerships and BW Research Partnership, which estimated that it would cost the state’s health care system $1.3 billion in the first year and at least $900 million every following year.
The union has disputed these estimates, citing a study that estimates the total costs at about $47 million.
An August study by the Massachusetts Behavioral Health System found that if the question passes behavioral health programs would be hit most severely. More than 1,000 of the state’s existing behavioral beds would be lost and the majority of facilities would “eliminate behavioral health beds and services,” the study stated.
Tracy Galvin, chief nursing officer at Lahey Hospital and Medical Center in Burlington, said this question could have an especially dramatic impact on emergency departments.
“Ultimately, if Question 1 is passed, hospitals will have to make very difficult decisions that will reduce services we are able to provide patients and the community,” Galvin said in a statement. “Emergency department wait times will dramatically increase, patient units will close, and there will not be enough resources to provide a number of vital community-based services and programs.”
Martha Rafferty, director of the emergency department at Emerson Hospital in Concord, voiced similar concerns. Rafferty said that if 1,000 behavioral beds are lost statewide, those patients will be more likely to end up in emergency departments and create a “bottleneck” for emergency patients.
“With bed unavailability because of boarding behavioral health patients (and) staffing ratios that we have no flexibility to change within the department, there will invariably be a backlog of ambulances trying to bring patients from the communities into the department,” Rafferty said.
Rafferty said this issue is likely to extend past Emerson.
“What happens at Emerson Hospital will be no different than what happens at an emergency department at Lowell General or anywhere else,” Rafferty said. “It’s a broad problem that will extend into every single community and will affect patient care in terms of the ability to treat patients in a timely fashion.”
Lowell General Hospital CEO Jody White said the ballot question’s cost would have “devastating” effects on the hospital.
“The $15 million cost to Lowell General Hospital generated by Question 1 in the first year alone will be devastating to a community hospital like ours,” White said in a statement. “It will force us to cut programs, disrupt access to care and increase wait times in our Emergency Departments and other entry points into our health system.”
Cecelia Lynch, Lowell General’s chief nurse executive, said she is not only concerned with the costs, but also with how this initiative would change nurse’s day-to-day lives.
“It is that the rigid language of the law takes all decision-making out of the hands of the professional nurses,” Lynch said. “Day in and day out nurses at the bedside make decisions about their patients’ care... and nurses have a strong say, particularly at Lowell General.”
The government shouldn’t be handling issues related to hospital staffing, Lynch said.
“Do nurses work hard? Absolutely,” Lynch said. “But I would say that the way to resolve issues when we have staffing issues is not to defer them to a government mandate.”
Emerson Hospital CEO Christine Schuster said she doesn’t support the question because “every hospital is not the same.” Like White, Schuster said she takes issue with the “rigidity” and lack of flexibility.
“It’s not good policy to put something in that’s so rigid when all hospitals are not created equal,” Schuster said.
Schuster said these staffing requirements and additional costs would be especially difficult for community hospitals. But she understands why people would be willing to vote for it.
“It’s a question that probably never should have come to the ballot because for the general public if you say, ‘do you want more nurses?’ who wouldn’t say yes?” Schuster said.
A similar effort in 2014 prompted the Legislature to pass a law mandating minimum staffing in intensive care units. A recent study found that law failed to make a significant change in patient safety.