Advocates Debate the Pros and Cons of Question 1
By Bob Katzen
There were no roll calls in the House or Senate last week. This week, Beacon Hill Roll Call begins are three-part series that looks at the three ballot questions that will be on the November 6 ballot. First up: Question 1.
Question 1 asks voters if they approve of a proposed law that would “limit how many patients could be assigned to each registered nurse in Massachusetts hospitals and certain other healthcare facilities. The maximum number of patients per registered nurse would vary by type of unit and level of care.”
Gov. Charlie Baker’s Office of Administration and Finance is required by law to analyze the fiscal consequences if the proposed law is approved.
“This proposed law may affect both state and municipal revenues and expenditures, with state-owned hospitals required to expend between an estimated $67.8 million and $74.8 million annually to comply with the proposed law, and the Health Policy Commission required to expend an estimated $1.28 million annually to monitor compliance,” says the Baker Administration.
“There will also be an impact on MassHealth, the state’s Medicaid program, and state-funded employee and retiree health care obligations to the extent that the initiative increases hospital costs or causes hospital closures. The overall fiscal consequences to state and municipal finances, however, are difficult to project due to the lack of reliable data.”
The sponsors and opponents of the issue are passionate.
“Right now there are no limits to the number of patients that a nurse can be assigned at the same time, and when it comes down to it, many voters recognize that this is about creating a standard of care for the already-vulnerable patients in our hospitals,” Kate Norton, spokesperson for the Committee to Ensure Safe Patient Care, the group urging a “yes” vote on Question 1 told Beacon Hill Roll Call. “It’s no secret that hospital executives are pouring millions into their deceptive opposition campaign, and though we may get outspent, we certainly won’t be outworked.”
Norton concluded, “There has been overwhelming support for a yes vote on Question 1, not just from nurses out knocking on doors every day, but also from the people across the commonwealth who know they may be patients themselves and want the best quality of care possible, and who know that the safe patient limits proposed by Question 1 are the right choice for safety.”
“Over one hundred health care organizations, representing tens of thousands of nurses, doctors, and healthcare workers joined in opposition against Question 1...” Dan Cence, spokesman for the Coalition to Protect Patient Safety spokesperson, the group urging a “no” vote on Question 1 told Beacon Hill Roll Call. “As the ones on the frontlines of delivering care, they know that rigid, government-mandated nurse staffing ratios that make it illegal for nurses to take even one patient over a quota--and provide no exception for emergencies like multi-car wrecks, fires and storms, or shootings -isn’t realistic and isn’t safe.”
Cence concluded, “Along with costing over $1 billion, Question 1 will lead to increased emergency room wait times, decreased access to routine care, a cut of at least 1,00 mental health beds and community hospital closures. With that high of a price tag, we should be expanding access to health care, not causing life-threatening delays and closures.”
Here are the official arguments, gathered by the secretary of state, on each side of the question.
IN FAVOR: Written by Donna Kelly-Williams, Massachusetts Nurses Association, (781) 821-4625 x 777 www.safepatientlimits.org
“I have worked as a bedside nurse for 40 years. I joined nurses from across Massachusetts to write this law and place safe patient limits on the ballot to improve the quality of patient care in Massachusetts hospitals. Independent scientific studies have consistently found that quality of care decreases dramatically when nurses are forced to care for too many patients at once, putting patients at increased risk for complications like pneumonia, medication errors and more.
This initiative establishes a safe maximum limit for the number of patients assigned to nurses in all hospital areas to ensure our patients receive the care and attention they need. It provides maximum flexibility, requiring hospitals to adjust registered nurse staffing levels based on the needs of patients and does so without reducing other members of the healthcare workforce. A recent survey found that 86 percent of registered nurses in Massachusetts favor this question.”
AGAINST: Amanda Oberlies, Coalition to Protect Patient Safety, 617-840-3465, www.protectpatientsafety.com
“Nurses are asking you to vote no on Question 1. Massachusetts hospitals rank among the best in the nation, but Question 1 will put that patient care quality and safety at risk. It forces rigid, government-imposed nurse staffing ratios at every hospital, overriding the professional judgment of nurses and doctors. Question 1 would create a massive unfunded government mandate costing more than one billion dollars in higher healthcare costs annually, causing community hospitals to close and forcing others to reduce emergency, addiction and behavioral health services.
Question 1 has been called ‘the most irresponsible approach to healthcare.’ There is no scientific evidence that these rigid ratios improve patient care. Question 1: higher costs, rigid mandates, and one-size-fits-all healthcare. Nurses and over one hundred healthcare organizations, including American Nurses Association Massachusetts, Massachusetts Medical Society, Massachusetts College of Emergency Physicians, and every Massachusetts hospital urge: Vote No on Question 1.”
Meanwhile, a new study released last week by the non-partisan Massachusetts Health Policy Commission (HPC) that was established in 2012 as an independent state agency that monitors health care spending growth in the state and makes recommendations regarding health care delivery and payment system reform. It does not take a stand on ballot questions.
The commission’s report said an additional 2,286 to 3,101 full-time nurses would be required to meet the proposed staffing mandates. It pegged the annual cost of the implementation to be between $676 million and $949 million - including hiring additional staff to meet staffing requirements, wage increases for existing nurses and implementation costs faced by state-operated hospitals. The commission said its estimates are conservative due to lack of detailed staffing data for emergency and outpatient departments.
The HPC also reports that the required increase in hospital nurses would likely increase the demand for nurses across the state and result in a 4 percent to 6 percent hike in their salaries. It also noted there are opportunities to save between $34 million and $47 million with the hiring of additional nurses, which could lead to reduced hospital lengths of stay and reduced adverse events.
The response from both sides to the HPC report were swift.
“We sounded the alarm from the moment we were made aware of the HPC cost estimate and did so with good reason,” said Julie Pinkham a supporter of Question 1 and the Executive Director of the Mass Nurses Association. “Up until this ballot issue, the HPC has developed cost estimates with a detailed and thorough review process over a period upwards of six months, but this has been anything but that. This guess on costs by the HPC is irresponsible and inconsistent and resembles nothing that the HPC has ever done before ... This is a state agency charged with oversight that chose to weigh in, and in instead of conducting a well-vetted and thoughtful analysis, they elected to use data provided by the single largest opponent to Question 1 - an approach they rejected in their merger report now before the attorney general.”
“This is the fox guarding the hen house,” Pinkham continued. “From start to finish this has been a ‘David and Goliath’ scenario and nurses have continued to put sunlight on the choices by hospital executives make when it comes to how they allocate their vast financial resources. What may be most disappointing of all is that those choices by hospital executives have never been challenged, and patients are left wondering why this multibillion-dollar industry is not allotting additional resources to direct patient care instead of executive compensation and real estate holdings.”
“It was an absolutely terrifying day for health care in our state,” said Cence, representing the group opposed to Question 1. “The HPC’s analysis confirms that the negative consequences are too great, and the costs are too high for rigid, government-mandated nurse staffing ratios in the commonwealth. This puts the cost question to bed.”
Cence added, “Even with the HPC unable to quantify Emergency Department costs, they still agree that the cost could reach almost a billion dollars. Community hospitals will close. One thousand mental health beds will be cut. Emergency room wait times will decidedly increase. The entire healthcare ecosystem will suffer irreparable harm with no increase in the quality of patient care.”