Editorial Comment: Healthcare and nursing regulations vary from state to state in the US, as does political culture. The nursing shortage of the mid-eighties in Massachusetts was brought to a halt by the passage of direct passthrough for the wages of caregivers, leading to a leap in pay and the return of many to the bedside. Almost immediately, consultants moved in to advise employers on how to cut labor costs. In 1988, job reengineering experiments began at the Boston University Medical Center, which was subsequently merged with the rebuilt and then privatized Boston City Hospital, and, ironically, at Quincy City Hospital, later privatized and taken over by Boston Medical Center, the fusion of BCH and BUMC. This experiment was effectively defused at the former institution, but in Quincy the scope of duties of the newly created job category, nursing technician, was merely limited through negotiations. Massive layoffs occurred in the Fall on 1989 when the newly constructed Quincy City Hospital opened, with RNs and housekeepers hardest hit. This was the first of many major layoffs of RNs in Massachusetts. When the dust settled, the RN-NT ratio on the large med-surg floors was fifty-fifty, with the RN responsible routinely for nine or ten patients on the day shift, plus the delegation of tasks to the unlicensed assistant. Later, American Practices Management, led by ANA-honoree Connie Curran, RN, came to Carney Hospital in Dorchester, and the subsequent battle was intense. In the mid-nineties, APM was driven out of Manitoba by a popular movement spearheaded by the Manitoba Nurses Union. The privatization of the facilities and services of the Commonwealth began under the administration of the Democrat Michael Dukakis and reached fever-pitch in the early nineties under the Republicans Weld and Cellucci. When the Senate chair of the Joint Committee on Health Care Ed Burke (Democrat - Framingham) proposed the deregulation of hospital finance, the Task Force on Health Care Finance of the MNA predicted that this deregulation would cause as much damage to the private sector as privatization was bringing to the public. Burke, referring to the Boston teaching hospitals, was quoted as stating that his move would place Œall the scorpions¹ in one bottle so we could see who survived. All the teaching hospitals have so far survived, but scores of community hospitals have not. Until the passage of this bipartisan measure, Chapter 495, in 1991, for-profit chains had not seen any incentive to buy acute-care hospitals in Massachusetts, even though eighty percent of nursing home beds came to be situated in facilities owned by such chains, and most specialty hospitals in psychiatry, rehabilitation and respiratory care were or soon became for-profit. The first incursion by a for-profit chain into the acute-care sector was by Columbia-HCA at MetroWest Medical Center in Framingham and Natick, the result of an earlier merger. And the chief spokesperson for Columbia-HCA turned out to be none other that Ed Burke. With deregulation also came increased penetration by managed care schemes, based on the false assumption that health care costs were so high because of out-of-control consumers who, presumably, could not wait to get their appendices out or deliver by Caesarian birth. Merger mania erupted to face this managed care onslaught, as more and more employers, the real Œconsumers¹ of much private health insurance, became convinced that managed care was the way to go to contain costs. Soon, predictions of the consolidation of health facilities in Massachusetts into a handful of conglomerates came true. This became especially true as the Clinton Œmanaged competition¹ fiasco devolved. The Clinton plan never promised more than an opportunity to get almost everyone into some private plan, preferably managed care, and cut down the Medicare/Medicaid Œentitlement.¹ This boondoggle to the largest private health insurers fit well with the fiscal conservatism of the Democratic Leadership Council, led by Clinton, Gore and Lieberman. Small and medium health insurance companies, organized into the Health Insurance Association of America, took out those famous ŒHarry and Louise¹ ads, while the seven or eight largest insurers looked forward to the chance to use their muscle to dominate the proposed regional purchasing cooperatives and intensify their monopoly positions. On the surface, the Clinton plan failed, but managed care became entrenched nationally and the privatization of Medicare and Medicaid proceeded apace. Collaterally, coalitions for real health care reform shattered over whether to endorse the Clinton plan or not. But the rebuilding of progressive movements in health care began almost immediately. In 1994, most of the local ballot questions calling for a Canadian-style single-payer universal health care system passed in Massachusetts, and this was endorsed by MNA. Early in 1995, the Massachusetts Campaign for Single Payer Health Care was formed, and MNA officially joined this coalition, which currently unites eighty local and state-wide unions, senior councils, religious organizations and neighborhood groups. Also in the Fall of 1994, MNA convened a meeting of 120 nursing activists to launch the Statewide Campaign for Safe Care. Alarmed by the pattern of degradation of care across the Commonwealth, the MNA Board and the MNA Cabinet for Labor Relations organized this endeavor to identify the specific problems, to uncover their roots, to build alliances and launch a plan of action to reach a set of attainable goals. Early in 1995, representatives of a number of nursing organizations assembled at MNA to explore the issues together. The Massachusetts Organization of Nurse Executives, the local affiliate of the American Organization of Nurse Executives, a wholly-owned subsidiary of the American Hospital Association, brought a full entourage. When the issue of safe staffing came up, and when the staff nurses present pushed for mandatory minimal staffing levels, they were treated to the same hollow argument that we hear now: mandated minimal levels will quickly become maximums. Were these nursing administrators warning or promising? In any event, their words meant nothing to those who were already responsible for far too many patients at a time. So now the counterattack against the recent breakthrough in California, and the promise of the same in Massachusetts and elsewhere, comes, with op-ed pieces written by those who never spent a moment at any bedside or know what nursing is all about. Even though some administrators and consultants have privately confessed their sins against the nursing profession and the public, the Hospital Association and its creation, the Joint Commission for the Accreditation of Health Care Organizations, their paid mouthpieces and their partners in ANA continue to defy rationality but opposing mandated RN-to-patient ratios. Practicing nurses have lost faith in the industry setting its own standards and are demanding that the public, through democratically accountable elected and appointed bodies, set those standards. All the reengineering, privatizing, deregulating, managing, merging, diluting, laying-off, shunting, speed-up and denial of care has created an assembly-line system, and has brought to birth its gravediggers. Organized nursing in Massachusetts is focused and on the move, united with such allies as the Massachusetts Senior Action Council and the Ad Hoc Committee to Defend Health Care. When a group of physicians came together early in 1997 to find ways to express their outrage at what the health care system had become, nurses were right there with them, helping them to reach out and insisting on a broad organization of health care workers. Nurses were among the shock troops for the placing of Question 5 on the 2000 ballot and the conduct of the subsequent campaign. Even though Question 5 did not explicitly project a single-payer system, it demanded universal health care by a date certain, as well as an HMO bill of rights, with at least 90% of the health care dollar actually going to care, and a moratorium on for-profit takeovers of health facilities until universal coverage was attained. Outspent fifty-to-one and opposed by virtually every corporate entity in the Commonwealth, but most especially by the five major Œnot-for-profit¹ HMOs, Question 5 nevertheless carried every section of the state that had been especially trampled by the current non-system, urban and rural, but lost in the vast suburban track of voters moved by the round-the-clock attack ads, coming in at 48%-52%. (Ad Hoc activists were puzzled when Mitch Rabkin, president-emeritus of Beth Israel Hospital, long-time exponent of single-payer health care and one of the original ten signers of the petition to place Question 5 on the ballot, came out publicly against it. The leading speculation at the time within Ad Hoc was that he realized that Beth Israel [now merged into CareGroup] was financially vulnerable and felt that even a bail-out by a for-profit was preferable to extinction. Recent events lend credibility to this notion.) Chapter 141, passed in July 2000 in a vain attempt to keep Question 5 off the ballot, established a Task Force on Consolidated Health Care Financing and Streamlined Delivery. That task force has hired consultants to bring forth specific recommendation to reach the stated goals in time for the 2002 election debates. The arm-wrestling between the single-payer advocates and the free-marketeers proceeds. In the meantime, the Œblue ribbon¹ committee appointed by then-governor Cellucci eighteen months ago to examine the status of health care in Massachusetts has just issued its final report. When this Œblue ribbon¹ (ie, blue blood) body was unveiled by the governor in the Ether Dome at Massachusetts General Hospital, a doc at MGH from the Ad Hoc Committee dropped by to observe the proceedings, and reported back that he had never seen so many suits in one place at any time. Subsequent complaints led to some democratization of its makeup, but the end product was quite predictable. For additional background on the Massachusetts Meltdown and the fightback, go to the Seachange Bulletin Archives <http://www.seachangebulletin.org>. For the latest news in this unfolding saga, bookmark the MNA web site <http://www.massnurses.org>. - Sandy Eaton, RN, Quincy, Massachusetts, USA
Governor's Blue Ribbon Health Care Task Force Releases Final Report Today
Task Force Proposes Moderate Changes With Continued Reliance on Status Quo
MNA Releases Minority Report Calling for Bolder Steps to Address a Growing Crisis
Massachusetts Nurses Association, January 28, 2002
The Governor's Blue Ribbon Health Care Task Force, which has been meeting for more than a year, will release its final report today. While calling for increased Medicare funding and stepped up oversight of the health care system, the report fails to call for more significant changes in the system that are needed to address a growing crisis in the Commonwealth.
Below is a copy of the MNA's Position Statement and Recommendations, which was provided to the Task Force and released to the media. The MNA believes the current system is broken and in need of fundamental reform, with the threatened closure of Waltham Hospital serving as the latest manifestation of the system's breakdown. Speaking from the perspective of nurses working on the front lines of health care, the MNA believes the current "market-based" system of health care delivery is a failure, depriving access to care for thousands, and delivering substandard care to those who gain access. The MNA report calls for adoption of a publicly funded, single payer health care system as proposed under the Massachusetts Health Care Trust Bill, legislation supported by MASS-CARE, a coalition of more than 70 health care, labor and citizen activists groups. To protect patients who gain access to the system, the MNA calls for the regulation of nurse staffing levels, including the imposition of minimum nurse-to-patient ratios, as proposed in safe staffing legislation (HB 1186) sponsored by State Rep. Christine Canavan (D-Brockton) and State Sen. Robert Creedon (D-Brockton).
Should members of the media want comments on either this statement, or our impressions of the draft report, please contact Julie Pinkham, RN, MNA Executive Director and our representative on the Task Force. She can be reached at 617-901-1948.
Massachusetts Nurses Association
Position Statement and Recommendations
The Massachusetts Health Care Task Force
As the Massachusetts Health Care Task Force prepares to release its draft report, the Massachusetts Nurses Association is compelled to present our position statement and official recommendations to both the Finance Task Force, as well as to the full membership of the Task Force.
The MNA represents 20,000 registered nurses and health care professionals in 51 Massachusetts hospitals, as well as a wide array of other health care settings, including VNAs, schools, long term care facilities, clinics and public health departments. Our members work on the front lines of the health care system, providing a real understanding of how the system works and, more importantly, given recent developments, how the system fails to work on behalf of patients and communities of the Commonwealth.
This statement contains a statement of nursing's view of the health care system as it operates today; a statement of basic principles upon which we base our position and recommendations, followed by the recommendations.
The health care system today: a failure of access and quality
From the perspective of nurses who work on the front lines and spend more time with patients and their families than any other provider group, the Massachusetts health care system is a complete and utter failure on all counts: depriving access to those who need services and delivering inadequate to unsafe care to those who manage to obtain access. While structured with the goal of being economically efficient, our health care system is one of the most costly in the nation. Unless dramatic changes are made, it is a system with no prospect of emerging from its current crisis state; it is a system on the verge of total collapse.
The media headlines tell the story: emergency room diversions on the rise in every corner of the Commonwealth; closing of community hospitals like Waltham Hospital (not for lack of need, but for lack of a rational system of health care finance and resource allocation); more than 400,000 residents without health insurance coverage and thousands more underinsured; unsafe staffing levels and deplorable working conditions that are driving nurses and other providers out of health care altogether and endangering the lives of thousands of patients every day; skyrocketing prescription drug costs that leave seniors destitute or on a bus to Canada for drugs they need to maintain their health; and the closure of nursing homes and home care agencies further undercutting the health care safety net. This is the picture of the health care system today as seen by nurses and as experienced by patients.
The picture becomes bleaker still when one considers that we have an aging population in Massachusetts that will increase its demands on a system already in shambles. Add to this the specter of a growing recession, and with it the increases in morbidity and mortality that follow rising unemployment and economic hardship and it is clear that urgent and sweeping reforms are warranted.
Statement of Principles that underpin and guide nurses' position on health care reform
There are four core principles that underpin and have guided our positions
on this issue. They are:
1. We believe that universal access to quality health care is a basic human right of every member of our society and that the inability to guarantee that right is evidence of a failure of our society that must be addressed.
2. We believe the health care system in our state is in serious crisis and in need of dramatic and comprehensive reform to secure the right of access to health care for all.
3. We believe the free-market, deregulated and corporatized approach to the delivery of health care in the Commonwealth which has been embraced by the legislature and the executive branch for the last decade is an abject failure, and it is the primary cause of the crisis we now face.
4. Nurses, as the providers who spend the most time with patients and families and who have the most experience in dealing with the outcomes of the current model of health care delivery in this state, can no longer morally or ethically accept incremental approaches to reform of this system; nor can we sit by while more consultants are hired and more task forces are formed to "study" these issues with no mandate to affect fundamental change.
While the Task Force was a laudable effort in recognition of the critical state of the Commonwealth's health care delivery system, the MNA, as an organization that has participated on the task force and followed its proceedings, fears there is little consensus or commitment by this body to meaningfully deal with the health care crisis on a long-term fundamental basis, which is so necessary at this time.
It may be that this commitment is lacking in large part due to the lack of consensus regarding the underlying core values of our health care system. Specifically, whether we are to view health care as a right and social responsibility (as the MNA believes) or rather, to view health care as a privilege and a commodity.
While there has been much rhetoric suggesting the former viewpoint, the current public policy stance has been to adopt the latter viewpoint with a clear promotion of business philosophy and "market competition" solutions to problems with social implications. Without fundamental agreement on the goal and definition of the core "values" of our health care system, there is little chance that meaningful long-term solutions will be found.
MNA Recommendations for Meaningful Health Care Reform
Given our reservations, the MNA would still offer one short-term recommendation that seems within the reach of the task force capabilities; a second long-term recommendation for the kind of reform most needed to restore our system to solvency, fairness and safety; and a third recommendation specific to the nursing profession and to the delivery of safe patient care.
Recommendation # 1 (Short-Term,) Single Health Care Administrator
We would suggest the creation of a "single administrator". This short-term measure could be implemented immediately, while more fundamental long-term solutions are developed. At a minimum, a pilot project should be constructed in one or more of the health service areas in which a number of payers exist (beyond Medicare and Medicaid, ie where there are a number of competing health plans serving as payers for services). The purpose of a single administrator is to provide efficiency in the coordination and management of the administration of health care from the point of approval for care (if relevant) to the payment for care to provider(s). This change would address the costly and confusing redundancy of documentation and paperwork for those operating and accessing the system. While not overly controversial, this also provides a first step of agreement regarding uniformity among and between insurers and providers.
Recommendation # 2 Adoption of the Massachusetts Health Care Trust Legislation Calling for a Universal Single Payer System for Massachusetts
From our perspective, the current multi-payer, market-driven system of health care financing is inefficient, ineffective and unredeemable. In its place we support and endorse a system as envisioned under the Massachusetts Health Care Trust Bill (S.599/H.2165) currently before the Massachusetts legislature, which would guarantee every Massachusetts resident health care coverage by replacing the current patchwork of public and private health care plans with a uniform and comprehensive health plan. It creates a single public entity called the Health Care Trust to replace all the present public and private bureaucracies. The Trust, appointed by the Governor, will have representation from consumers, professionals and government. It will:
* Oversee the delivery of health care services to Massachusetts's residents, with emphasis on universality, rational and effective allocation of resources, preventive medicine and the need for health care choices to be made by provider and patient.
* Collect and disburse funds for the purpose of providing comprehensive health care for all residents of the Commonwealth. These funds will derive from current state and federal expenditures for medical care, additional public and private sources to be proposed by the Trust following completion of a study undertaken by the legislature and sales taxes on products that tend to increase health costs.
* Negotiate or set fair and reasonable methods and rates of compensation with providers of medical services and with health care facilities and approve capital expenditures in excess of $500,000.
Massachusetts spends more on health care than any other state in the US, yet over a million of our residents have no health insurance or are underinsured! We already spend enough on health care in the Commonwealth to provide quality care for all of our residents. Under this bill, money that currently goes to administrative costs such as paperwork, marketing and profits would be spent on providing care.
We currently pay for health care many times over. As taxpayers, we pay for the public programs that make up almost half of direct health care spending. We pay for tax subsidies for employers who offer health insurance, whether our own employer offers coverage or not. As individuals, if we get employer-based coverage, we pay our share of the premium, and, on average, earn about 20% less than we would otherwise in order to cover the employer's share. Then we pay cash out-of-pocket for co-pays and deductibles. Businesses and individuals who buy liability insurance (auto, homeowners, product) pay for health care coverage for the people hurt, regardless of whether those people already have coverage -- only insurance companies benefit from this duplicative arrangement.
By replacing private dollars with public dollars and making funding of health care more equitable, most individuals and Massachusetts businesses would, on average, pay no more than they do now for health care. Coordinating funding through a single payer (Health Care Trust) will save enough in administrative costs to pay for the health care needs of all Massachusetts residents.
Recommendation # 3 Regulate Nurse Staffing Levels in Order to Recruit and
Retain Registered Nurses to Ensure Safe Patient Care
We respectfully believe that the Task Force may fail to address one of the most pressing problems of the health care system. Today in Massachusetts hospitalized patients must share their nurse with too many other patients. The problem of inadequate registered nurse staffing is having a negative impact on patient care and driving registered nurses away from the bedside.
Nursing traditionally has gone through cyclical but manageable shortages; however, the hospital and managed care industry in the 1990s have turned a normal shortage into a national crisis. Regrettably, this current shortage was predictable and avoidable.
Led by traditional industrial business consultants, the industry laid-off nurses by the tens of thousands and then tried to transfer the science-based and professionally licensed work of the registered nurse to well-meaning but inadequately prepared and unlicensed personnel.
The registered nurses still on staff after consultants such as the Hunter Group departed town were now given more and sicker patients for whom to care. As staffing levels deteriorated, and the pressure of bigger patient caseloads mounted, many RNs left for safer and less stressful work.
Hospitals responded by systematically forcing overtime on the remaining RNs to plug the holes, speeding up even faster the exodus from the profession.
At the same time that conditions are driving registered nurses away from the bedside, we know that the level of registered nursing care impacts patient outcomes.
Studies over the past two decades have clearly shown that the amount and quality of care provided by registered nurses is directly related to the length of stay, patient complications and patient satisfaction. A recent study conducted by the Harvard School of Public Health, of 5 million patient discharges found a "strong and consistent" link between nurse staffing levels and patient outcomes. As nurse staffing levels decreased, negative patient outcomes increased.
Perversely, the same forces that conspired to create today's nursing crisis are now busy promoting supposed solutions. Many hospitals are pushing large sign-on bonuses for RNs. They're also paying exorbitant fees to temporary staffing agencies and seeking government help with nursing school loan forgiveness and tuition reimbursement.
Those tactics, however, don't fix the structural problems behind the shortage. Sign-on bonuses simply increase the competition for a dwindling supply of nurses. Temporary staffing agencies sap hospital resources while becoming extremely wealthy in the process. And school financial incentives may get more students for the moment into nursing, but the new nurse on the job still confronts the intolerable working conditions that are driving older colleagues out of the profession.
To fix this problem, our lawmakers are going to have to step in with government-enforced registered nurse staffing standards before we further endanger our families and the public health. A formula for the safe nurse-to-patient ratios should be imposed. Mandatory overtime should be eliminated except in cases of declared emergency. Medicare, Medicaid and HMO reimbursements must use their funding authority to require improved nurse staffing levels for the sake of patient care.
In order to improve patient care and retain and attract registered nurses in the profession, registered nurse staffing levels must be improved.
The good news is Massachusetts has a unique opportunity. Because of the conditions only 1/4 of licensed registered nurses are practicing at the bedside now. More importantly, Massachusetts has the highest per capita nursing population in the nation. Unlike other states, we don't have a shortage of nurses, we have a shortage of nurses who are willing to work under the staffing/working conditions this system imposes. National and international surveys of nurses who are considering leaving nursing because of these types of conditions have shown the vast majority would stay at the bedside or consider returning to the bedside if nurse staffing is improved. In Victoria, Australia, where nurse-to-patient staffing ratios were mandated, more than 2,100 nurses returned to the bedside in a matter of months. The state of California last week became the first state in the nation to announce mandated minimum nurse-to-patient ratios for all acute care hospitals as a means of protecting patients and ending the nursing shortage in their state.
Nurses have always been the backbone of America's health system. As stated above, nurses are the providers who spend the most time with patients, and according to recent research, when there are more nurses, lengths of hospital stay are shortened and costly complications are averted. They are needed now more than ever as our parents and grandparents age and the country faces these uncertain times of terrorist threats.
Conclusion
It is clear to the nurses of Massachusetts that our health care system is broken and in need of a complete and drastic overhaul. Without a commitment to the provision of health care as a socially good and basic human right for all; without a complete revamping of how we finance and administer health care to ensure we provide this right to all of our citizens; and without a system of regulations to ensure that patients receive the attention and care they require to recover from illness and injury, thousands of our citizens will suffer and many will die. The MNA, and the thousands of nurses and health professionals we represent, call upon all stakeholders to the health care debate to join with us in seeing that we end this crisis and create a health care system that works for the betterment of our society.
David Schildmeier
Director of Public Communications
Massachusetts Nurses Association
340 Turnpike Street
Canton, MA 02021
800-882-2056 x717 (Within Mass. only)
781-830-5717
781-821-4445 (fax)
781-249-0430 (cell phone)
508-426-1655 (pager)
dschildmeier@mnarn.org
Web Site: <http:www.massnurses.org>
Boost in Medicaid share to hospitals suggested
<http://www.boston.com/dailyglobe2/028/metro/Boost_in_Medicaid_share_to_hospitals_suggested+.shtml>
Liz Kowalczyk, Boston Globe Staff, January 28, 2002
An emergency task force appointed 18 months ago to study the state's troubled health care system will recommend higher Medicaid payments to hospitals and nursing homes and closer monitoring of financial problems, in a final report scheduled to be released today. But several of the group's members are calling for more aggressive intervention. The task force was appointed by the governor and Legislature after Harvard Pilgrim Health Care, one of the state's largest managed care insurance companies, nearly went bankrupt in the winter of 2000. The panel has made no dramatic recommendations, and the report mostly advises state officials and lawmakers to continue ''watchful waiting'' of troubled hospitals, insurers, and nursing homes. ...
Panel, critics want health reform
<http://www.businesstoday.com/business/business/task01282002.htm>
Jennifer Heldt Powell, Boston Herald, January 28, 2002
The government should pour more money into health care and take on a greater role overseeing the medical system, according to a long-awaited report to be released today to the Governor's Blue Ribbon Task Force on Health Care. But critics say more radical solutions are needed, including a move away from a free market. The report, which must be accepted by the panel, is the culmination of more than a year's worth of meetings and information gathering on various aspects of the health-care system from hospitals to nursing homes. The principle conclusion is that the system is underfunded and that more people will likely be without health coverage in the coming months. ...
CareGroup, Massachusetts:
A model career in the service
<http://www.boston.com/dailyglobe2/024/west/A_model_career_in_the_service+.shtml>
Emily Sweeney, Boston Globe, January 24, 2002
WALTHAM - Like most hospitals in Massachusetts, Deaconess-Waltham hasn't been making money. While the hospital's fiscal situation isn't a surprise, the decision by its parent health-care network to close the 116-year-old facility has shocked the community and mobilized elected officials. A recent Massachusetts Hospital Association study of 58 hospitals found that only six showed a profit from 1997 to 2001 - and Deaconess-Waltham was not one of them. ...
Glover advocates wary of future
<http://www.boston.com/dailyglobe2/024/west/Glover_advocates_wary_of_future+.shtml>
Erica Noonan, Boston Globe, January 24, 2002
Questions about the future of Deaconess-Glover Hospital are emerging from the financial crisis surrounding CareGroup Health Systems, which owns the facility. The chain, which runs Beth Israel Deaconess Medical Center and New England Baptist Hospital in Boston and Mt. Auburn Hospital in Cambridge, announced last week that it would close one of its suburban facilities, the 163-bed Deaconess-Waltham Hospital. The move will eliminate 1,200 jobs and Waltham's only community hospital. News of the Waltham shutdown set Deaconess-Glover afire with rumors and questions as staff and patients wondered whether their hospital would be next on the corporate chopping block. ...
Hospital staff to get notices: CareGroup mail letters informing workers of job cuts at closing
<http://www.dailynewstribune.com/news/local_regional/walthosp01242002.htm>
Patrick Golden, Waltham Daily News Tribune, January 24, 2002
WALTHAM - Deaconess-Waltham Hospital staffers are finding themselves wedged between the tidal forces trying to shut down the 116-year-old institution and a community scrapping to keep it open. Employees learned on Tuesday afternoon that Dana Ramish, the hospital's chief executive, resigned. The announcement was coupled with news that a private firm, Transition Management Group, has been hired to push along the hospital's closure and search for a late buyer. Yesterday, employees were told Dawn Gideon of Transition Management had been appointed the hospital's interim head. ...
Local reps know the clock is ticking
<http://www.dailynewstribune.com/news/local_regional/waltreps01242002.htm>
Patrick Golden, Waltham Daily News Tribune, January 24, 2002
WALTHAM - With the clock ticking on the fate of Deaconess-Waltham Hospital, local officials say they are continuing to search for ways to keep the Hope Avenue institution from closing its doors in April. Mayor David Gately said yesterday he plans to request the City Council ask the state Legislature to enact special legislation that would increase the amount of time the hospital must stay open from 90 to 270 days. Gately said he thinks more than 90 days is needed to put together a suitable plan for saving the hospital. ...
Spiegel: Waltham emergency brings back memories
<http://www.dailynewstribune.com/news/opinion/colspiegel01252002.htm>
Brad Spiegel, Waltham Daily News Tribune, January 25, 2002
To tell you the truth, I have never had to visit Deaconess-Waltham Hospital due to an injury. But that doesn't mean I don't feel for everyone who is fighting to keep it open. ...
Brandeis interested in site of hospital
<http://www.businesstoday.com/business/business/fsox01252002.htm>
Eric Convey, Boston Herald, January 25, 2002
While bankers hired by CareGroup Inc. explore options for financially strapped Deaconess-Waltham Hospital, Brandeis University officials are eyeing its land, sources said yesterday. The property - more than five acres - is only a stone's throw from the Brandeis campus and would offer a real estate bonanza to the school. ...
Waltham hospital gets buy offer
<http://www.businesstoday.com/business/business/care01262002.htm>
Jennifer Heldt Powell, Boston Herald, January 26, 2002
A Nashville for-profit hospital company yesterday offered to buy the troubled Deaconess-Waltham Hospital, which is slated to close in April. Essent Healthcare Inc. would preserve the 163-bed facility as an acute care hospital and form a working partnership with the New England Medical Center in Boston, officials said. ...
4 of 6 CareGroup hospitals, led by Beth Israel Deaconess, lost money in 2001
<http://www.boston.com/dailyglobe2/026/business/4_of_6_CareGroup_hospitals_led_by_Beth_Israel_Deaconess_lost_money_in_2001+.shtml>
Liz Kowalczyk, Boston Globe, January 26, 2002
Four of the six hospitals in the CareGroup medical network lost money last year, while the organization's flagship Harvard teaching hospital, Beth Israel Deaconess Medical Center, lost millions more than executives had hoped. Hospital leaders were well aware that Beth Israel Deaconess had significant losses during the fiscal year that ended Oct. 1. But yesterday CareGroup released final results that confirmed the tenuous situation at the hospital, where the new chief executive, Paul Levy, plans to lay off up to 700 employees this month. ...
Deaconess-Waltham clings to life support
<http://www.boston.com/dailyglobe2/027/west/Deaconess_Waltham_clings_to_life_support+.shtml>
Emily Sweeney, Boston Globe, January 27, 2002
Rich Bandemer has been working extra hard lately to keep the floors at Deaconess-Waltham Hospital sparkling. As the supervisor of housekeeping at the 116-year-old Waltham institution, he hopes every little bit of effort will keep the hospital from closing in April. Deaconess-Waltham Hospital has been on the selling block since last summer, but no buyers have stepped forward. Bandemer, 54, hasn't started to look for another job yet. He isn't even sure what type of job he would apply for; he has worked for the hospital for 27 years. He tells his housekeeping crew to hold tight as the proposed closure date approaches: ''Don't give up what you got here. Hang on and see what happens.'' Bandemer attended the ''Save Waltham Hospital'' rally last week. The event drew an overflow crowd to the 500-seat auditorium at the Kennedy Middle School, where helium-filled green balloons with Band-Aids on them were tied to seats with green ribbons. Hand-lettered posters proclaimed: ''Give Us Time,'' ''We Are Open,'' and ''Salvemos Nuestro Hospital,'' or ''Save Our Hospital'' in Spanish. ...
Politicians lobby Washington over fate of Deaconess-Waltham
<http://www.metrowestdailynews.com/news/local_regional/walthospitallobby01282002.htm>
Patrick Golden, MetroWest Daily News, January 28, 2002
WALTHAM - A host of local officials traveled to the nation's capital on Friday to lobby for the support needed to prevent closure of Deaconess-Waltham Hospital. Mayor David Gately traveled with Councilor at large Paul Brasco, Ward 7 Councilor Joe Giordano and Police Chief Edward Drew to meet with representatives from Sens. Edward Kennedy and John Kerry's office, as well as representatives from Congressman Edward Markey's office. ...
Hospital campaigners greet Democratic gubernatorial candidates
<http://www.dailynewstribune.com/news/local_regional/waltcandidatesdebate01282002.htm>
Elisabeth J. Beardsley, Boston Herald, January 28, 2002
WALTHAM - Democratic candidates for governor made their way past a large number of demonstrators on behalf of Waltham hospital as they entered a forum at Brandeis University Saturday. "Help us - Don't buy us," read a hand-lettered sign carried by one of the demonstrators, referring to published stories Brandeis is interested in the hospital campus, which lies on an adjoining hilltop. The hospital supporters were orderly, lining both sides of a campus road, without blocking traffic. They chanted, "We won't close," as attendees filed into a joint appearance sponsored by the 5th Middlesex Area Democrats. The demonstrators then filed into the hall and lined the back and sides of the room, several deep. "We'll just come in and make our point quietly and respectfully," said one woman. ...
Fund is set up to save hospital
<http://www.dailynewstribune.com/news/local_regional/walthospitalfund01282002.htm>
Patrick Golden, Waltham Daily News Tribune, January 28, 2002
WALTHAM - While Deaconess-Waltham Hospital is slated to close in less than three months, a newly-established fund aims to generate enough money to keep the facility open. Jane Kirsch, who served as chairwoman of the hospital's board of trustees from 1995-99 and was among the members ousted by CareGroup on Jan. 11 for refusing to vote for the hospital's closure, has spearheaded "Save the Waltham Hospital Fund" to keep the hospital afloat. ...
Around Massachusetts:
ER fills prescription to treat and soothe
<http://www.boston.com/dailyglobe2/024/south/ER_fills_prescription_to_treat_and_soothe+.shtml>
Kimberly Atkins, Boston Globe, January 24, 2002
The South Shore's newest lobby - complete with a full-time greeter, concierge, muted lighting, and potted palms - doesn't belong to a hotel. It's part of the new, expanded emergency department at South Shore Hospital. ...
More health care providers called No. 1 challenge on Cape
<http://www.townonline.com/tol/news/health/33892052.htm>
SUSANNA GRAHAM-PYE, SGRAHAMP@CNC.COM, January 21, 2002
ORLEANS If he loses sleep over one thing, it¹s staffing, says Stephen Abbot, president and CEO of Cape Cod Healthcare Inc. "That is our single greatest challenge," Abbott said during a Tuesday night meeting sponsored by the Orleans Citizen¹s Forum. Luring technicians, nurses and young physicians to Cape Cod is difficult, Abbott explained, primarily because of the growing affordable housing crisis here. ...
Surgeon Resignation Spurs Public Uproar
Citizens Plan Open Forum to Discuss Troubles at the Vineyard Hospital
Early February Meeting Discussed
<http://www.mvgazette.com/news/2002/01/25/hospital_uproar.php>
Julia Wells, Martha¹s Vineyard Gazette, January 26, 2002
Heated opinions continue to percolate in the Vineyard community this week regarding the recent conflict between the chief executive officer of and a leading surgeon at Martha's Vineyard Hospital. Dr. Richard Koehler, a highly skilled laparoscopic surgeon who has worked for the Vineyard hospital for the last seven years, announced two weeks ago that he will sever his contract with the hospital. Dr. Koehler cited irreconcilable differences with hospital CEO Kevin Burchill as the reason for his resignation. ... Yesterday, a Chilmark resident who is leading the effort to host a forum said he hopes for an event that will create a meeting of the minds on all fronts. ... Mr. Simon said the forum will include a panel of speakers, and that Dr. Koehler, Dr. Jason Lew, Dr. Stuart Kendall and Dr. Rocco Monto have already agreed to be on the panel. Mr. Simon said he also plans to invite a spokesman for the nurses, some hospital trustees and Mr. Burchill to join the panel. ...
Martha¹s Vineyard: Public Forum
This site is sponsored by an informal group of concerned citizens.
<http://www.hospital-petition.vineyard.net/forumnotice.html>
An informal group of concerned citizens is trying to organize a Public Forum on the current hospital situation. It is clear that the public has grave concerns but lacks basic information. The idea would be to have representatives from a variety of organizations within the hospital come before the public to field questions and hear concerns and ideas. ... Those willing to plan for and participate on the forum panel should contact us at the following email address and provide contact information: mvhforum@jmayhew.vineyard.net ... We are aiming at Tuesday evening, February 5th, but this is subject to change depending on many factors. Put February 5th on your calendar, and stay tuned to the web site for further details as they become arranged. Also look in the newspapers for notices. ...
Chamber speakers discuss health care crisis
<http://www.thetranscript.com/Stories/0,1002,9054%257E360482,00.html>
Carrie Saldo, North Adams Transcript, January 25, 2002
WILLIAMSTOWN -- A varied discussion on a "long term fix to health care" was on the agenda Friday morning at the Berkshire County Chamber of Commerce meeting where members of the chamber, health care professionals, and legislators met to discuss the issue. John CJ Cronin, CEO of Northern Berkshire Health Systems, which runs North Adams Regional Hospital, used the Deaconess-Waltham Hospital located in Waltham as an example "meant to demonstrate the seriousness" surrounding the health care situation. ...
Layoffs delayed at Soldiers' Home
<http://www.gazettenet.com/01262002/news/10921.htm>
Mary Carey, Hampshire Daily Gazette, January 26, 2002
Acting Gov. Jane Swift has agreed to a two-week freeze of 54 layoffs at the Soldiers' Home in Holyoke. The freeze will allow the Legislature to act on an appropriations bill containing separate funding for the home. That legislation is currently before the House of Representatives, and its passage is imminent, according to state Sen. Michael Knapik, R-Westfield, who represents Holyoke. ...
Discipline and cash resuscitate Lynn hospital
<http://www.boston.com/dailyglobe2/027/north/Discipline_and_cash_resuscitate_Lynn_hospital+.shtml>
Kathy McCabe, Boston Globe, January 27, 2002
LYNN - Five years ago, Union Hospital was on life support. Saddled with $38.5 million in long-term debt, the community hospital could not afford to invest in facilities or expand patient services. The hospital ultimately was put up for sale, attracting competitive bids from both local hospitals and out-of-state for-profit health care companies. Ultimately, after a lengthy public selection process, Union merged with its next-door neighbor and longtime competitor, North Shore Medical Center in Salem. ...
Low-income patients blocked from services as doctors drop MassHealth
<http://www.boston.com/dailynews/027/region/Low_income_patients_blocked_fr:.shtml>
Associated Press, January 27, 2002
SPRINGFIELD, Mass. (AP) An increasing number of low-income people are not getting the medical services they need close to home because more and more doctors are refusing to treat patients insured by the state's version of Medicaid, health professionals say. Radiologists, anesthesiologists, and pediatric mental health professionals may be ready to bolt from the MassHealth program because the program isn't covering their costs, said Dr. Francis X. Rockett, president of the Massachusetts Medical Society. ...
Prognosis: workers needed
Health care recruiting gets aggressive
<http://bostonworks.boston.com/globe/articles/012702_health.html>
Barbara Claire Kasselmann, Boston Globe, January 27, 2002
From billboard ads and national recruiting teams to referral bonuses and more flexible schedules, local hospitals are taking an aggressive approach to wooing prospective health care workers ‹ particularly for hard-to-fill positions in nursing, radiography, and pharmacy. To keep these hard-won employees, hospitals are offering a smorgasbord of special perks ‹ tuition reimbursement, holiday bonuses, child care, elder care, and more. With current shortfalls in these fields expected to worsen in the near term, administrators are struggling to find new ways to lead the next generation into health care, and to reach out to people seeking career changes. ...
California Safe Staffing Breakthrough:
A History of Nurse-to-Patient Ratios in California
<http://www.calnurse.org/cna/12202/12402history.html>
1992-1993:
The California Nurses Association sponsors AB 1445, the first legislation in the U.S. to establish nurse-to-patient ratios, in response to the acceleration of hospital restructuring, downsizing, and replacement of RNs with unlicensed assistive personnel.
1996:
CNA co-sponsors Proposition 216, the Patient Protection Act, a groundbreaking HMO reform ballot initiative that was the model of subsequent managed care reforms in California and the nation. The initiative directed the Department of Health Services (DHS) to promulgate emergency regulations within 6 months of enactment establishing licensed nurse to patient ratios in health care settings - a major reason Kaiser Permanente and other hospital systems contribute millions of dollars to defeat it. The Service Employees union (SEIU) also opposes Prop. 216, and introduces a competing measure, Proposition 214 without nurse-to-patient ratios. Both initiatives lose after the industry outspends supporters by about 10-1.
1997:
January. CNA returns to the legislative arena, sponsoring AB 695, which establishes specific nurse-to-patient ratios. Nurses across state mobilize in support of the bill, with letters, calls, and postcards.
1998:
August. AB 695 passes the State Legislature, the first time a ratio law has ever reached a U.S. governor.
September. CNA hosts widely covered press conferences across California increasing visibility on the need for the law. Following extensive lobbying by the hospital industry, then-Governor Pete Wilson vetoes the bill.
1999:
AB 394 is introduced, patterned after AB 695, authored by then Assembly member Sheila Kuehl on behalf of CNA. CNA contacts nurses and patients throughout the state, gathering more than 14,000 letters in support of AB 394, which are delivered to legislators and the governor. AB 394 is also backed by several other nursing and consumer organizations. Primary opposition comes from Kaiser Permanente, other hospital chains, and SEIU, which demands ratios for unlicensed staff which it represents in an attempt to kill the bill.
August. A public opinion poll commissioned by CNA shows that more than 80 percent of Californians favor legislation requiring safe nurse-to-patient ratios in California hospitals - even after hearing arguments against the bill.
September. On the day the State Senate is slated to vote on the bill, CNA mobilizes over 1,800 RNs for a mass rally on the steps of the Capitol. The Senate gives final passage to the bill. Three days later, hundreds of other nurses march and rally in downtown Los Angeles in support of AB 394.
October 10. Governor Gray Davis signs AB 394, making California the first state in the U.S. to agree to safe nurse staffing standards, drawing national and international headlines. The specific ratios are to be determined by the state Department of Health Services which requests a one-year delay in implementing the ratio provisions.
2000:
January. The provisions of AB 394 limiting the unsafe use of unlicensed personnel go into effect, with an advisory statement from the California Board of Registered Nursing announcing the specific provisions would be enforced.
April. DHS calls together the stakeholders establishing criteria for proposals. DHS asks all stakeholders submit their proposals. In August, the hospital industry, through its lobbying arm, the California Healthcare Association (CHA), submitted its proposal for staffing ratios to the DHS, proposing ratios as high as 1:12, considered unsafe by many professional health care organizations.
2001:
January-March. CNA conducts 21 Town Hall meetings across the state to hold a dialogue with over 1,000 RNs and augment research CNA has underway on its ratio proposal. The RNs are encouraged to raise their voices and step up their participation to ensure that safe ratios are enacted.
March. CNA submits its proposal for the ratios - based upon a landmark scientific research study by the Institute for Health and Socio-Economic Policy (IHSP). At the center of the IHSP research is an exhaustive study of nearly 22 million publicly available discharge records of California hospital patients from 1993 to 1998, the Diagnosis Related Groups (DRG) designations, and the severity of illness (acuity) for those patients.
July. Kaiser Permanente, which led the opposition to AB 394, announces support for limited ratios - but calls for a delay in implementation of up to five years. SEIU endorses Kaiser's call for a delay.
September. CNA mobilized one of the largest events ever in Sacramento - a rally by over 2,100 RNs, patients, and consumers to continue the campaign for safe ratios. Nurses from throughout the United States and Australia join the event. A major hearing, attended by the top leaders of the DHS, follows the rally with panels of RNs providing testimony on current conditions in California hospitals.
December. CNA sponsors events at some 150 hospitals, clinics, and other health care facilities around California to urge hospitals to support implementation of safe staffing ratios.
2002:
January. Governor Davis announces the ratios at in a Los Angeles press conference where he is joined on the stage by the CNA Board of Directors and DHS Director Diana Bonta, RN. CNA announces a series of workshops in California to train nurses to enforce the new ratios and hasten implementation and in states across the nation to encourage others to follow the California model.
Governor offers $60 million to recruit, train new nurses
The initiative aims to reverse a growing shortage of health care workers
<http://www.contracostatimes.com/news/topstory/davis_20020124.htm>
Andrew LaMar, Contra Costa Times, January 24, 2002
SACRAMENTO - California will spend $60 million over three years to recruit and train 5,100 new nurses in an effort to eliminate a growing shortage of the health care professionals, Gov. Gray Davis announced Wednesday. News of the initiative comes the day after the Davis administration proposed minimum nurse-to-patient ratios, a mandate expected to take effect in hospitals in July 2003. California is the first state in the nation to pursue such a standard. ...
Davis Pledges $60 Million to Train Nurses
Plan includes a campaign to attract newcomers and a bid to make the application process easier.
Experts say more openings at colleges are needed.
<http://www.latimes.com/news/local/la-000006074jan24.story>
Andrea Perera & Dan Morain, Los Angeles Times, January 24, 2002
Gov. Gray Davis expanded Wednesday on his proposal of a day earlier to set minimum nurse staffing levels in hospitals by pledging $60 million to train 5,100 nurses during the next three years. The money would come from special funds earmarked for work force training, and from health-oriented foundations. Davis said the proposal includes additional training for nurses, steps to make it easier to apply for nursing jobs and a statewide advertising campaign designed to attract people into nursing. The proposal includes $24 million for training in hospitals, community colleges and state universities. "We cannot get by working the existing corps of nurses harder and harder," Davis said. ...
Proposal seeks more care providers
Gov. Davis' regulations on nurses would require local hospitals to up their staff.
<http://www.latimes.com/tcn/glendale/news/la-gn0021254jan24.story>
Karen S. Kim, Low Angeles Times, January 24, 2002
GLENDALE -- A set of nursing staff ratios proposed by Gov. Gray Davis could send local hospital administrations out in hot pursuit of new hires. But with California ranking 49th in the nation in its share of registered nurses, according to the US Department of Health and Human Services, the pursuit could be a difficult one. ...
State sets nurse-patient quotas
<http://www.newsreview.com/issues/chico/2002-01-24/health.asp>
Tom Gascoyne, Chico News & Review, January 24, 2002
Two years after it was adopted by California voters, the so-called Safe Staffing Law to set nurse-to-patient ratios in the state's hospitals finally has some numbers to back it up. On Jan. 22, Gov. Gray Davis announced the range of minimum ratios as adopted by the Department of Health Services. The law, AB 394, authored by state Sen. Sheila Kuehl, D-Santa Monica, and championed by the California Nurses Association, makes the state the first in the nation to set minimum ratios. The law was triggered, supporters say, by the mass exodus in recent years of nurses from hospitals into private-care jobs or out of the profession completely. Hospital administrators say the law will be hard to enforce because of the nursing shortage. Supporters say the law will work to bring nurses back into the fold. ...
Your nurse won't be exhausted
Staffing ratios announced by Gov. Davis should assure patients they will receive top-quality care
<http://www0.mercurycenter.com/premium/opinion/edit/066117.htm>
San Jose Mercury News Editorial, January 24, 2002
NURSES are ecstatic. Hospitals are worried. And patients should be cautiously optimistic. The cause of all this emotion? California's new nurse-to-patient ratios, announced with great fanfare by Gov. Davis on Tuesday. The ratios -- the result of 10 years of effort by nurses' associations and legislators -- put California in the forefront of efforts to protect hospital patients from dangerously low levels of staffing. Ratios had already existed in the most critical care areas, such as intensive care units and operating rooms. Now, ratios will apply to the emergency room, psychiatric units, medical/surgical floors and so on. There is plenty of evidence that current staffing levels, that often leave one nurse in charge of 10 seriously ill patients, are inadequate. ...
Is staffing plan more hype than change?
<http://www.sacbee.com/content/opinion/story/1523473p-1599898c.html>
Sacramento Bee Editorial, January 25, 2002
On the day that the Republican candidates for governor faced each other in debate for the first time, Gov. Gray Davis' media counterattack was to surround himself with happy nurses. He took Tuesday to unveil what seemed like major news. He announced how he planned to implement a new law that made California the first state in the nation to require specified numbers of nurses to care for hospital patients. As he rolled out these new nurse-patient ratios, the nurses were happy and the hospital executives were not. "The more nurses, the better the care," the governor said. Yet was all this for a headline without any actual substance? ...
COMMENTARY: Nursing Is Not Just a Numbers Game
<http://www.latimes.com/news/printedition/opinion/la-000006205jan25.story>
Shirley V. Svorny, Los Angeles Times, January 25, 2002
Searching for something on which to base his reelection campaign, Gov. Gray Davis has chosen to pose as a champion of health care, with a proposal to mandate increased nurse-patient ratios across the state. Although his plan will win votes, it won't improve health care. Davis' plan presumes that hospitals are not concerned with caring for their patients and saving lives; that they are not working to get the best outcomes, given what people are willing to pay for health care. A mandate that forces hospitals to use more nurses will result in worse care, as hospitals cut back on other important needs. ...
ON ELDER-CARE: Get to know your relatives' nurses
<http://www.contracostatimes.com/health/columnists/moorhead/stories/x26comcol_20020126.htm>
Mary B. Moorhead, Contra Costa Times, January 26, 2002
MY CLOSE FRIEND Susan, who was 96, died this year because of a tiny bedsore on her heel. She contracted the bedsore while in the hospital to fix a broken hip. This barely noticed abrasion was caused by her heel rubbing on the sheet for too long. The bedsore deepened and grew until it turned into gangrene of the entire foot. Susan's only two options were to cut off her foot or let the gangrene continue until it killed her. She chose the latter ... It should be common medical practice for nursing staff to turn frail elderly patients every two hours to prevent this common abrasion. Was it an oversight that caused the staff to overlook Susan? Or were there not enough nurses to attend to her needs? ...
Web Directory:
Portland, Oregon, Strikers <http://www.fairpay4nurses.org>
Smithtown, New York, Strikers <http://www.nysna.org/NEWS/current/stcath.htm>
Australian Nursing Federation <http://www.anf.org.au>
California Nurses Association <http://www.califnurses.org>
Canadian Federation of Nurses Unions <http://www.nursesunions.ca>
LabourStart <http://www.labourstart.org>
Maine State Nurses Association <http://www.mainenurse.org>
Massachusetts Green Party <http://www.massgreens.org>
Massachusetts Labor Party <http://users.rcn.com/wbumpus/masslaborparty/index.html>
Massachusetts Nurses Association <http://www.massnurses.org>
New Zealand Nurses Organization <http://www.nzno.org.nz>
PASNAP <http://www.pennanurses.org>
Revolution Magazine <http://www.revolutionmag.com>
Seachange Bulletin <http://www.seachangebulletin.org>
Union Web Services <http://www.unionwebservices.com>
United Health Care Workers <http://www.uhcw.org>
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