Hospitals Need 25% More Nurses | LAT | 10.26.04
Officials say the L.A. County facilities cannot fully comply with state ratios. Some employees refusing to take on more patients are suspended.
Los Angeles County’s five public hospitals are more than 25% short of the number of nurses they need to fully comply with state laws on nurse-patient ratios, and officials doubt they can substantially increase the nursing ranks anytime soon. …
County officials deny they are jeopardizing the health of patients but acknowledge they are not in full compliance with the ratios. The county says it needs 4,555 nurses to meet state rules but has only 3,361 nurses at the five hospitals.
Dr. Thomas Garthwaite, director of the county’s Department of Health Services, said he is unhappy with the situation but sees little alternative…”If it was unsafe today, we would take immediate action,” he said. …
Nurses at Harbor-UCLA Medical Center and County-USC have refused to take on more patients than allowed and called union representatives to back them up. Some arguments with supervisors grew so heated that police were called. …
Los Angeles County is not alone in its struggle to meet the state’s mandate, said Jan Emerson, a spokeswoman for the California Healthcare Assn.
About 85% of the hospitals throughout the state do not meet the nurse-to-patient ratios. On average they had 15% fewer nurses than needed to fully meet the ratio rules. …
“They’re always staffing to the bottom line, saying they didn’t anticipate emergencies or anticipate a nurse calling in sick.”
Anyone working in a high performance EMS system will recognize the tremendous conceptual gulf that nursing-ratios have created between what has been implemented and what is needed. In essence, ratios are the EMS-equivalent of the responsive time parameter. If an EMS system has a response time of 4 minutes for BLS at the 90th percentile and 8 minutes for ALS at the 90th percentile this translates into a time-of-day, day-of-week, and time-of-year staffing regime. A high performance EMS can [not] offer this degree of performance based on anything less than a peak-staffing model based on historical data. What the nurse-staffing ratios forced in January was average staffing driven in a reactionary fashion. Peak-staffing is expensive, but in the long term it may be the only way to meet compliance (which is not going away, on the horizons are significant litigations—not to mention what role ratios will play with malpractice) and decrease the tremendous costs of filling staffing deficiencies with “travelers.”
With regards to a nexus between ratios and malpractice, will ratio non-compliance ever be used to prove negligence, via negligence per se, in proving negligent liability?
{ 4 comments… read them below or add one }
I'm not sure, but this might be a situation where a little bit more liability exposure on the part of the hospitals would be helpful. When you have 85% of the hospitals in the state out of compliance, either the regulations are unreasonable (doubtful), or the perceived risks of noncompliance aren't serious enough.
Perhaps (I'm just speculating) the hospitals know that it's virtually impossible for a patient to prevail in a malpractice action against the hospital based on respondeat superior or “ostensible agency.”
In that case, the malpractice suits that are filed might focus exclusively on the physicians, who will be held responsible for errors caused by inadequate nurse staffing ratios–over which the physicians had no control.
I’m not sure, but this might be a situation where a little bit more liability exposure on the part of the hospitals would be helpful. When you have 85% of the hospitals in the state out of compliance, either the regulations are unreasonable (doubtful), or the perceived risks of noncompliance aren’t serious enough.
Perhaps (I’m just speculating) the hospitals know that it’s virtually impossible for a patient to prevail in a malpractice action against the hospital based on respondeat superior or “ostensible agency.”
In that case, the malpractice suits that are filed might focus exclusively on the physicians, who will be held responsible for errors caused by inadequate nurse staffing ratios–over which the physicians had no control.
I agree with all three of your statements. I'm also concerned about the potential interplay of the staffing ratios and the EMTALA mandate. There is the EMTALA mandate to provide a medical screening exam and provide emergency stablizing care for all comers and often that mandate forces significant impaction of Emergency Departments (ED) and volumes that often exceeds staffing ratios. The relief either comes in ED closures (by diversion of ambulances) or remaining open and “violating” the ratios.
I agree with all three of your statements. I’m also concerned about the potential interplay of the staffing ratios and the EMTALA mandate. There is the EMTALA mandate to provide a medical screening exam and provide emergency stablizing care for all comers and often that mandate forces significant impaction of Emergency Departments (ED) and volumes that often exceeds staffing ratios. The relief either comes in ED closures (by diversion of ambulances) or remaining open and “violating” the ratios.