Lodi hospital fails to meet nurse ratio

Despite closing 12 of its beds while searching for 35 new nurses, Lodi Memorial Hospital was unable to fully comply with a nurse-to-patient ratio law that went into effect on New Year's Day.

All of California's hospitals are now required to comply with the 1999 nurse ratio law despite a last-minute court challenge by the California Healthcare Association on Tuesday. The law, the first of its kind in the nation, requires hospitals to have a set number of nurses in relation to patients in each ward. These ratios vary ward by ward. For example, in the medical/surgical ward the ratio is 1:6, but in pediatrics the ratio is 1:4.

Lodi Memorial was not able to comply fully with the new ratios on Jan. 1, said hospital spokeswoman Carol Farron on Friday. Farron did not have specifics about which wards were not in compliance, nor for how long they could remain in that status. She said the hospital would report the noncompliance to the state.

Right up to the Jan. 1 deadline, hospitals across the state scrambled to hire enough nurses to meet the ratios. Hospitals went on recruiting sprints and hired expensive traveling nurses on temporary contracts.

Lodi Memorial currently has 256 staff nurses. Last year, Lodi Memorial hired 22 traveling nurses to meet the ratio law despite recruitment trips to Ohio, a state with a much higher per capita number of nurses than California. Traveling nurses can be paid up to twice as much as staff nurses, who are paid an average of $77,000 a year, said Farron.

"The most significant impact on this community is ... that we had to shut down some of our (medical/surgical) beds."

Of the 12 beds closed, eight were medical/surgical beds, Farron said.

"With a community this size and a hospital this size it is big," Farron added. "It's going to mean longer waits if you require admission to the hospital."

A final version of the ratios were published by the state Department of Health Services in July after a grueling debate between hospital industry advocates and nurses unions over how to set the ratios. When the final version was published, they reflected mostly recommendations that the California Nurses Association, the law's sponsor, had advocated.

"They're pretty close," Liz Jacobs, a registered nurse and spokesperson for the California Nurses Association said Wednesday. "By 2008 they're going to continue to improve."

In 2005, even tighter ratios for some wards will be required by the law, and more in 2006, and so forth. For example, the nurse-to-patient ratio in medical surgical wards is 1:6 now and will jump to 1:5 in 2005, under the law. The requirement for nurses in telemetry wards is 1:5 now and in 2008 will be 1:4.

On Tuesday afternoon, the California Healthcare Association filed a lawsuit against the Department of Health Services, challenging a portion of the law which requires hospitals to be in continual compliance with the new law.

Jan Emerson, a spokeswoman for the California Healthcare Association, said the lawsuit was filed because the state Department of Health Services did not define what it meant by "continual compliance" until after public hearings on the matter were closed. The continual compliance portion of the law will require hospital wards to staff back-up nurses to cover for a nurse that wheels a patient to take an X-ray, takes a lunch break, or uses the restroom, Emerson said.

Farron agreed.

"The requirement that the ratios be in effect at all times are going to be impossible to meet," Farron said.

Lea Brooks, a spokeswoman for the California Department of Health Services, declined to comment directly on the lawsuit Wednesday.

"We are reviewing the lawsuit and it is inappropriate to comment on an issue that's open to litigation," she said.

Officials at the state Department of Health Services could not be reached for comment.

Efforts to hire new nurses have been stymied by a statewide nursing shortage, claim hospital advocates. Last year, California ranked 49th in number of nurses per capita in the country, topping only Nevada, according to the U.S. Department Bureau of Labor Statistics.

But the California Nurses Association blames the nursing shortage on the hospitals.

"There has not been a shortage of nurses there has been a lack of nurses willing to work in unsafe conditions," Jacobs said. Hospitals have laid-off more qualified and experienced nurses for less experienced ones that are paid less out of concern for their bottom line, Jacobs said.

The threat that some hospitals will have to close beds is not much more than a scare tactic, Jacobs said.

That is a claim Farron strongly disagrees with.

"No that's ridiculous," she said. "We spend our greatest energy in recruiting and retaining nurses."

Closing hospital beds is only in response to a very real shortage, Farron added.

Emerson also maintains that hospitals are feeling the crunch from the number of uninsured that arrive at hospital emergency rooms. Hospitals are required by law to accept patients that come into their emergency rooms, regardless of whether or not they have coverage.

Jacobs agreed that part of the problem, at least, is systemic.

"Overall, there is a basic fundamental problem with our health care, there does need to be some sort of single payer rate for the uninsured," Jacobs said. "Hospitals have become the primary source of care (for sick people)."