📷 Ed Moore, President and CEO, Harrington Healthcare System. Courtesy Harrington Healthcare System.
By Sarah Champagne, Managing Editor
Question One on November’s ballot, regarding nursing to patient staffing ratios, has brought about a robust debate, with both sides providing arguments and pleas to either vote in favor or against the proposed staffing ratio limits and the fines described in the initiative petition. Harrington Healthcare has made no secret of its position that a “yes” vote on this ballot question will create an unmanageable financial burden for the organization and will hurt the community-based hospital’s ability to provide the region with sufficient health care services.
Recently, a rumor has circulated that if the ballot item passes that Harrington Hospital would have to close its doors after nearly a century of serving Southbridge and the surrounding area. Harrington Healthcare CEO Ed Moore recently responded to whether the rumor was true or an exaggeration of the potential impact if Massachusetts voters say “yes” to the ballot question.
“I don’t want to be alarmist, but we would have to cut back on services. We would have to make some difficult decisions,” Moore says, noting that a financial analysis performed for the hospital predicts that it would cost the healthcare company $7 million per year.
“It doesn’t imply immediate closure. On the other hand, we would have to close some services,” Moore remarks, noting that even a time frame is hard to predict, but that changes might emerge over a period of three to five years.
“Obviously it would be our goal not to close. But it would put a hardship on our ability to operate long-term,” Moore says.
Moore notes that services such as behavioral health, pediatric inpatient beds and substance abuse treatment could be some of the areas that are considered for cuts if the financial position of the hospital is negatively impacted by the passage of Question One. He also reports that the ability for the hospital to transfer emergency room patients to inpatient admissions would be compromised, calling the bill “not feasible, not logical.”
Moore notes that larger research or teaching hospitals have larger investment portfolios and endowments that provide them with a more significant cushion for the predicted financial impact of the ballot question’s regulations. Smaller community hospitals, Moore claims, do not have the ability to weather the financial storm.
How could the financial impact be so large and devastating, when the question simply asks for more nurses per patient? According to Moore, the answer lies not just in the need to hire and retain more nurses under unpredictable conditions, but in the severe financial penalties per incident and per day of noncompliance.
According to The Secretary of the Commonwealth’s publication, Information for Voters: 2018 Ballot Questions, the penalty for incidents of noncompliance is “up to $25,000 per violation as well as up to $25,000 for each day a violation continued after the Commission notified the covered facility of the violation.” Healthcare facilities also have to post notices of the staffing ratio requirements in patent areas, subject to a fine of $250 and $2500 per day.
The ballot question requires varied nurse to patient ratios in different departments and situations. For example, one nurse is required per patient under anesthesia or for critical or intensive care patient in the emergency room. Two patients per nurse are allowed post-anesthesia and for patients deemed stable in the emergency room. Psychiatric or rehabilitation units require five patients per nurse. And in “units with pediatric, medical, surgical, telemetry or observational/outpatient treatment patients, or any other unit,” staffing must provide for one nurse for every four patients.
The full text of the requirements is available in the Massachusetts Information for Voters Guide, which can be found in most town halls and libraries. A copy is also mailed to households throughout the state. An online guide to the three ballot questions is also available online (click here).
The law would take effect Jan. 1, 2019. Moore says that the law if passed does not provide for the unpredictable nature of the healthcare setting or for the differences found in different sizes and types of hospitals. He provided the examples of attempting to replace a nurse who is on a lunch break without pulling a nurse from another area that is staffed within the allowable limits, or complying with the staffing ratio limits when nurses have to call in to work.
“This question is bad for access, bad for patients,” Moore concludes.