Massachusetts Medical Society: MMS States Opposition to Two Pending Ballot Questions

MMS States Opposition to Two Pending Ballot Questions

Richard. P Gulla
(781) 434-7101

Waltham, Mass. -- June 13, 2014 -- The Massachusetts Medical Society today announced its opposition to two bills before the Massachusetts Legislature that, unless approved by the Legislature before the end of the current session, are expected to become state ballot initiatives in November.

The measures are House Initiative Petition No. 3843, “The Patient Safety Act”, which would designate specific staffing ratios of registered nurses to patients in other hospitals and other health care facilities; and House Bill 3844, “The Hospital Profit and Transparency Act.”

Statement on H. 3843, by Richard S. Pieters, MD, president of the Massachusetts Medical Society:

“In considering our opposition to this proposal, we should note that the Massachusetts Medical Society has always advocated for the safety of all patients in Massachusetts health care facilities. The MMS also recognizes that there are significant changes in the manner in which such facilities are staffed, and the tasks that staffs are required to do, both in terms of direct, hands-on patient care and indirectly when complying with ever increasing documentation regulations.

“The Society appreciates that efforts to accurately quantify nurse/patient ratios are conducted in the face of marked variation - not only between hospitals (by nature of their specialty and subspecialty patient populations), but even among nursing units within one institution. 

“It seems logical to consider all of the factors which impact patient safety for a given unit when arriving at staffing recommendations, and to be careful not to limit the ability of those managing the nursing unit to make changes in order to maximally utilize available resources when an unanticipated need arises.

“It also is clear that in the current environment, no additional funds will be diverted to health care for increasing nurse/patient ratios; in fact the fiscal policy of the state and the country is to decrease the cost of health care wherever possible. 

“Mandating increasing nurse/patient ratios in this setting will, of necessity, require cutting costs in other health care disciplines. Reductions in numbers of hospitalists, physical therapists, respiratory therapists, pharmacists, transport staff, housekeepers, and dietary staff (to name a few) will invariably decrease the quality of the care offered, and possibly prolong hospital length of stay, in addition to giving rise to new concerns about a decline in immediate patient safety.

“The MMS believes that the utilization of our nursing colleagues should be reviewed to determine how much of their current responsibilities unrelated to direct patient contact could be reduced by either absolute reduction  or transfer to non-nursing personnel, giving the nurses more time to spend with their patients. 

“We also recommend that the Massachusetts Nurses Association and the Massachusetts Hospital Association work together to evaluate more completely the aspects of nursing/patient ratios which impact patient safety. An attempt to come to agreement on a way to achieve maximal patient safety without the negative impact of simply mandating fixed ratios serves everyone’s best interests. The MMS is more than happy to contribute to this working group in any way to support such worthy goals.

“California is the only state that defines mandatory nurse staffing ratios in health care settings. Laws such as California’s have not been shown to improve patient safety. However, as common sense and experience support, the literature tends to indicate that ‘those hospitals that are most effective in ensuring patient safety generally find it optimal to employ more nurses per patient.’

“This conclusion highlights an important distinction: improved nurse staffing, in combination with other elements of the hospital, may contribute to improved patient safety; however, laws mandating patient nursing ratios have not had a significant effect alone on improving patient safety, and the effects of such laws have been difficult to distinguish, given the number of confounding factors that contribute to patient outcomes in health care settings.

“The nursing community does not unanimously favor mandated nurse staffing levels. Although the MNA supports mandated nurse staffing ratios, the American Nurses Association advocates for a more flexible approach. The ANA’s position accounts for patient numbers and the variable intensity of care required; the level of education, training, and experience of the nurses providing care; and care provided by other health care personnel, among other factors. The Organization of Nurse Leaders of Massachusetts and Rhode Island opposes the approach as well.”

Statement on H.3844, “The Hospital Profit and Transparency Act,” by Dr. Pieters:

“One stated purpose of the measure is to increase transparency.  As such, there are already many opportunities for the public to obtain such information, and for that purpose this measure is unnecessary. 
“Further, the civil penalties proposed seem arbitrary and punitive. Penalties would be on hospitals whose profits exceed 8 percent, or whose CEOs receive compensation exceeding 100 times the hospital’s lowest paid staff workers. These and other benchmarks have no discernible basis in science or any other objective measure.”

The Massachusetts Medical Society, with more than 24,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society, under the auspices of NEJM Group, publishes the New England Journal of Medicine, a leading global medical journal and web site, and NEJM Journal Watch alerts and publications covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country.

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