2002: nurse-to-patient ratios.

'ALTHOUGH labor emerged as the clear victor last week when the state finally issued nurse-to-patient staffing ratios, the hospital industry is likely to fight some of the plan," the Business Journal reported in January 2002.

"Industry officials said they are mostly concerned about meeting the ratios affecting emergency rooms. The state essentially sided with labor, proposing individual nurses care for no more than a single trauma patient, two critical care cases and four regular patients," the Business Journal reported.

"The industry's primary concern about the ratios is that there aren't enough nurses around to fill them, a concern in particular with ER nurses since they have specialized training. Emergency rooms in the region and throughout the state have become notoriously overcrowded, routinely turning away patients when they are filled."

When the regulations took effect in January 2004, the hospital industry's concerns appeared to be justified. Santa Teresita, a tiny 30-bed facility in Duarte, shut down within weeks, citing the ratios. And by July, at least seven Los Angeles area hospitals either closed or downgraded their psychiatric units, also citing the nurse-to-patient ratios, as well as decreased reimbursements.

In all, a half-dozen hospital closures were announced this year among L.A.'s 79 acute care facilities, with a good share of the blame heaped on the ratios. But the California Nurses Association said the industry was pointing a finger at the ratios in order to weaken them.

Then, in early November, Gov. Arnold Schwarzenegger eased the requirements, allowing leeway for breaks and flexibility for emergency rooms among other changes, prompting the nurses association to accuse the governor of caving in to the industry.

"Out of the Past" is published each week to celebrate the 25th anniversary of the Business Journal.