Pressure on governor to alter nurse ratio rules.

Pressure is building on Gov. Arnold Schwarzenegger to delay or amend the state's landmark nurse staffing law, with his administration coming under hospital industry lobbying and even a petition from the Democrat-dominated L.A. County Board of Supervisors.

The law, set to go into effect on Jan. 1, requires hospitals to staff wards with specific nurse-to-patient ratios, but the industry contends that a nursing shortage has made it impossible for many hospitals to hire enough nurses to do so.

Those complaints failed to sway the Davis administration, which established the specific ratios last year following the law's passage in 1999. But with the new governor stressing the importance of making the state more business friendly, there are new efforts to change the law as its implementation date approaches.

"We do not want the regulations to go into effect until they are changed," said Jim Lott, executive vice president of the Healthcare Association of Southern California, a trade group representing the region's hospital industry. "We are not necessarily advocating a delay. You can fix it in 24 hours--or you can delay it and fix it after."

The ratios require at least one nurse for every six patients in a hospital's medical/surgical wards, where most patients are located, but as many as one nurse for every two intensive care patients. The regulations represented a compromise but still the industry was not happy with their final form.

The governor signaled that he might be open to amending the regulations when he issued an executive order after taking office placing on hold all pending Davis administration regulations for up to 90 days while a review was completed on their impact on business.

It is unclear, though, whether the nurse staffing regulations, which already had gone through the administrative law process and were set for implementation, could be subject to such a delay.

A spokeswoman for the governor said the staffing regulations were being studied to determine if they would fall under the order. The governor's office otherwise did not comment.

Beth Cappel, a lobbyist for the Service Employees International Union, which represents nurses in California, disputed that the governor would have the power to arbitrarily delay or change the law.

"It is a regulation that is in place. To revise it would require a change in the law or a change in the regulation. He cannot simply suspend. We have due process. Three branches of government. He is not the king," Cappel said.

California Nurses Association, the registered nurses professional association that sponsored the law, deplored the industry lobbying, said Chuck Idelson, its spokesman.

"Hospitals have had four years to prepare for this law, and because of their failure to prepare and their continuing opposition to a law they don't like they are now trying to sabotage the health and safety of millions," he said.

Specific changes sought

The industry contends that unless certain changes are made, it will be impossible for hospitals to comply with the rules, making them liable for state sanctions.

Specifically, the industry is looking to relax regulations applied to emergency rooms, where hospitals must have one nurse on duty for every four patients. The ratios are even tougher for patients requiring critical care and for trauma victims.

Hospital representatives have argued that unpredictable fluctuations in admissions to emergency rooms make the requirement difficult to comply with. There also are concerns that nurses who operate radios to communicate with paramedics during emergencies cannot be included in the ratios.

"You may staff based on historical data, and all of a sudden you have more ambulances coming to your hospital and more patients than you expected and you are out of compliance," Lott said.

Also at issue are ratios in psychiatric and rehabilitation wards, which hospital groups want relaxed during the evening when patients are sleeping. Moreover, they would like the state to exempt hospitals from sanctions if it can be shown they have done all they can to recruit nurses but are unable to find enough. Current regulations require hospitals to close beds if they do not have enough nurses to staff them.

Representatives of the unions said Davis and the state Department of Health Services had considered these points when the regulations were drafted.

Idelson charged that with the sanctions only amounting to $50 per day per affected patient, what the industry really wants is limiting their economic exposure from lawsuits.

"What they are really afraid of is that the state of California had determined (through these ratios) that the minimum safety standards are for hospitals, and if a patient is harmed by unsafe staffing then you have an enhanced opportunity for litigation," he said.

The hospital industry turned back legislation earlier this year that would have strengthened sanctions, upping them to $5,000 per violation.

The unions' hard line opposition to changes in the law softened last week when the SEIU worked out an agreement with Los Angeles County supervisors who passed a motion asking for limited relief.

Originally the motion, introduced by Supervisor Mike Antonovich, asked for wide-ranging relief for county hospitals. But the union, which represents county hospital and other workers, opposed it. The amended petition asked for the county to be exempted from any sanctions while it continues to vigorously recruit new nurses.

Supervisor Yvonne Brathwaite Burke said she voted for the petition, which passed unanimously, after being convinced that the county will not have enough nurses on hand by Jan. 1 to staff all the available beds in its public hospitals.

"We can't find the nurses. Some of the private hospitals can pay so much more than we can pay," she said. "I support the idea, but I just don't know how we can do it."

L.A. County has been in the process of hiring 640 nurses to meet the ratios, while other private hospitals report similar numbers. Tenet Healthcare Corp., which operates 39 hospitals statewide, has been trying to recruit 1,000 nurses, while Catholic Healthcare West, with 37 hospitals statewide, also is recruiting large numbers of nurses.

However, top facilities like UCLA Medical Center and Cedars-Sinai Medical Center, as well as Kaiser Permanente facilities, say they will have enough nurses and do not anticipate any problems.