Question 1: Battle of information over nurse staffing

The battle over Question 1 on the upcoming November ballot 1 continues to divide health professionals in Massachusetts. (Creative Commons)

By Patrick Lovett
Boston University Statehouse Program

This article was previously published in the Daily Hampshire Gazette.

WESTERN MASS. — A study for the state Health Policy Commission released last Wednesday adds to the sharp division among western Massachusetts health professionals over Question 1, the November ballot proposal that would set limits on the number of patients nurses can care for in hospital settings.

Brought to the ballot by the Massachusetts Nurses Association, Question 1 would set a limit on the number of patients per nurse, varying by each type of unit and level of care. The union argues the limit would be safer for patients. Hospitals and health organizations overwhelmingly oppose it.

Recent polls show voters are largely split over the proposed mandate. According to a recent WBUR poll, 44 percent plan to vote “yes,” 44 percent plan to vote “no,” and 12 percent are still undecided.

The debate was re-energized with the Health Policy Commission-sponsored review that pegged the question’s cost at a range of $674 million to $949 million to implement.

That is much more than the $35 million to $47 million the Massachusetts Nurses Association estimated, but less than the $1.31 billion the Coalition to Protect Patient Safety, an anti-Question 1 group, recently estimated.

MNA Executive Director Julie Pinkham said in a statement the commission’s estimate was inaccurate and suggested it correlated with the numbers from the Coalition to Protect Patient Safety.

In western Massachusetts, Cooley Dickinson Health Care, Baystate Health, and Heywood Hospital have opposed the question, allying with the Coalition to Protect Patient Safety.

“I’m really concerned about patients’ access to care,” said Angela Belmont, the head of nursing at Cooley Dickinson in Northampton. “This question could force our nurses to choose between treating patients or breaking the law.”

The ballot initiative proposes penalizing health care providers with a $25,000 fine for every instance they break the limit, adding to many providers’ concerns over the implementation cost. Belmont and other managers say costs will likely cause them to shut down community programs.

“There are only two reasons a health care system would do that,” countered Donna Stern, a registered nurse at Baystate Franklin Medical Center. “One, they are actually in financial trouble, or two, they don’t want to.”

Stern is a regional director of the MNA representing northwestern Massachusetts. She claimed anti-Question 1 groups have resorted to “scare tactics” to protect their financial interests.

“You need to look at who is actually supporting and opposing the question,” Stern said. “Eighty-six percent of bedside nurses support patient limits,” emphasizing bedside as opposed to nurse managers.

Even that percentage is up for debate. Belmont said 86 percent is a deeply flawed number and the MNA has less support than advertised.

Both sides also claim to support nurse flexibility and patient safety. The Coalition to Protect Patient Safety and its supporters argue a flood of patients would overwhelm a hospital with patient limits.

“This mandate will dramatically increase emergency department wait times and delay other lifesaving care services,” said Deb Provost, the chief nursing officer at Baystate Franklin. “There are no exceptions to this mandate. The law would prevent hospitals from making essential last-minute changes, even in the event of an unexpected influx of patients.”

Stern claims this argument is inaccurate, citing The Emergency Medical Treatment and Active Labor Act, a federal mandate that says patients may not be turned away regardless of their ability to pay.

“There would be no diversion or turning patients away,” she said. “That’s illegal, whether there is a disaster or not.”

So far, several candidates for elected office have taken sides. Notably, U.S. Sen. Elizabeth Warren and Democratic gubernatorial candidate Jay Gonzalez  have endorsed it, while Gov. Charlie Baker has remained neutral, awaiting the cost analysis.

“Nurses work hard to take care of all of us when it matters the most,” Warren said in a statement. “We should do the same for them by establishing standards to ensure they have the help they need to do their job safely.”

Northampton resident Stanley Moulton, a former Gazette editor who served on a Citizens Initiative Review panel, heard from both experts and advocates on the question. He said the challenges and intricacies of the question make the review panel’s report especially valuable.

State Rep. Jonathan Hecht, D-Watertown, who started the citizen’s review panel, echoed that sentiment.

“Voters find these issues confusing,” Hecht said.

“The goal is not to advocate for a certain side, but to distill it down to the most essential parts of the question,” he said, referring to matters like financial cost, nursing support, mandated procedures and how similar regulations have played out in other states.  “That way voters will make an informed decision in November.”

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