QUESTION ONE IS A BALLOT INITIATIVE THAT CALLS FOR THE
LIMITS ON THE NUMBER OF PATIENTS ASSIGNED TO ONE NURSE AT A TIME.
SUCH A MEASURE WILL ENSURE PATIENT SAFETY BUT NOT EVERYONE
IN THE MEDICAL COMMUNITY AGREES.
LAST NIGHT WE HER FROM THOSE IN FAVOR OF QUESTION ONE AND
TONIGHT WE HEAR FROM THOSE AGAINST IT.
THEY SAY IT WOULD DO MORE HARM THAN GOOD.
CAROL JEA -- CAROL McGRAFF TO FIND OUT
WHY THEY ARE OPPOSED TO QUESTION ONE.
>> WE HAVE RATIOS, ONE-TO-ONE, ONE TO SIX.
DEPENDING ON THE SEVERITY OF THE PATIENTS.
THIS RIGID LIMIT IS WHAT REALLY IS AN ISSUE FOR HOSPITALS LIKE
HOLYOKE MEDICAL CENTER, SMALL HOSPITALS, BECAUSE WE HAVE FEW
RESOURCES TO PAY FOR THE ADDITIONAL NURSES REQUIRED.
FRANKLY, FROM A PATIENT SAFETY STANDPOINT WE DON'T SEE THE NEED
FOR IT.
THERE IS NO NEED TO SAY, AT NIGHT, WHEN PATIENTS ARE RESTING
TO HAVE A LIMIT THAT'S AS STRICT AS THE ONE TO FOUR THAT'S BEING
PROPOSED.
IT'S REALLY A LAW THAT COULD PUT HOLYOKE MEDICAL CENTER OUT OF
BUSINESS.
IT'S FINANCIALLY UNSUSTAINABLE FOR HOLYOKE MEDICAL CENTER, AND,
IN ADDITION TO, YOU KNOW, FACT IT WILL COST $6 MILLION THAT WE
CAN'T AFFORD IT WILL PUT PATIENTS AT RISK.
>> HOW WOULD IT PUT PATIENTS AT RISK?
THOSE IN FAVOR OF IT SAY THAT IT WON'T.
THAT IT WILL IMPROVE PATIENT SAFETY.
>> THE WAY IT WILL PUT PATIENT AT RISK IS ALL THE HOSPITALS IN
MASSACHUSETTS WOULD HAVE TO RAMP UP AND HIRE MANY NURSES.
HOLYOKE MEDICAL CENTER ALONE HAS 63 OR 64 NURSES THAT IT WOULD
HAVE TO HIRE AND THERE IS A NURSING SHORTAGE.
WE'RE TRYING VERY HARD TO KEEP ALL OUR POSITIONS FILLED.
IT WOULD BE LITERALLY IMPOSSIBLE TO DO THAT AND THE WAY THEIR
TIMES AND THE BACK-UP WOULD BE, IT WOULD BE SIGNIFICANT.
>> HOW WOULD THIS IMPACT YOUR JOB?
SO THE RATIOS THEY ARE TALKING ABOUT IS ONE-TO-ONE IN
MATERNITY.
ONE TO FOUR IN SURGERY, THAT MAKES SENSE FOR THE LAY PERSON
BUT WHAT WOULD THIS MEAN, YOU KNOW, FOR YOU, AS A NURSE?
>> YOU KNOW, QUITE A BIT.
WE HAVE RATIOS ALREADY, SO TO SPEAK.
WE HAVE PATIENT LIMITS ALREADY, SO TO SPEAK.
IT'S A COMPLEX DECISION-MAKING PROCESS.
THERE IS NO SPECIFIC RECIPE THAT WORKS.
IT DEPENDS ON DIFFERENT SCENARIOS ON DIFFERENT DAYS.
AND SO TO THINK ABOUT THIS BEING A RATIO THAT'S SO STRICT AND
RIGID AND WITHOUT FAIL IS DIFFICULT, FROM A CHIEF NURSING
PERSPECTIVE, TO STAFF FOR THAT, AND TO MAKE SURE THAT THERE IS
COVERAGE IS A PHENOMENAL CHALLENGE.
THERE AREN'T BANKS OF NURSES THAT WANT TO TAKE PER DIEM CALL
JUST IN CASE PEOPLE WANT A RELIABLE PAYCHECK AND
CONSISTENCY.
THOSE LOGISTICS ARE TOUGH AND FOR NURSES AT-THE-BEDSIDE I FEAR
MOSTLY ABOUT THEIR AYUTONOMY AN PROFESSIONALISM BEING TAKEN
AWAY.
>> TALK A LITTLE BIT ABOUT THAT.
YOU WERE TALKING ABOUT AWAY TIMES AND SERVICES BUT WHAT
WOULD THAT MEAN FOR PEOPLE?
>> IF I HAVE TO CAP ON THE FLOOR OR ON THE INPATIENT SIDE BECAUSE
THERE AREN'T ENOUGH NURSES, WE'RE AT OUR MAXIMUM RATIO IT
FLOWS DOWNHILL THAT MEANS PATIENTS HAVE TO BOARD IN THE
EMERGENCY DEPARTMENT AND WE SEE THAT TODAY WITH OUR ICU LAW
THAT'S ALREADY IN EFFECT.
TO THINK ABOUT THAT BEING MAGNIFIED TO MORE AREAS IS
FRIGHTENING.
IT'S LOUD IN THE EMERGENCY ROOM, CROWDED, IT'S NOT THERAPEUTIC.
FAMILIES CAN'T VISIT AND THEN THE PEOPLE IN THE WAITING ROOM,
IT BACKS UP MORE AND THEY CAN'T BE SEEN AND THAT'S TERRIFYING.
>> AND LET'S TALK A LITTLE BIT ABOUT THE NUMBERS BECAUSE I KNOW
THERE IS A DISPUTE ABOUT HOW MUCH THIS WOULD COST HOSPITALS
IN MASSACHUSETTS.
I KNOW THERE WAS AN INITIAL REPORT BY THE COALITION TO
PROTECT PATIENT SAFETY WHICH SAID $1.3 BILLION, AND THOSE IN
FAVOR OF QUESTION ONE SAID NO, IT MIGHT BE AROUND $50 MILLION,
AND THEN THERE WAS ANOTHER REPORT THAT JUST CAME OUT BY THE
HEALTH COMMISSION THAT SAID IT WOULD BE AROUND $900,000.
WHAT ARE WE TALKING FOR NUMBERS?
WHAT'S THE REAL STORY?
>> THE REPORT THAT CAME OUT IS PUTTING A NUMBER AT $950
MILLION.
$949 MILLION, NOT THOUSAND.
I JUST WANT TO MAKE SURE.
AND REALLY, ESSENTIALLY, IT VALIDATES WHAT THE COALITION TO
PROTECT PATIENT SAFETY HAS BEEN SAYING ALL ALONG, WHAT THE
HOSPITALS HAVE BEEN SAYING, WHICH IS, IT'S A VERY COSTLY
BILL, AND WE DON'T QUITE UNDERSTAND WHY THE -- WHERE THE
VERY LOW NUMBER OF $50 MILLION COMES FROM.
FOR HOLYOKE MEDICAL CENTER THE NUMBER IS $6 MILLION.
IT CAN'T BE THAT LOW.
NOW WE HAVE VALIDATION BY AN INDEPENDENT AGENCY THAT SAYS IT
WILL COST NEARLY A BILLION DOLLARS TO IMPLEMENT.
>> DO YOU THINK PEOPLE REALIZE THAT BECAUSE, YOU KNOW, -- ON S
FACE IT SEEMS LIKE IT'S A GREAT IDEA.
THAT THERE ARE PLENTY OF PEOPLE SURROUNDING THEM, GIVING THOSE
WRAPAROUND SERVICES IN THE HOSPITAL AND IT SOUNDS LIKE THIS
IS THE RIGHT MOVE.
HOW DO YOU CONVINCE VOTERS WHO WILL GO OUT THERE AND TRY AND
MAKE THIS DECISION, THAT THIS IS NOT GOING TO MAKE THINGS BETTER
FOR THEM?
>> OH, I THINK, I THINK IT'S IMPORTANT FOR VOTERS TO TUNE IN
LIKE THEY ARE TODAY AND TO HEAR THE DIFFERENT SIDES.
I THINK IT'S IMPORTANT FOR PEOPLE TO READ THE LANGUAGE.
AND I THINK IT'S IMPORTANT FOR PEOPLE TO THINK ABOUT WHAT IT
MEANS FOR THEM AND THAT HEALTHCARE COST THAT'S BEING
QUOTED AS CLOSE TO A BILLION DOLLARS IS GOING TO TRANSLATE TO
PAYERS, AND THE COMMUNITY, SO THAT'S ONE THING.
MORE IMPORTANTLY, THOUGH, I THINK IT'S REALLY IMPORTANT FOR
FOLKS TO UNDERSTAND THAT THEIR ACCESS TO CARE WILL BE LIMITED.
THERE WILL BE WAIT TIMES IN EMERGENCY DEPARTMENTS, AND THAT
UNKNOWN DIAGNOSIS IS RISKY, AND, BOY, THAT HITS HOME.
THAT'S WHAT I THINK IT MEANS TO THE PUBLIC THAT'S MOST
IMPORTANT.
>> AND FOR THE SMALL COMMUNITY HOSPITALS IN PARTICULAR, WHAT
ARE YOU HEARING FROM OTHER HOSPITALS IN WESTERN
MASSACHUSETTS?
>> THE IMPACT IS ESSENTIALLY THE SAME ACROSS THE STATE.
IT'S JUST ON A BIGGER SCALE IF YOU'RE A BIGGER HOSPITAL.
SOMETIMES, YOU KNOW, SYSTEMS CAN -- BIGGER SYSTEMS CAN ABSORB
COSTS A LOT EASIER.
FOR COMMUNITY HOSPITALS IT LITERALLY IS A DIRE SITUATION.
I MEAN, OUR BOTTOM LINE LAST YEAR WAS MUCH SMALLER THAN THE
NUMBER, THE $6 MILLION IT WILL COST US TO IMPLEMENT IT.
IT'S DIRE ACROSS THE STATE.
>> WHAT SERVICES, OFF THE TOP OF YOUR HEAD, WOULD BE GONE IF THIS
WENT INTO EFFECT?
YOU SAID IT'S A PRETTY QUICK TURNAROUND IF IT WENT INTO
EFFECT THAT YOU WOULD HAVE TO MAKE THOSE ADJUSTMENTS?
>> IN FAIRNESS TO FOLKS WATCHING AND OUR PATIENTS, I WOULDN'T
WANT TO PUT OUT SPECIFIC SERVICES THAT WE MAY HAVE TO
SCALE BACK.
IT'S NOT FAIR TO HAVE THESE DISCUSSIONS BEFORE WE KNOW IF WE
HAVE TO, BUT THE REALITY IS, WE CAN'T CONTINUE TO DO EVERYTHING
THAT WE'RE DOING TODAY AND COME UP WITH $6 MILLION.
AT SOME POINT WE'LL HAVE TO DECIDE WHAT ELSE WE NEED TO
ELIMINATE OR CUT BACK IN ORDER TO PAY FOR THIS BILL.
AND, AT A TIME WHEN HOLYOKE MEDICAL CENTER HAS DONE A LOT OF
WORK OVER THE LAST FIVE YEARS TO GROW SERVICES AND PROVIDE MORE
SERVICES IT WOULD BE VERY UNFORTUNATE TO HAVE TO CUT BACK.