JUNE 18 TESTIMONY

TESTIMONY OF LEO STOLBACH, M.D. TO THE JOINT COMMITTEE ON HEALTH CARE, MASSACHUSETTS LEGISLATURE, 6/18/03

My name is Leo Stolbach. I have been a practicing Medical Oncologist since 1964. I am a Professor of Medicine at the University of Massachusetts Medical School and most recently was Director of Hematology & Oncology at St. Vincent Hospital in Worcester from 1991-1998.

As a medical oncologist caring for patients with cancer, I know the crucial role of nurses in the care of these patients. This includes checking of doses and proper administration of chemotherapy drugs, monitoring of side effects of chemotherapy, and dealing with the numerous complications related to the disease and/or its treatment. Most important, nurses also have to have the time to support patients emotionally since they are dealing with a life threatening diagnosis.

The oncology nurses that I have worked with over the years have had these important goals as central to their mission of giving patients excellent care. However, in the past 10 years their ability to carry out this mission has been steadily eroded--by understaffing and transferring of responsibility to less trained personnel, and by fatigue due to mandatory overtime.

I had the honor of marching on the picket line with nurses at St. Vincent Hospital in Worcester, who challenged the hospital’s mandatory overtime policy. The issue was not financial gain for the nurses; it was patient safety that was at the heart of the protest.

As a practicing physician I have come to appreciate that adequate time with patients is crucial to their optimal care, for MDs and nurses. I strongly support Bill 1282 with its requirement for adequate staffing levels. In my field of oncology, nurses cannot do justice to caring for 6-8 patients who are receiving chemotherapy and having complications. The present bill requires a nurse to patient ratio of at least 1 to 4 for medical and surgical patients and requires acuity measurements to determine the appropriate number of patients assigned to a nurse.

Medical Oncology has changed significantly during my years of practice. We used to admit a significant percentage of our patients for chemotherapy and for diagnostic workups. Because of improvements in therapy and cost constraints, most of these things are being done in the outpatient department. The patients who are admitted are, therefore, the sickest with the highest acuity scores, and often need more attention. It is for this reason that acuity scores need to be considered in assigning a given number of patients to nurses. The safety of our patients is crucial and adequate and appropriate staffing is an important part of the answer.

Finally, I have seen many competent and well-trained nurses leaving the active practice of nursing and going into ancillary fields. I am convinced that when safe staffing returns to the hospitals that many nurses will also return to the work that they love and are dedicated to.