Bill Would Improve Health Care Quality and Safety, Help Reduce Costs
Boston, MA – Representatives of Massachusetts health care organizations, medical professionals, senior citizens, and others testified at a hearing before the Legislature’s Joint Committee on Health Care in support of The Patient Safety Act, H.3912, on Tuesday, November 3 at the State House. The Patient Safety Act would set limits on the number of patients a hospital nurse can be forced to care for at one time, leading to reductions in the incidence of medication errors, hospital-acquired infections, and other adverse patient outcomes.
The Centers for Disease Control (CDC) reports that in Massachusetts, 2,000 people per year, or almost six people per day, are dying because of hospital-acquired infection and medical error. Nurses signaled this trend early. A statewide survey conducted in 2007 by Opinion Dynamics Corporation (ODC) for the Massachusetts Nurses Association (a member of the Coalition to Protect Massachusetts Patients, a statewide consortium working to pass the legislation), indicates that 28% of Massachusetts hospital patients and their families say that their safety, or a family member’s safety, was directly compromised by nurse understaffing during their hospital stay.
“One of those who died needlessly in a Massachusetts hospital was my daughter Taylor who we lost because her care was not properly monitored and coordinated,” said John McCormack, co-chair of the Coalition to Protect Massachusetts Patients (CPMP).
“More than anything else — I am here today to keep a promise I made to my baby girl. When I carried Taylor’s body to the hospital morgue, I told her that I would do all I can to not let this happen to anyone else.”
Leaving a photo of his late daughter with the committee, McCormack stated, “Let me ask all of you – if someone you loved was sick or dying – would you argue against allowing their nurse to provide the right amount of attention to their medical needs and comfort?”
Angela Delima, a resident of Fall River, member of the Coalition for Social Justice and a family member of a patient who suffered substandard care at a local hospital shared her experience stating, “I watched day after day, as my Grandma’s nurses struggled to provide the care she needed and deserved. I watched mistakes being made, not because these nurses didn’t care, but because they were running themselves ragged, caring for far too many patients. On one occasion, my Grandmother, who was in the hospital with severe respiratory disease, went without her desperately needed oxygen, because nurses hadn’t been to the room in hours to change the tank. In essence, my Grandmother was left to suffocate for lack of nursing attention.”
John Bennett, president of the Massachusetts Senior Action Council spoke about the need for the measure to address the needs of the state’s elderly residents, who are most at risk under the current staffing conditions. “The suffering the lack of nursing care causes is unacceptable. This is particularly true for the elderly, whose frail health demands an even higher degree of vigilance and whose physical needs are so urgent,” said Bennett. “As an older citizen and leader of a grassroots organization of seniors, I have been continually hearing complaints from our members about problems they and their family members have experienced in hospitals as a result of nurse understaffing. Tragically, recent studies have documented that this experience is widespread; the less attention and oversight you receive from your caregiver, the more your health is at risk.
A 2008 Health Services Research study reports that preventing these and other avoidable medical errors would reduce the loss of life and could reduce health care costs in Massachusetts by as much as 30 percent. According to William Encinosa, a co-author, “The point of our paper is that the cost savings from reducing medical errors are much larger than previously thought.
The Patient Safety Act calls upon the Massachusetts Department of Public Health (DPH) to set safe limits on the number of hospital patients a nurse is forced to care for at one time. The limits would be based on scientific research and testimony from public hearings and, once established, could be adjusted in accordance with patient needs and requirements using a standardized, DPH-approved system. The Bill would also prohibit mandatory overtime, such as forcing RNs to work extra hours or double shifts, and protects against the reduction in the number of other members of the health-care team including LPNs, aides, and technicians. Patients would have the right to know and demand safe limits.
Coalition members cite a number of reasons why passage of The Patient Safety Act is an urgent priority.
- Safe staffing saves lives. “Each year thousands of people in Massachusetts are suffering needlessly from avoidable medical complications and infections that you can get in the hospital,” said Donna Kelly-Williams, RN, president of the Massachusetts Nurses Association. “Safe staffing will let bedside nurses give patients the care they need.” One of the nation’s leading organizations on patient safety, the Agency for Healthcare Research and Quality, examined more than 95 studies on nurse staffing levels and reported that reducing the number of patients assigned to each nurse was consistently associated with reduced hospital mortality and fewer adverse patient events.
- Safe staffing will reduce the overall cost of healthcare. According to Health Services Research, a patient who experiences serious post-operative infections or other complications, for example, will incur $20,000 to $50,000 or more in additional medical costs, which drive up the cost of insurance and taxes for everyone. Safe staffing will reduce those costs by reducing preventable errors, avoidable complications, increased lengths of stay, and readmissions.
- Hospitals are aware of this problem, but their actions to address it have been insufficient. Instead of investing in safer nursing care, the Massachusetts hospital industry’s response to the mounting death toll has been to create a “Patients First” web site that posts proposed nurse staffing plans with no guarantee that the staffing plans are accurate, and with no uniform standard of care that patients can expect in all hospitals.
- Safe staffing keeps nurses in the profession and at the bedside. Far from exacerbating a nursing shortage, safe staffing can actually increase the number of nurses. Massachusetts has had more RNs per capita than any other state in the country, but less than 50% are working at the bedside, and nearly 60% of bedside nurses are working only part time. A recent survey by Opinion Dynamics found that some 40% of nurses in Massachusetts report a desire to leave bedside nursing, with the majority identifying poor staffing and workload stress as the primary reason.
- Experience shows that safe staffing works. The state of California was the first in the nation to implement safe-staffing standards. Even though California is a much larger state than Massachusetts, and its budgetary problems are far more severe, hospitals have not seen their overall costs increase since the legislation took effect in 2004. Increases in nursing personnel costs have been largely offset by savings from reductions in preventable complications. Moreover, the number of actively licensed RNs in California has increased by over 60,000, and nurses are flocking back to the bedside.
The hearing on The Patient Safety Act took place at the State House. Among the people who offered testimony in support of the Bill are:
- John McCormack of Pembroke, co-chair of the Coalition to Protect Massachusetts Patients, who shared a personal story about his two-year-old daughter’s death as a result of an avoidable hospital medical error;
- Donna Kelly-Williams of Cambridge, co-chair of the Coalition to Protect Massachusetts Patients and president of the Massachusetts Nurses Association (which is a member of the Coalition), who discussed recent studies linking reduced patient numbers for each nurse to reduced hospital mortality rates and adverse patient events;
- Jon Weissman of Granby, coordinator of Western Massachusetts Jobs With Justice, who shared a personal medical story;
- John Bennett of Agawam, president of Massachusetts Senior Action Council, who discussed why seniors support this law; and
- Angelina DeLima of Fall River, a member of the Coalition for Social Justice, who shared a personal story about her grandmother receiving substandard care at a local hospital because of understaffing.
The Patient Safety Act is co-sponsored by State Representative Christine Canavan (D-Brockton) and State Senator Mark R. Pacheco (D-Bridgewater).
The Coalition to Protect Massachusetts Patients comprises more than 125 leading health care and consumer organizations, including the American Lung Association, Massachusetts Association of Councils on Aging, Fenway Community Health Center, League of Women Voters, and a number of health care, nursing and labor organizations.