News & Events

Mass SJC Rules Ballot Measure to Set Safe Patient Limits is Valid Decision Clears Path for Patient Safety Act to Be on the Ballot in November

Today’s ruling by the Massachusetts Supreme Judicial Court (SJC) to validate a pending ballot measure – A Law Relative to Patient Safety and Hospital Transparency (or, the Patient Safety Act) – is a vitally important step in an effort by nurses, health care advocates and hundreds of thousands of residents of the Commonwealth to improve patient safety in Massachusetts hospitals by setting a safe maximum limit on the number of patients assigned to a nurse at one time, while providing flexibility to hospitals to adjust nurses’ patient assignments based on specific patient needs.

“We applaud the SJC for their decision to allow the Patient Safety Act to go before the voters of Massachusetts, as this measure will positively impact the quality and safety of hospital care for every patient cared for in our state’s acute care hospitals,” said Kate Norton, spokesperson for the Committee to Ensure Safe Patient Care, a coalition of more than 100 health care, nursing and consumer groups promoting the measure.  “Right now, outside of hospital intensive care units, there is no law limiting the number of patients assigned to our hospital nurses. Scientific studies show this lack of patient limits is eroding the quality of care patients receive. Without safe limits, patients experience longer hospital stays, an increase in medication errors and infections, preventable readmission of patients, longer ED wait times and higher health care costs in Massachusetts.”

A recent survey of the state’s nurses found that 77 percent report they are forced to care for too many patients at one time, 77 percent report an increase in medical errors due to unsafe patient assignments and fully 90 percent of the state’s nurses report not being able to provide the comfort and care patients need.  Just as importantly, nearly 65 percent of nurses report that when they ask for hospital and nursing executives to adjust patient assignments to ensure adequate care for patients, those requests for additional resources are ignored. In fact, the Ballot measure, which was validated by the SJC today, was drafted by frontline nurses to ensure better care for their patients.  

“In an industry that is controlled by massive corporate health care networks and Wall Street hedge funds, the safety of patients is too often sacrificed for the bottom line and increased hospital profit margins,” Norton said.  “The legislature has tried to address this crisis for more than a decade, yet the powerful hospital lobby spends millions to defeat this common-sense patient safety measure.  Since patients are those most impacted by these decisions, we believe they should have the ultimate say in the quality of their care, which the Patient Safety Act will provide.”

The decision comes on the eve of the deadline for proponents of the measure to submit the final round of signatures needed to place the question before the votes on the ballot in November.  Tomorrow, members of the Committee to Ensure Safe Patient Care will deliver signatures to local municipalities across the state in support the Patient Safety Act.  

To ensure inclusion on the November 2018 ballot, a second round of 10,792 certified signatures must be submitted to the Secretary of the Commonwealth by July 3, 2018. Signatures must be submitted to local election officials by June 19, 2018, for certification.  The Committee will be submitting a final round of approximately 26,000 signatures in municipalities statewide.

In December, the Committee submitted more than 100,000 signatures to the Office of the Secretary of the Commonwealth, per the Attorney General’s Initiative Petition Process for two versions of the ballot measure, one of which included a requirement that the hospital industry report their financial holdings to the public.  The SJC today rejected this second version of the question.  

“We submitted the alternative version of the question requiring hospital financial reporting because we believe Massachusetts patients and their families deserve to know how their money is being spent, at a time when the multi-billion dollar industry claims they can’t afford to provide a safe standard of care,” Norton explained.  “The decision by the SJC not to approve the version of the safe patient limits ballot initiative, including a section covering hospital financial transparency, demonstrates how difficult it is to go up against entrenched corporate interests. Not only do hospital executives care more about profits than protecting and improving patient care, they also do not want the public to know how they are spending tax dollars.”

The Massachusetts Health & Hospital Association, the main force behind the opposition campaign, receives millions of dollars every year from hospitals around the state, according to its 990 tax forms. Those hospitals are largely publicly funded by way of Medicare, Medicaid and state health care dollars. MHHA has spent public money on lawyers to keep the public from knowing how their money is being spent, and recently spent nearly $2 million on an advertising campaign against this measure, where every claim in the ad was patently false or misleading.

“The millionaire executives making this decision – hospital CEOs on MHHA’s board – claim they cannot afford to ensure the safe level of care that will come with enacting patient limits, even though studies show these limits will drive down medical errors, injuries and other expensive health care outcomes. How can hospital executives both claim a cost burden and refuse to be financially transparent? The hospital industry is posting profits in excess of a billion dollars each year and is stashing an additional $900 million in offshore accounts while spending several more billion dollars on new construction projects and to purchase hospitals in other states and in other countries. The public needs safe patient limits and deserves to know how hospital executives are spending their money.”


Today in Massachusetts hospitals, except in ICUs, there is no law and no limit to guide the number of patients that can be assigned to a nurse at one time.

The Patient Safety Act will dramatically improve patient safety in Massachusetts hospitals by setting a safe maximum limit in the number of patients assigned to a nurse at one time, while providing flexibility to adjust nurses’ patient assignments based on the specific patient needs.  It also protects other valuable members of the health care team by preventing the reduction of other caregivers to meet the limits set by the law.

Independent scientific studies have consistently found that the quality of care decreases dramatically when nurses are forced to care for too many patients at once, putting patients at increased risk for complications like pneumonia, bedsores, medication errors and an increased risk for costly readmissions. Evidence-based medical journals such as the Institute of Medicine, the Journal of the American Medical Association, and the New England Journal of Medicine have all written on the impact of the nurse-to-patient assignment and the quality of patient care.

14 years ago, California established maximum limits on the number of patients that could be assigned to a nurse at one time and the results have been universally positive. Recent studies have shown that patients in Massachusetts receive less time with their nurses, resulting in higher rates of complications and readmissions and longer wait times than in California, while costs in California remain below both the Massachusetts average and the national average.