Calif. law requires nurse-to-patient ratio; Hospitals will be required to meet standard in attempt to ensure high-quality care


LOS ANGELES -- Over the objections of the state's health care industry, Gov. Gray Davis has signed a bill backed by the state nurses' union that will make California the first state to require hospitals to meet fixed nurse-to-patient ratios, in an effort to force higher-quality care and combat cost-cutting measures in the place where managed care was born.

Davis signed the new law over the weekend as part of a last batch of bills from this year's legislative session, which also produced a package of measures that the Democratic governor signed last month, expanding patients' access to mental health care and their rights to sue their health insurers for punitive damages and seek outside reviews of decisions denying coverage.

Health care has been a major political issue in California, given the prominence of health-maintenance organizations and for-profit hospitals here, and the hospital industry and business groups had lobbied against the nurses staffing bill. Davis' Republican predecessor, former Gov. Pete Wilson, vetoed a similar measure two years ago.

The new bill on nurse staffing levels -- which covers all "licensed nurses," including registered and licensed practical nurses -- does not specify minimum nurse-to-patient ratios, but instead requires the state Department of Health Services to set such standards.

In order to secure Davis' support, the measure's sponsor, Assemblywoman Sheila James Kuehl, a Santa Monica Democrat, agreed to sponsor a follow-up bill next year, delaying the implementation by at least a year, until 2002, to allow the state time to work out the desired ratios.

Nurse staffing levels have been a hot-button issue among health care consumers in recent years as hospitals have sought to save money by laying off registered nurses and consolidating a range of nursing functions in the hands of less-qualified workers. Kuehl sponsored the bill at the urging of the nurses' union two years ago, and it passed the Legislature but was vetoed by Wilson.

"This is one of the most significant days in the history of nursing," Kay McVay, president of the California Nurses Association, said in a statement after Davis signed the bill.

Rose Ann DeMaro, executive director of the California Nurses Association, which represents 200,000 nurses, said the new regulations were necessary to address severe gaps in care that have resulted from the combination of cutbacks in nursing staffs and the fact that hospital patients in general are sicker than in the past, because HMOs resist putting patients in the hospital to save money.

The measure will also bar hospitals from assigning unlicensed workers to perform certain medical procedures, including administering drugs and assessing a patient's condition, and it will prohibit hospitals from shifting nurses trained in one unit to duty in another without adequate preparation.

Pub Date: 10/12/99

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