By Jessica Bartlett
August 7, 2018
Mental health hospitals are sounding the alarm about ballot question that would limit the number of patients each nurse can have, saying the law would have dire consequences and would lead to the loss of more than 1,000 behavioral health beds in the state.
A report by the Massachusetts Association of Behavioral Health Systems, set to be released later Tuesday afternoon, says that the proposed staffing mandates aren’t doable with the current staffing shortages at behavioral health hospitals, and would lead hospitals to close beds. The issue will be on the ballot in November.
“There will be less beds, and in all likelihood, we will lose hospitals,” said David Matteodo, the executive director of the Massachusetts Association of Behavioral Health Systems.
But David Schildmeier, a spokesman for the Massachusetts Nurses Association, which is backing the ballot question, said there are enough nurses to meet the ballot’s demands. He said nurses are available and looking for work, pointing to the shuttering of psychiatric beds at Medfield State Hospital in 2003, Fitchburg’s Burbank Hospital in 2011, Taunton State Hospital in 2014, and UMass Memorial Medical Center earlier this year. Providence Behavioral Health Hospital in Holyoke also temporarily closed beds in April.
“There is no problem with having enough nurses to provide psychiatric care,” Schildmeier said. “The problem is the industry isn’t providing enough beds or (hiring) nurses to take care of them. The evidence is the dramatic overcrowding of emergency departments across the state.”
The ballot question, which is being sponsored by the nurse union group Committee to Ensure Safe Patient Care, imposes strict patient maximums for nurses in a variety of units at hospitals throughout the state.
Currently, behavioral health units staff about one nurse for every 10 patients, with a number of other caregivers also providing treatment, Matteodo said. Under the ballot, behavioral health care units would be required to limit nurses to no more than five patients each. For substance abuse units, which are not specifically listed in the ballot, the ratio would default to four patients to every one nurse. The ballot mandates that hospitals not cut back on other staffing to accommodate more nurses.
Matteodo said that isn’t feasible. If imposed, the ballot would impose about $226 million in combined annual costs on the state’s 13 freestanding psychiatric hospitals, eight state-owned psychiatric hospitals and 46 acute care hospitals with psychiatric units, the report says.
But even if hospitals had the money, the staff to fill those new positions doesn’t exist, Matteodo said. The bill would require mental health units to hire another 900 full-time nurses, at a time when many hospitals throughout the state are struggling to hire even a tenth of that.
At Westboro Behavioral Healthcare hospital, which opened in November, CEO Greg Brownstein is struggling to hire enough nurses. In eight months, he said he’s hired enough staff to operate just over 30 beds, out of 152 total.
“It’s getting more difficult nationally and in particular around here because of all of our health care institutions,” Brownstein said. “You have new beds that have opened the last few years and the number of nurses has decreased (as people retire and age out of the system). You have a perfect storm.”
Operating without the required number of nurses isn’t an option, according to the report, with fines as high as $25,000 per violation per day.
The result, Matteodo said, is that hospitals will close beds. Under the ballot, 38 percent of the state’s 2,800 private beds and 600 state-owned behavioral health beds wouldn’t be staffed, according to the report, drastically reducing revenue and potentially threatening the viability of those hospitals.
“A number of my hospitals have told me they would close,” Matteodo said. “It’s an impossible task (to staff up). And we’d have to do it by Jan 1.”
Franciscan Children’s, which has both an inpatient and outpatient psychiatric unit, as well as rehabilitation services for children, is preparing for that reality. The hospital says the nurse ballot question would cost it $1.6 million.
“We won’t be able to recruit the staff that is demanded so we will have to cut back on our medical services and mental health services to meet these guidelines, and when you do that you cut back on revenue,” Franciscan CEO John Nash said. “It’s a spiraling issue for us. We’re thinking (about) how we will survive if that happens.”
Kate Norton, a spokeswoman for the coalition sponsoring the ballot, disputed the assertion that there weren’t enough nurses, saying Massachusetts nursing schools graduated more than 18,000 nurses in the last four years.
Union nurses behind the ballot said the real problem is that hospitals have been closing psychiatric units throughout the state to create more profitable services, and haven’t hired enough nurses to meet the present demand.
“Several thousand patients a year are boarding and waiting for beds and nurses to take care of them,” Schildmeier, the Massachusetts Nurses Association spokesman, said. “For this group, this industry, which has regularly and consciously closed services and cut staffing to make profits off the mentally ill, which is failing to provide adequate care, to now claim they can’t afford to meet the requirements of a law that would give patients the care they need — that’s shameful.”
The report is only the latest from an industry group protesting the ballot question. The Massachusetts Health & Hospital Association previously commissioned a study that found the ballot would cost Massachusetts hospitals $1.3 billion in the first year and $900 million annually thereafter, by requiring them to hire an additional 5,911 nurses throughout the state. Those figures do not include the recently released data on freestanding psychiatric hospitals and state-owned mental health hospitals.