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Capitol Punishment: Legislation Worsens Hospital Crisis

Capitol Punishment: Legislation Worsens Hospital Crisis Guest Column By Gregory N. Lippe Over the past several years we have experienced numerous examples of the detrimental effects to our state’s future resulting from a common cause. I’m referring to long-term commitments made by our elected officials to deal with immediate and usually short-term conditions. We have experienced the effects of high-cost long-term energy contracts signed by Gov. Davis to solve an immediate crisis. We have seen our state’s financial condition change from a surplus to a monstrous deficit due substantially to increased long-term spending programs implemented during a short-term revenue bubble attributable to the dot-com era. Now we are experiencing a major shortage of hospital bed space and qualified nursing personnel. This condition is being severely aggravated by the current and future effects of legislation passed in prior years. On September 21, 1994, in the aftermath of the Northridge earthquake and the repeat of significant damage to Olive View Hospital, SB 1953, authored by State Sen. Alquist was signed into law. This bill requires seismic retrofit to be accomplished at all acute care facilities by 2008 unless extended to 2013 by qualifying exemption. Tenet Healthcare Corporation estimates that the costs to retrofit its California hospitals will exceed $1.6 billion. Tenet is presently attempting to sell 19 of these hospitals, including the two campuses of Encino Tarzana Regional Medical Center. According to Encino attorney Lee Kanon Alpert, chairman of Encino Tarzana Regional Medical Center, the sale of the 19 hospitals will save Tenet approximately $1 billion in retrofit costs. Additionally, Alpert stated, “the retrofit requirements placed on the hospitals far exceed the safety standards placed on school buildings, and many of the hospitals that are facing significant retrofit costs survived the previous quakes without significant damage.” Could it be that our legislators did not mandate the same rigorous requirements for school buildings because they would have needed to provide the funds to cover the costs? Mandating the expenditures without providing some form of government cost reimbursement or tax incentives to all hospital owners is placing a significant burden on these owner companies. When will legislators stop using one standard for business and another for government? The threat of the impending burden on hospital owners is causing facility closures, halting expansion plans and reducing capital expenditures for upgrading equipment and services. All of this is occurring at a time when there is a serious shortage of hospital facilities and beds available to meet the current demands. One evening last week the 10-year-old physically and developmentally disabled son of a friend of mine fell victim to the effects of the critical shortage that exists. My friend and his wife brought their son to their local hospital to be treated for pneumonia. The hospital provided preliminary treatment in the emergency room and then informed the concerned parents that the hospital no longer had a pediatric ward and that their son should be admitted to a hospital that did. Eight hospitals were contacted from Thousand Oaks throughout the San Fernando Valley to Los Angeles Children’s Hospital. None of these hospitals had beds available. After keeping the child in the emergency room throughout the night, due to the lack of a facility for admission, the decision was made to provide antibiotics and breathing aids and to send him home to be treated by his parents. Flirting with disaster What would happen if our cities were to suffer a catastrophic event requiring significant hospital resources? As if SB 1953 was not enough, our hospitals must deal with yet another costly and restrictive bill. On October 10, 1999 AB 394, authored by then Assemblymember, now Senator Sheila Kuehl was signed into law. Final regulations were released last summer and implementation began on Jan. 1. This bill mandates minimum nurse-to-patient ratios for acute care facilities ranging from 1:1 for trauma and triage to 1:6 for general medical and surgical. The California Department of Health Services (DHS) interprets the regulations as requiring these ratios to be maintained “at all times.” This interpretation means that hospitals must keep qualified, surplus nursing staff standing by to provide fill-in coverage anytime an assigned nurse is temporarily away from his or her patients, including lunch and restroom breaks etc. Non-compliance can result in a hospital administrator being charged with a criminal misdemeanor. This bill also does not provide for any form of government reimbursement for additional costs or tax incentives to lighten the burden on hospital owners. Additionally, the ratios do not distinguish between hospitals that have state-of-the-art monitoring equipment that would logically need less nursing personnel and those that have less sophisticated equipment requiring more personnel. Finally, exemptions have not been provided for the inability of many hospitals to meet the mandated ratios due to the current shortage of nurses in California. Victim of regulation As indicated above, implementation of the minimum nurse-to-patient ratio regulations began on Jan. 1. On Jan. 8, Santa Teresita Hospital in Duarte became the first hospital in Los Angeles County to announce its cessation of operations as an acute care hospital due to inability to meet the new mandated staffing requirements. Once again, the potential long-term effects of what appears to be well-intended legislation were not carefully considered. The sad result poses a serious threat to the wellbeing of all residents of California. Voting information for SB 1953 and AB 394 is provided below. None of the legislators that voted on SB 1953 still represent the Valley and some of the legislators that voted on AB 394 who were assemblymembers in 1999 are now senators. The information provided below presents the legislators in the offices they held at the time of the vote: -Valley legislators voting for SB 1953: Assembly, Boland, Katz, B. Friedman, T. Friedman, Takasugi; Senate, Roberti, Rogers, Rosenthal, Wright. -Valley legislators voting against SB 1953: None -Valley legislators absent, abstaining or not voting on SB 1953: Assembly, Margolin. -Valley legislators voting for AB 394: Assembly, Cardenas, Kuehl; Senate, Alarcon. -Valley legislators voting against AB 394: Assembly, Margett, McClintock, Strickland; Senate, Knight. Gregory N. Lippe, CPA, is managing partner of the Woodland Hills-based CPA firm of Lever, Lippe, Hellie & Russell LLP (LLHR) and a director of the Valley Industry and Commerce Association (VICA).

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