BMC doctor flags timely treatment with Question 1; proponents say care would improve

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PITTSFIELD — The chief of emergency medicine at Berkshire Medical Center says passage of a nurse staffing ballot question next month could force the hospital to keep patients on hold in ambulances or its waiting rooms, unable to accommodate them as quickly as it does now.

"I got into medicine to take care of patients, and that's what I want to do," Dr. Michael McHugh said in an interview Wednesday.

McHugh joined a chorus of doctors and administrators at BMC speaking out against Question 1 on the Nov. 6 ballot.

But advocates of the question say mandatory staffing ratios for registered nurses in all areas of hospital operations, including emergency departments, will improve care for patients.

And they say first responders will join a public event Thursday in Boston, prepared to press their belief that care will improve under the measure, with shorter wait times in emergency departments and a better flow of patients within hospitals.

In such departments, the ballot measure would require specific nurse-to-patient ratios depending on the condition of the person receiving care — from a maximum of one patient in critical care or intensive care units to five patients listed in "non-urgent stable" condition.

McHugh said he believes the measure would lead to patient delays in getting emergency care, including time spent in waiting rooms while hospital teams monitor and adhere to set RN staffing ratios.

He said the law also could result in patients who are ready to move from emergency care into the hospital having to remain in the limbo of "boarding." That happens when hospital units cannot yet accommodate new patients.

New ratios, McHugh said, could exacerbate that problem. And so could tie-ups with ambulances in the region.

If an ambulance cannot discharge its patient promptly, due to delays getting in to emergency departments, those vehicles would not be ready to free up space on medical and surgical floors by taking patients who need transport to other facilities.

"It becomes this cycle that there's no way out of," McHugh said.

The emergency department at BMC handles 50,000 patient visits a year, according to spokesman Michael Leary. The hospital has said it would need to hire the full-time equivalent of 125 RNs to meet terms of the proposed law. Of that number, an additional 23.4 FTE registered nurses would be needed to be added to the ED staff to meet the staffing ratio mandate at all times, he said.

The cost to the institution to comply with the law would be $23 million, it has estimated.

McHugh said he believes the referendum would force the hospital to rely solely on RNs in the emergency department, squeezing out nurses' aides and other staff who normally take on duties for which RN training is not required.

"I don't really need to have [RNs] pushing a patient to a CAT scan," McHugh said.

He said the hospital's current approach, using teams of caregivers with various medical training, works well.

"It provides us with the right mix of individuals working to the top of their degree," McHugh said.

In a BMC statement Wednesday, McHugh said that delays getting patients from ambulances into hospitals could lead emergency medical service providers "to take a patient to another hospital, and since all Massachusetts hospitals would have the same ratio and predicament, that likely means a hospital out of state."

Kate Norton, a spokeswoman for the Committee to Ensure Safe Patient Care, which backs Question 1, said BMC's statement regarding the possible diversion of patients stands in conflict with two laws that forbid hospitals from sending patients away.

The BMC statement refers to a situation that "could force an EMS provider" to go elsewhere.

McHugh acknowledged that the 32-year-old Emergency Medical Treatment and Active Labor Act bars emergency departments from turning away patients.

Norton said she believes that hospital executives who oppose Question 1 have been misleading the public about the risk of diversion, in an "attempt to scare the voters."

Last month, the pro-Question 1 coalition struck back at a TV spot that said the measure would imperil care in emergency departments.

"The ad claims that emergency rooms will have to limit capacity, turning away up to 100 patients," the committee said in a statement Sept. 17 to TV stations airing the campaign ad. "This deceptive claim is a regular talking point for the hospital executive opposition in an attempt to scare voters. The claim is simply false and is blatantly misleading to the public."

In pushing back at the TV ad, the pro-Question 1 campaign provided a statement from Kathy Reardon, an ED nurse at Steward Norwood Hospital in Norwood.

"As an emergency department nurse for more than 30 years it simply defies common sense to claim that having more nurses on hand to treat patients in the ED would increase wait times or harm patients in any way," Reardon said. "My own experience as a nurse shows that with more support we can provide you with much better care."

At 10 a.m. Thursday, proponents of the measure plan to gather first responders from the Boston area and nurses to talk about how the measure would affect care in emergency departments.

The event takes place at 55 Hallet St. in Boston and will be streamed on the committee's Facebook page.

Larry Parnass can be reached at lparnass@berkshireeagle.com, at @larryparnass on Twitter and 413-496-6214.


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