Clarence Fanto: Clear the fog of confusion on Question 1


LENOX — Nurses union leaders and many members say vote "yes." Some nurses say "no." Hospital officials warn of service cutbacks. An independent state commission issues findings that back up hospital administrators and medical staffers.

Voters are understandably bewildered about the accusatory, contradictory swirls of pro and con. Ballot Question 1, a binding referendum, looms as the high-stakes issue in the upcoming election, with early voting beginning Oct. 22 ahead of Election Day on Nov. 6.

Some people wonder why the state should be involved in regulating staffing levels at hospitals by requiring a limit of four patients assigned to one nurse at any time, even overnight, the same as already in effect at intensive care units.

Even well-informed residents might be forgiven for throwing their hands up, totally perplexed.

Here's what one voter, this writer, has pieced together:

- The state's independent, nonpartisan Health Policy Commission warns that if Question 1 passes, hospitals statewide could face $676 million to $949 million a year in extra costs, with regional and community hospitals like Berkshire Medical Center taking the biggest hit because many of their lower-income patients are on MassHealth. Leaders of BMC parent Berkshire Health Systems have forecast a nearly $25 million annual impact, a cost increase up to 4 percent, because 125 full-time-equivalent registered nurses would have to be hired. BMC already employs about 800 RNs in Pittsfield and North Adams.

BHS President and CEO David Phelps has stated that "rigid staffing ratios" might require "no choice but to delay care or refer the patient somewhere else — maybe even out of state, as all Massachusetts hospitals will face the same dilemma."

Hospital officials say ballot question approval would force a decline in patient admissions to avoid violating staffing requirements. The commission's independent analysis backs up these warnings, adding that higher insurance premiums are likely.

The commission findings resemble those of the Massachusetts Health and Hospital Association, although that industry group opposing the ballot question projected a $1.3 billion first-year hit. Steve Walsh, association president, asserted that the commission's findings "conclusively confirm the outrageous costs that would be imposed by Question 1 without any benefit to patient safety."

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- The Massachusetts Nurses Association put out a vastly different study, calculating the annual statewide impact at $35 million to $47 million. The union's study was produced by a Boston College researcher who is a former president of the MNA. Association Executive Director Julie Pinkham described the independent analysis as "irresponsible, inconsistent and resembles nothing that the commission has ever done before." Union leaders contend that nurses are overburdened with too many patients, leading to safety issues and jeopardizing the quality of medical care.

A local registered nurse wrote a letter to the editor recently accusing Berkshire Health Systems of "scare tactics Who would you rather have taking care of your family member — a nurse with four or seven patients assigned?"

Another letter writer, union official Amber VanBramer of Pittsfield, urging a "yes" vote on Question 1, stated: "I work at bedside and the care gets tougher and tougher as the years go by due to sicker patients, the epidemics going on in our country and patients needing more of our attention and education. The proposed law would help nurses feel safer at bedside knowing the limits are there, by law, and they can spend more time with their sicker clients and give them the time and care they all deserve."

However, a recent letter from 15 physicians and leaders of the BMC medical staff was quite revealing: "Question 1 will impact the teams of health care professionals who work at the hospital. It will also have a negative impact on access to care and provision of care in the hospital. Aside from the challenge recruiting and retaining the additional RN staff to meet this mandate would pose or the financial penalties that would hit the hospital if the mandates were not met, it is the impact on our ability to provide care for our patients that is the most frightening aspect of this misguided ballot initiative."

I know several of these physicians, and it's only fair to add, based on personal experience from 30 years of living here full time, the quality of care by doctors, nurses, physicians' assistants and the rest of the staff at BMC and its facilities such as the Crane Center is outstanding.

Still, after many hours researching Question 1, I remain on the fence. A recent statewide poll found voters split down the middle.

Since health care is an obvious top-priority issue, a countywide informational forum at a major venue such as the Colonial Theatre would be an invaluable public service. Let hospital leaders, nurses union officials and a representative of the Health Policy Commission vigorously debate the pros and cons of Question 1, taking questions from the audience.

The debate should be streamed and also carried on public access TV and on radio.

A vote of such importance requires maximum information. Both sides have stated their cases powerfully. Let civility prevail, giving residents the best chance to cast a well-informed vote by clearing away the fog of confusion.

Clarence Fanto can be reached at or on Twitter @BE_cfanto. The opinions expressed by columnists do not necessarily reflect the views of The Berkshire Eagle.


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