Hospital Association Pressures Lawmakers to Drop Mandates to Protect Nurses
June 26, 2013 – Pinal Patel is only 29 years old, but the certified nursing assistant has already suffered two major injuries from lifting patients at Legacy Emanuel Medical Center in north Portland.
“I live with pain,” she told the House Health Committee. “It's clear to me that I won't be able to continue this work up until retirement. It feels like my body is deteriorating day by day. Legacy representatives will tell you that they have a safe lifting program, but in my experience it's not good enough to keep staff and patients safe.”
Legacy has mechanical lifts, she said, but they are seldom used and often broken. “Oftentimes I must lift patients who weigh 200 or 300 pounds by myself.”
The Service Employees Union, which represents Patel, and the Oregon Nurses Association, put forward Senate Bill 572 this session to require hospitals to do a better job of protecting nurses and certified nursing assistants who have the difficult job of lifting immobilized patients.
The bill would require each Oregon hospital to set up a safe patient handling committee to devise a systematic plan to safely move patients who require mechanical lifts and equipment. The plan would also help ensure adequate staffing levels.
Some hospitals — such as the Kaiser Permanente system — already have safe patient handling teams.
“We’ve seen a significant reduction in injuries at Kaiser throughout the region,” said Angel Garris, an SEIU member who works on a safe team at Kaiser Sunnyside Hospital in Clackamas. “It’s important to have a team that has critical thinking skills and uses safety equipment often.”
But not all hospitals have as good a track record as Kaiser, let alone a systematic policy that includes a safe team. And, lobbyists from the Oregon Association of Hospital and Health Systems appear to have successfully beaten down SB 572 which would require hospitals to adopt safe handling policies.
Right now that bill is stuck in the House Rules Committee, and its chairman, Rep. Chris Garrett, D-Lake Oswego, wouldn’t comment on whether it would see the light of day. Typically bills that die end up in the Rules Committee.
Unions and Hospitals at Odds
In her testimony before the House Health Committee in May, Patti O'Sullivan, who lobbies on behalf of the hospital association, talked about her 14 years as an employee of the Oregon Occupational Safety & Health Administration and a career dedicated to worker safety, while now she's being paid to kill a safety bill.
“I truly believe in injury prevention,” O’Sullivan told the committee. “I believe that all hospitals believe in that.”
O’Sullivan said hospital injuries are in everyone’s interest to avoid because they drive up costs. Small hospitals especially treat their staff “like families,” where injuries are taken personally, she added.
Despite O'Sullivan's testimony, representatives of the nurses and hospital workers unions contend the injuries keep piling up.
“We’ve been trying to get the hospitals to deal with this on a non-regulatory basis, and they haven’t,” Andrea Salinas, a lobbyist for the Service Employees International Union, told The Lund Report. “We’ve let hospitals adopt their safe handling policies to their needs, and it hasn’t reduced injuries to our workers.”
Lynda Enos, a nurse safety expert with Human Fit, said the Legislature needs to step in. Without a mandate, hospital supervisors will continue to overlook safe patient handling as a priority, she said.
Safe patient handling is an issue that has attracted national attention and support for healthcare workers. Eight states, from Texas to Minnesota and Oregon’s neighbors, Washington and California, have adopted varying nurse safety laws.
Olympia provided financial assistance to help hospitals comply with its 2006 law, while lawmakers in Sacramento simply mandated that hospitals replace manual lifting with lifting devices and lift teams in a 2011 law.
“It’s great to see Oregon join the legislative battle,” said Anne Hudson, a public health nurse and author from Coos Bay who works as a national advocate for safe patient handling. “Many nurses who become back-injured from lifting patients never work as nurses again."
The Senate did pass a version of Senate Bill 572 — but that version was rewritten by the hospital association and it only asks that hospitals review their workers compensation data to help set policy, something that's already in their best financial interest, Salinas said.
Monnes Anderson Supports Unions
Sen. Laurie Monnes Anderson, D-Gresham, a retired nurse and the chairwoman of the Senate Health Committee, told her colleagues in the House that she approved the hospitals’ watered-down version in the Senate because she didn’t want to push a measure that would expose partisan divisions early in the session.
“We were worried there would be a vote problem on the floor,” said Monnes Anderson, who supports the unions’ efforts to amend the bill to include a mandated safe handling committee and systematic safe handling policy. If the House is willing to pass the stronger version of this bill, Monnes Anderson said she would try to get her chamber to agree.
Meanwhile, O’Sullivan accused the unions of blindsiding her with the new amendments: “I had no idea there were amendments until three minutes before the hearing.”
But Felisa Hagins of SEIU disputed those remarks. She told The Lund Report that the hospital association and O’Sullivan had indeed been emailed those amendments — a full week before the hearing.
The hospital association used other tactics to kill the safe handling mandates, including an attempt to put nursing homes under the bill’s requirements, thus increasing the cost to taxpayers exponentially.
Dale Penn, who lobbies on behalf of the Oregon Health Care Association, said there was much less need for long-term care facilities to be included in SB 572 because his members already have higher staffing levels and a good relationship with their labor force.
Also, including long-term care facilities would have effectively killed the bill because it would have increased the state's budget for Medicaid patients in nursing homes.
In the end, the hospital association was able to kill the bill through old-fashioned lobbying that caused one of the unions’ supporters to withdraw.
Thompson and Lively Block Bill
After the lobbying against the unions’ version by the hospital association, Rep. Jim Thompson, R-Dallas, vice-chair of the House Health Care Committee, decided it was best to send that version to the Rules Committee, where the issues might be worked out. Earlier, he had supported the stronger bill, according to SEIU's Salinas.
“I like consensus bills. I’m worried that the division is so wide. I don’t know what to do,” Thompson told The Lund Report. “We’ve got people on both sides with their hair on fire.”
Rep. John Lively, D-Springfield, opposed the nurses’ version of the bill, and once sat on the board of McKenzie-Willamette Medical Center in Springfield. Each hospital, he said, has a safety committee that could deal with these issues.
“I didn’t agree that we needed another committee,” Lively told The Lund Report. “I understand it’s a problem … Nobody could convince me that they couldn’t take care of this on the safety committee.”
He also felt the bill was too prescriptive, because conditions in a rural Oregon hospital are quite different than those at a major trauma hospital in Portland for things such as mechanical lifts.
But Salinas pointed out that while the original bill introduced in February did specify the number of mechanical lifts each hospital must have, that language was omitted from the current proposal, which allows each hospital’s safe patient handling committee to determine the need.
“We put parameters around what we would like to see, but no numbers of lifts or staffing ratios,” Salinas told The Lund Report. “We felt we gave them flexibility.”
She also said hospital safety committees are set up to deal with patient safety, not the safety of the workers.
Work Continues After Session
At the same time SB 572 was kicked to Rules, Rep. Mitch Greenlick, D-Portland, sent a non-controversial bill, Senate Bill 753, to that committee. SB 753 was sponsored by Republicans and would give the Oregon Health Authority better tools to crack down on Medicaid fraud, particularly among providers who are paid according to the number of procedures they provide.
The bill was largely symbolic since it would not apply to coordinated care organizations, which are tasked with taking care of the vast majority of Medicaid clients through a global payment system.
By shipping the Republicans’ bill to Rules along with SB 572, Greenlick helped the Democrats provide leverage so that the bill would have a pathway to the floor. But supporters now say they prefer to have a more thorough discussion with the hospitals after the session to deal with safety concerns.
Any attempt to have a weaker version is worse than no bill at all, and both SEIU and the Oregon Nurses Association would stand in opposition, Salinas said. After the session ends, she's hopeful that representatives from the unions and the hospitals can sit down and reach agreement on the best safety measures to protect workers.
Christopher David Gray can be reached at firstname.lastname@example.org.