California Hospitals Given Leeway To Use ‘Last Resort’ Staffing Waivers, Analysis Shows

March 4, 2021 at 10:27 AM PST

Speaker 1: 00:00 Speaker 2: 00:26 Speaker 1: 00:30 Speaker 2: 00:41 Speaker 1: 00:50 Speaker 2: 01:04 Speaker 1: 01:10 Speaker 3: 01:25 Speaker 1: 01:37 Speaker 2: 02:04 Speaker 1: 02:11 Speaker 2: 02:31 Speaker 1: 02:37 Speaker 2: 03:15 Speaker 1: 03:22 Speaker 2: 03:43 Speaker 1: 03:55 Speaker 4: 04:21 Speaker 1: 04:37 Speaker 4: 05:05 Speaker 1: 05:10 Speaker 4: 06:06 Speaker 1: 06:13 Speaker 4: 06:46 Speaker 1: 07:02 Speaker 4: 08:03 Speaker 1: 08:07 Speaker 4: 09:05 Speaker 1: 09:10 Speaker 4: 09:43 California saw a hospitalization skyrocket around the holidays when staffing couldn't keep up. The state led hospitals put more patients on a nurse's workload than the law usually allows. In the first of a two part series KPBS health reporter, Taran mento tells us how nurses felt pushed to the brink by that move and questioned whether it was even necessary. It's been a long year for nurse George Santiago, Multiple code blues in one shift that really drains you Santiago's job is to rush toward those calls as a rapid response nurse at Palomar medical center Escondido. And he carries the extra burden of often being a patient's last contact. If this was my family member and there's nothing that I can do. Yeah. The, the desperation, the hopelessness. That is what kinda that's what kind of kills you. The weight grew heavy during the late 2020 surge Palomar received state permission to stray from a landmark law that limits the amount of patients under a nurse's care staff could now be asked to take on one to two additional patients Here. Why don't you carry this pile of bricks while you're trying to travel more? You know, so that's the equivalent Is one of more than 200 California facilities that received temporary staffing waivers during the pandemic governor Gavin Newsome expedited the waiver process when COVID 19 patients skyrocketed late last year, but staffing did not. These nurses in particular that are just doing heroic work every single day, asking yet again for a little bit more during these very challenging, challenging, next few weeks, State health department declined an interview, but said in an email waivers should be a last resort. The waiver application says hospitals should exhaust alternatives before seeking one. But the state said in its email, that facilities actually don't need to in a KPBS I, new source analysis of publicly posted waivers found dozens of approved facilities did not document. They attempted the listed alternatives before seeking the waiver. The process is easy. The process can be approved in as little as eight hours, and then there you go. Stephanie Roberson leads government relations for the California nurses association. She says under the expedited process, a staffing waiver could be granted in less than a day. The union has protested against the waivers, including at Palomar. Roberson says they've successfully contested three of the, at least 43 waivers that have been rescinded in the state. We're sitting on the ground. We're looking at your at your form. And number one, you haven't checked any of the remedies. The application form asks hospitals. What other options they've tried that includes transferring patients to other beds, rescheduling, elective procedures, and passably setting up clinics for non-emergency cases. The KPBS I new source review found about half of approved hospitals did not report. They tried all options, including some in San Diego to be quite it's. It's just a formality, most local facilities that received waivers declined or ignored requests for interviews. But Santiago says the waiver didn't need to happen at Palomar. The facility laid off more than 300 staffers when patient tallies dropped last April, Which of course we can't get back now because they're not going to hang around or they're going to look for other sources. Applications ask if hospitals experienced layoffs within the last two months, the Palomar layoffs were several months before Santiago says the Escondido facility applied. However, the details of its application are not posted on the state's website, but Santiago says the Escondido facility did not cancel elective procedures before getting its waiver Was the, even more difficult for the recovery room nurses because they have their load of people that they have to recover for surgery from surgery. And then they have to handle, you know, uh, COVID patients too. San Diego says the union filed a grievance because Palomar did not communicate with them before getting a waiver Palomar refused request for an interview. But a spokesman previously said claims of unsafe working conditions were inaccurate and called them appalling and irresponsible. All expedited waivers were due to expire last month, but at least 84 hospitals received extensions until the state provides additional staffing resources. Joining me is KPBS health reporter Taran mentor Taryn. Welcome. Thanks, Maureen. Tell us a little more about the law that originally limited the number of patients. One ICU nurse could care for you call that law landmark. Okay. Right. So California's law is very unique. It's the only state to have nurse patient ratios across all hospital departments. So some hospitals, some other States have rules on how many patients an ICU nurse can take on, but in California, there are limits on how many patients nurses can manage in emergency rooms, pediatrics and other medical beds. Um, so it was passed back in 99 and it wasn't implemented though until 2004 in order to give hospitals time to adjust to those. So why did the governor say hospitals could request these waivers? Well, hospitalizations, uh, late last year were just increasing at such an incredible rate and staffing just couldn't keep up. And on top of that, you had, uh, ICU nurses that are really highly skilled workforce and it takes years to be able to get those skills. And there just wasn't enough of them to go around. And there wasn't enough time to train up many others to be able to fill that gap. So by having the waiver, hospitals could continue to accept the patients that needed their care. And then the hospitals wouldn't face fines for being outside of ratios. If they couldn't find enough staff as more patients came in and it's, uh, January, 2020. So a couple months just before the pandemic hit the state health department, put out a notice saying that staffing violations could result in fines of 15,000 to $30,000. W what could have been the consequences to patients during the COVID surge? If waivers weren't granted The president of the California hospital association said that those individuals could just continue to have to wait in emergency rooms or ambulances because they couldn't be as admitted if the other wards didn't have the staff to allow them to come in. So her main was concerned that these people just weren't going to get care, um, because the law wasn't going to allow them to break from these ratios and welcomed them in. So they would have to wait to get more care. And that was one of the main concerns that Carmela coil from the California hospital association was talking about. Now, the nurses that you interviewed say the winter COVID surge did not necessarily need to threaten staffing levels at hospitals because it was predictable. People knew it was coming. So what do they say hospitals should have done to prepare? Well, hospitals staffed up a lot in the early months of the pandemic, but then because, um, there was just a really good job done by keeping people out of, um, you know, acute care facilities that, that wave never came. So some facilities let some people go, some of these travel nurses, maybe that they, they, um, recruited because they just weren't seeing the patient volumes. But then as the pandemic, um, continued and we saw a surge is happening across the country, then everybody started competing for that mobile workforce. So if some nurses were saying, if we had maintained staffing levels, knowing that, you know, we weren't going to get out of this pandemic with just that one, um, couple of months where we saw patient tallies go down, um, then we wouldn't have been in such a dire circumstance when we saw that surge later in the year. And we were competing for the same, um, for the same workforce that people in New York and all across the country where we're calling and trying to recruit, What's been the fallout on the nursing staff from these emergency waivers. You know, nurses have just come said that they are just completely burnt out. And, um, there were protests, you know, all across the state, including here in San Diego County, opposing these waivers. Um, and they, that continued all up and down the state. And recently when the governor did announce back, um, early February, that hospitalizations had declined. And so resources were not as strained anymore. All of these fast tracked waivers were now canceled save for some of the hospitals about 84, um, that actually got extensions because they still needed some staffing support. But when the governor canceled that the nurses kind of considered that a victory and they felt that that was, um, because of all of the pushback and all of the, how vocal they have been, that these were in their mind, you know, not needed at all in our investigation showed that there were a lot of, uh, a lot of instances in when, um, these alternatives were not, were not exhausted or even, or even used. You have part two of your report on waivers coming up to Mara. Can you give us a preview? Yes. Tomorrow we will be talking, um, hearing from Scripps health. A couple of their facilities here in San Diego did receive some waivers, some of the checkmarks. So some of the sorry, some of the check boxes were not marked all of them for all of these, um, alternatives that they could have done prior to seeking a waiver, such as maybe canceling elective procedures or transferring patients out. So we talked to them about why they didn't Mark those, but also why they really needed the waiver and what the conditions and staffing and patient conditions were like inside the hospital for them to need it. Okay. Then I've been speaking with KPBS health reporter, Taran mento, Taran. Thanks. Thanks, Maureen.

By KPBS Public Media

An inewsource-KPBS investigation found dozens of facilities that received waivers failed to document that it had tried the state’s alternative options first.