State officials have allowed accountability and transparency to lapse as for-profit firms have gained control of a growing number of hospitals, according to a report by a union representing nurses and other healthcare workers.
A report released yesterday by the Health Professionals and Allied Employees calls on the state to increase the minimum number of nurses that hospitals must have on staff, to reinstate inspections required for renewal of state hospital licenses, and to take steps to increase hospitals’ fiscal transparency, among other changes.
The “white paper” report drew support from several healthcare advocates, as well as two Rutgers University professors who recently coauthored a report criticizing state oversight of hospital contracts.
But state Department of Health officials defended their practices, saying that the state does provide strong oversight of hospitals, including those converting to for-profit status, and regularly updates nurse-staffing levels.
HPAE Policy Director Jeanne Otersen said the state is failing to use its regulatory power effectively.
“The signal to hospitals has been regulations will not be the means by which they protect patient safety,” Otersen said.
The HPAE has been gaining legislative allies in its push for boosting staffing levels, arguing that they haven’t been increased since 1987. The report notes that the Affordable Care Act penalizes hospitals for poor levels of readmission, hospital-acquired-infection and patient satisfaction, all of which can be affected by the size of nursing staffs.
Stephanie Orrico, a registered nurse and HPAE executive committee chairwoman, said the state minimums have become outdated.
“Many hospitals use these minimum numbers as maximum numbers,” Orrico said.
Department of Health spokeswoman Donna Leusner said both the state and the hospitals themselves regularly review appropriate staffing levels and that hospitals must maintain safe staffing levels as part of their accreditation. The state’s regulations are updated every five years, she said.
New Jersey Appleseed Public Interest Law Center Executive Director Renee Steinhagen said the state has never used its power to conduct a full-scale analysis of the impact on public health of the conversion of nonprofit hospitals to for-profit ownership. She said the state has that power under a 1999 state law, the Community Health Care Assets Protection Act.
The state has abdicated its role as a healthcare planner and regulator, she said.
But Leusner said the state has applied rigorous standards to hospital license transfers, noting that Department of Health staff produced a 33-page review as part of their recommendation that the transfer of the license of St. Mary’s Hospital in Passaic to Prime Healthcare Services be allowed to occur.
“It’s extremely thorough, extremely specific, and we’ve had two public hearings,” on the issue, Leusner said.
India Hayes Larrier, an organizer for the nonprofit New Jersey Citizen Action, singled out the proposed St. Mary’s sale for criticism. She is leading a coalition of union, community and healthcare advocates who oppose the sale.
“Essentially they’re leaving this hospital and abandoning them to the whims of the highest bidder, and that’s a problem,” she said.
While HPAE officials and Hayes Larrier are urging the state to appoint an independent monitor if the St. Mary’s sale moves forward, state officials believe that they can provide more direct and effective oversight than a monitor.
Rutgers public policy professor Patrice Mareschal, one of four coauthors of a separate report criticizing state oversight of contracts, said the HPAE white paper highlights an “appalling lack” of both oversight and transparency.
Mareschal and Rutgers labor studies associate professor Janice Fine wrote an afterward to the HPAE white paper, adding that oversight is an “inseparable element of good government.”
Another concern raised in the HPAE report is the state’s shift from Department of Health inspections to determine whether hospital licenses should be renewed – the inspections were originally conducted annually and then every two years – to basing license renewal on private accreditation reports. The contents of these reports are private, as opposed to the public inspection reports.
Fine agreed with the concern.
“It’s a problem with oversight, it’s a problem with transparency and we think it’s something that needs to be addressed,” she said.
However, Leusner pointed out that New Jersey is one of 48 states that recognize the accreditation reports. She also noted that the state conducts inspections of every hospital every two years, and also investigates complaints against hospitals.
HPAE officials note that complaint-investigation results aren’t available on the Department of Health website.
Leusner said officials are working on the issue and want to present the information in a format accessible to consumers. She noted that the investigation reports are available through open-records requests, and that the state has made reports publicly available for ambulatory surgery centers and nursing facilities.
HPAE officials also expressed disappointment that the state hasn’t reached out to the union and healthcare advocates regarding an upcoming review of hospital financial transparency that is required by legislation.
State officials noted that all hospitals, including for-profits, must file monthly financial statements with the state.
HPAE members plan to present a petition tomorrow calling for the state to establish “safe” staffing levels and strengthen its oversight.