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Documents Allege Patient Care Undermined at UC Davis Med Center

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(Sacramento, CA)
Wednesday, August 11, 2010
State regulators are investigating the UC Davis Medical Center in Sacramento. The California Department of Public Health is looking at whether the center met staffing regulations. They are also examining whether nurse understaffing undermined patient care, according to interviews conducted with several staff nurses.

Documents provided by the California Nurses Association allege some patients at the center have recieved sub-par care due to nursing staffing shortages. UC Davis Med Center officials deny those allegations. (The documents can be found in the right hand upper corner of this webpage.)

State law mandates how many nurses are needed to tend to patients. Staffing levels differ by department. At the emergency room, law requires four nurses for every patient. In the operating room, it's one nurse per patient. If a patient needs extra monitoring because of a condition like suicidal behavior or internal bleeding, the nurse to patient ratio decreases.

According to documents provided by the California Nurses Association's Beth Kean, patient mishaps occur at UC Davis, and other UC hospitals, in part because administrators are not following the rules of acuity and nurse staffing.

"On a shift one day, a patient who had been on a ventilator somehow came off the ventilator accidently," Kean alleges. "The nurse did not know how long he was off the ventilator because the nurse was tied up with another very sick patient. When the nurse finally responded to the patient who came off the ventilator, he was in very serious respiratory distress, and it took a long while to stabilize him."

There are other documented claims, including: A critical care infant whose stomach was pumped because of over feeding. The documents also claim a patient came close to suicide at the hospital, and that a bleeding patient could not promptly find help.

UC Davis's Carol Robinson denies most of those claims. As the Chief Nursing Officer, she oversees more than 1800 employees. She also rejects CNA's allegation that hospital administration 'plays' with staffing numbers to appear that the required number of nurses are in each unit.

"No, we don't play with the numbers. The numbers are the numbers provided by the nurses themselves. We're required by law to keep records of everything that we staff, and how we staff," Robinson says.

Robinson provided records for this report, and they indicate staffing ratios met the required levels.

Previously under Robinson's watch, investigators cited UC Davis for understaffing. In 2005, according to California Department of Public Health records, investigators found 82 of 136 nursing shifts were understaffed---including in the Intensive Care Unit and the Cardiology Unit. CNA members say many changes the hospital agreed to after that investigation have not been implemented. Again, UC Davis officials say they are following the law.

Yet, according to Jaime Court, hospital officials have reasons not to report errors or shortcomings. Court heads the Los Angeles based Consumer Watchdog, an organization that focuses heavily on patient care.

"Nurses have a nursing license they could lose if they don't tell the truth. And so when nurses report problems with care to their union, they are doing so as licensed professionals," Court says. "Y'know, a hospital owner, I don't care if it's the UC system or not, doesn't have any license they are putting on the line. In fact, when they lie, they save themselves the cost of medical malpractice lawsuits. So I tend not to believe hospital owners in terms of being credible versus a nurse."

The CDPH will decide whether staffing levels are within the law, and if patient care is being compromised. UC Davis Medical Center officials call the investigation "thorough," while nurses say the hospital has ramped up staffing in certain units since regulators started asking questions.

CNA first reported the allegations in November, following up with the CDPH early this year. CDPH is not commenting on the investigation.

CNA and the UC Hospital system are also in negotiations this month over a new contract.

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