View From Lodi, CA: Arnold Versus the Nurses
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Many years ago, when my father was in the final days of his life at UCLA Medical Center, his nurses were a great comfort to him.

Dad's doctors came into his room, delivered their abrupt updates and left without further ado.

But the nurses lingered, held Dad's hand and spoke to him in gentle, loving tones.

Since that time some twenty-five years ago, nurses have always held a special place in my heart.

So I am torn about the battle between the California Nurses Association and Governor Arnold Schwarzenegger.

At issue is whether to protect a 1999 safe staffing law that would have changed the existing nurse-patient ratio from one nurse per six patients to one nurse per five patients effective January 1 2005.

In November, Schwarzenegger issued an emergency order that maintained the previous one to six ratio.

Nurses balked.

Then, at the Governor's Conference on Women and Families, Schwarzenegger ejected protesting nurses. According to the nurses, Schwarzenegger behaved boorishly by mocking them from the podium, calling them "special interests" and saying he was going to "kick their butts."

Understandably, nurses objected to being labeled with a term most frequently associated with major corporate donors.

They fought back.

CNA filed a lawsuit asking the Sacramento Supreme Court to set aside Schwarzenegger's emergency order. The suit claims that Schwarzenegger violated the legal requirements for issuing an emergency order since such orders are only necessary for the immediate safety and well being of the public.

CNA predicts that, if allowed to stand, the emergency order would set a precedent that would allow regulations or laws enacted in the public interest to be set aside without legislative review.

Taking its message to the public, the CNA ran a television advertising campaign that took Schwarzenegger's patient safety concepts to task.

The ads, directed voluntarily by Emmy-award winning documentary filmmaker Robert Greenwald, appeared on every major cable market in California.

In the ad, registered nurse Melita Dionosio-Temple says, "One thing the public should know is one day you will be in that bed and realize that because of the number of patients one nurse has to take care of you may be calling and there is nobody there."

But the story is incredibly more complex than Dionosio-Temple paints it.

California faces a critical shortage of nurses—possibly as high as 14,000. At Lodi Memorial Hospital, 13 open nursing positions are unfilled.

And according to a California Hospital Association report titled "California Health Care 2005-2010: A View of the Future" [PDF] the shortage will grow larger by the end of the decade.

As the patient load steadily increases, the demands on every aspect of hospital care become greater.

By 2010, the C.H.A. projects that California will have more than 40 million residents. Of that number, 4.5 million will be older than 65, an increase of 30% from today's 3.6 million.

Uncompensated health care costs will continue to increase, according to the report.

Against this backdrop, in 2004 nine California hospitals shut their doors as did two hospital emergency centers and two trauma units.

In short, California faces the distinct possibility of more hospital closings and severely rationed health care if current conditions continue.

Given the dire conditions of California health care today, is this the time for the CNA to force Schwarzenegger's hand regarding nurse/patient ratios?

What both sides need to do is tone down the rhetoric. Clearly, nurses are not special interests. For Schwarzenegger to deride them doesn't advance his side of the debate.

But to call Schwarzenegger a "vulgar, arrogant bully," as C.N.A. executive director Rose Ann De Moro recently did, won't take the nurses where they want to go either.

Instead of leading with his chin, as Schwarzenegger has done of late, he should acknowledge that nurses are, to quote Greenwald, "the true heroes and heroines in our world."

No one will argue. But until California gets a better handle on managing health care, then postponing the adjustment in patient/ nurse ratios until 2008 might be the wisest decision.

Joseph P. Harrington, the President and Chief Executive Officer of the Lodi Memorial Hospital, agrees.

This week, during conversations I had with his office, Harrington said, "We must preserve access to care and address nursing shortage with a systemic, fact-based response.  The changes made by the Governor will allow us the opportunity to do that."

In the meantime, there are signs that conditions in nursing may be turning around. Johnson and Johnson Health Care Systems is promoting nursing among young people through its "Discover Nursing" program.  

Through its outreach to youngsters, Johnson and Johnson hopes to restore the image of nursing and help the profession regain its status as one of the most rewarding careers anyone can choose.


Illegal immigration has devastated health care in the US.

Whether you are a veteran trying to access benefits once available to you, a workingman trying to hold on to family coverage or one of the tens of millions of uninsured Americans, the ability of illegal aliens to receive medical treatment has reduced your chances of decent coverage.

The lucky ones who can still afford coverage are paying higher premiums and co-pays.

Backbreaking medical costs are often cited as one of the leading causes in personal bankruptcies.

A young friend of mine is a nurse at a major Oakland hospital. She told me that last week, a non-English speaking patient pulled out a scrap of paper from his shirt pocket. There someone had written his name and address for identification purposes.

My friend called a Filipino nurse over to help her understand what the man wanted. He had been in the United States three days and wanted to know if he could get long-term care for cancer at the hospital.

He was admitted.

As a doctor recently said to me, "You pay more because they pay nothing."

Joe Guzzardi [email him], an instructor in English at the Lodi Adult School, has been writing a weekly column since 1988. It currently appears in the Lodi News-Sentinel.

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