By Dina Burstein
In her car before she walks into the hospital, a nurse prays, “Please, please help me make sure that all my patients make it out alive.”
In Harborview’s renowned Burn Intensive Care Unit, a nurse is about to begin a two hour wound care procedure on her patient, when she is given a second patient requiring one-to-one care. The new patient is a five year old just out of brain aneurism surgery.
A custodian at Swedish was responsible to clean 17 rooms per day when she first took the job 10 years ago. Now she is responsible to clean 28 rooms per day.
At Swedish- Ballard, a charge nurse faced with too many patients begs for more nurses but is refused help. The nurse is later viciously assaulted by a patient wielding his IV pole.
How are these stories possible? Hasn’t the Affordable Care Act made health care better in Washington State? A forum put on by SEIU Healthcare 1199NW and Washington Community Action Network on May 7 provides troubling answers.
Washington hospitals are consolidating into national corporate chains. Swedish has become part of Providence Health and Services, with 34 hospitals in five states. UW Medical Center, Harborview, Northwest and Valley Medical Centers, UW Clinics, and Airlift Northwest are all part of UW Medicine. Highline Medical Center is now part of Catholic Health Initiatives, which has 93 hospitals in 18 states. These hospital systems are earning impressively. For instance, in 2014 Providence earned $771.4 million in profit. CEO/administrator salary is also growing. Valley Medical CEO’s total compensation for 2013 was $1,427,341. Northwest Hospital’s CEO earned $1,380,436 in 2012. The CEO of Providence earned $1,918,810 in 2013.
But staffing at these hospitals continues to suffer. In a bedside survey from 2014, 67 percent of RNs at SwedishProvidence responded that staffing on their unit was “what it should be” only 50 percent of the time. Poor staffing does not just give staff a hard day at work. It costs lives. Each year 400,000 patients die from preventable medical errors which could be avoided if hospital staffing was adequate. And in hospitals where patient safety suffers, Medicare cuts payments. In 2014, Medicare penalized all Swedish Hospitals, Harborview, Northwest and Valley Medical Centers over concerns about patient safety.
California passed a landmark law in 2004 limiting the number of patients assigned to one RN. It remains the only state with a safe staffing ratio law for all hospital patients, and national staffing legislation sits waiting in the House and Senate.
Before the implementation of most provisions of the Affordable Care Act (ACA) in 2013, over 20 percent of American adults struggled to pay their medical bills, and three in five bankruptcies were due to medical bills. But now that insurance coverage has expanded, the predominant cause of medical debt has changed from uninsured to underinsured patients. High co-pays and deductibles, uncovered procedures and specialists, insurance plans and processes that are difficult to understand all lead to debt. And there remain many Washingtonians who are uninsured because they can’t afford their premiums for insurance, even premiums for insurance provided by the ACA. Immigrants with legal documentation are not eligible for Medicaid or for state exchange insurance subsidies. And immigrants over the age of 21 who do not have legal documentation are not eligible for health exchange coverage or Medicaid at all.
Even though hospitals are required to offer charity care to patients with bills they cannot pay, Washington hospitals place barriers in the way of patients receiving charity care. Financial assistance counselors do not inform patients about charity care. The application for charity care is long and requires financial documents which an ill patient may have difficulty locating. Hospitals have established a 14- day deadline for completion of the application, a short deadline which is difficult for a sick patient to meet. And hospital charity care provisions do not cover contracted medical services performed in a hospital.
Consider the experience of Ben, a Seattle resident diagnosed with nonHodgkins lymphoma 18 months ago. He was fortunate to have good health insurance and a supportive employer. He was treated with surgeries and chemotherapy, and is now cancer-free. But he could not pay all the co-insurance charges. He was awakened early on a Sunday morning by a loud banging on his door. The hospital had sold his debt to an aggressive debt collection agency who served him notice that morning that they would sue him if he failed to pay.
He and others like him with medical debt face collections harassment, application of interest and fees, garnishment of wages, and liens.
What needs to happen
Hospitals have a responsibility to provide safe, affordable care. They need to staff adequately for safe caregiver-to-patient ratios. Since hospitals have declared their opposition to safe staffing minimums, we must compel these minimums through statewide or national legislation like the 2004 law in California.
Hospitals need to inform patients who qualify for charity care of its availability, create an application process that is not too complex for a sick hospital patient to complete, and provide a longer time period in which a patient can make a charity care application.
Hospitals should not send patients to collection agencies, particularly patients who should have been enrolled in charity care in the first place.
Insurance plans need to clarify which providers and institutions they cover.
The ACA has led to great improvement for a large number of people in Washington. But there is clearly room for improvement in quality of care and billing practices.
Health Care Is a Human Right- Washington, a coalition which includes PSARA, is working to create a universal singlepayer health care system for all Washingtonians. If we could achieve that, along with safe staffing ratios, we would see many fewer nurses praying in their cars on the way to work, and many fewer Bens seeing their hospital and its CEO get rich off of their needed cancer care.
The Washington legislature, with the support of the Governor, should pass legislation that provides universal health care coverage for all Washington residents. Additionally, legislation must be passed, following the example of California, to require the hospitals to provide safe staffing ratios to protect hospitalized patients and the staff that care for them. In the absence of legislation, the city must find ways to hold the hospitals accountable, including support for a charity care policy that will help to eliminate the medical debt that should be covered by charity care.
Dina Burstein is a nurse, a member of SEIU 1199NW, and a member of PSARA.