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Advocates fear patient care will suffer under state budget cuts

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Gov. Jerry Brown announced a state budget yesterday that relies on hospitals and nursing homes to achieve nearly $400 million in savings – a week after a far smaller proposal prompted concerns about patient care.

The governor's revised budget is the starting point to closing a $15.7 billion deficit. He proposed making further cuts to human services, paring down hours of care provided to In-Home Supportive Services recipients, and limiting child care support provided by the CalWORKs program.

The revised budget poses a new set of challenges to care providers and patient advocates. Last week, groups representing doctors, nurses and nursing home residents decried a comparatively minor budget change that would have cut the mandate for hospital and nursing home inspectors to perform unannounced inspections to monitor compliance with state laws.

The budget proposal by the state Health and Human Services Agency would have eliminated 25 nurse-inspector positions and slashed fees paid by hospitals and nursing homes that go toward enforcing patient safety laws.

Health and Human Services Agency Director Diana Dooley said that the proposal to change facility inspections was unrelated to yesterday's budget cuts. Rather, it was meant to streamline state operations “where we believed we could assure quality and safety in care,” Dooley said.

While both Senate and Assembly budget subcommittees voted down the proposal last week, advocates say they are wary that it may arise again. Ken August, a spokesman for the Department of Public Health, which inspects care facilities, said no decision had been made as to whether the proposed change might resurface.

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Under the proposal, inspections for compliance with federal patient safety safeguards would still take place. But advocates opposing the proposal point to a raft of California-only provisions that are meant to protect patients young and old.

The California Medical Association, which represents about 30,000 doctors, wrote a letter in opposition, listing some protections that might be curtailed if inspectors stop checking.

The protections include requirements that emergency medications in neonatal intensive care units are appropriate for babies. They encompass informed-consent rights for patients undergoing a sterilization or hysterectomy. And they require that inspectors verify that reports are made to the state Medical Board about potentially errant or negligent doctors.

The budget proposal would have also removed the requirement that hospitals be inspected by a licensed doctor, nurse and "persons experienced in hospital administration and sanitary inspections.”

The medical board also opposed that proposal, saying in an era of major changes due to budget cuts and health reform, “the need to continue to ensure facilities’ compliance with vital state laws has never been greater.”

State hospital and nursing home inspectors fine facilities for some violations. For others, they cite deficiencies and follow-up with administrators on corrective actions.

The California Hospital Association has not taken a position on the proposal, said spokeswoman Jan Emerson Shea.

Representatives of the United Nurses Association of California and Disability Rights California opposed the agency's budget change. Also, advocates for nursing home patients spoke out during last week's hearing.

Sylvia Taylor-Stein, executive director of Long Term Care Services of Ventura County, said the end of inspections to check compliance with state law would “set us back 30 years of reform.”

“To be doing this, we would be going so far back, we would be abandoning the residents who depend on us,” Taylor-Stein said.

A Senate committee analysis of the proposal said the changes would end checks on laws that require a doctor to approve the use of physical restraints on patients.

It would also lift requirements that the state examine nursing homes’ use of antipsychotic medications, which can hasten death in patients who have dementia.

The California Advocates for Nursing Home Reform reviewed a series [PDF] of 2010 state inspections on the matter and found that facilities repeatedly failed to obtain informed consent or dispensed potent and risky drugs to patients who had a tendency to wander.

The proposal would have had no effect on federal inspection requirements. Medicare authorities can put nursing homes under aggressive quality-improvement monitoring or cut their funding after major and recurring problems. A recent investigation by the U.S. Health and Human Services inspector general concluded that California health inspectors were falling short in documenting and ensuring compliance with federal standards.

During last week's hearing, Sen. Elaine Alquist, D-San Jose, spoke against the proposal, which would have also pushed out deadlines on complaint investigations that were set in a bill she carried in 2006.

“I think it’s really important to find out in a timely fashion what occurred, so hopefully it doesn’t happen again,” she said.

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