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Editorial: Leery of this ballot initiative

Should public health policy be subject to the voting booth? If you’re the Massachusetts Nursing Association, the answer is “yes” — particularly in trying to get the union’s version of safer staffing levels written into the lawbooks.

But we think that the citizens of Massachusetts should, as with any ballot initiative, be leery of this approach.

For more than a decade, the largest union of nurses in the state has been proposing and supporting legislation that would regulate nurse-to-patient ratios. Despite years of effort, however, the proposed legislation has failed to make it out of the Legislature.

And, while there is a staffing bill currently being considered by lawmakers, the union is trying a different prescription — a ballot initiative.

Recently, the Patient Safety Act, as the referendum is titled, was certified by the state attorney general, setting in motion the next step of getting the measure on the ballot. The union now must get some 69,000 signatures this fall to move it toward the November 2014 ballot. If the proposed legislation gets enough valid signatures, passes other hurdles and wins approval at the polls, then Massachusetts would be in line to be the second state to impose such staffing ratios.

So far, only California has approved such legislation, and did so more than a decade ago.

The MNA says it is motivated by concerns over patient safety and is seeking to make it illegal to have more than four patients for those nurses assigned to a medical/surgical unit or no more than two patients for those nurses assigned to critical care units. Along with creating these ratios, the proposal comes with a penalty — hospitals that don’t follow these ratios would be fined $25,000 a day.

That’s just one financial aspect of this proposal, though. The Massachusetts Hospital Association opposes it, pointing out that these rigid rules would mean more nursing staff, which could drive hospital bills up.

Not surprisingly, there’s a large gap between what the union and the hospital group see as the estimated cost if this proposal becomes law.

It may not matter who is right on the financial bottom line, since both sides are talking about needing hundreds of millions of dollars to implement the rules.

But there are questions that need answering before making a decision on these proposed regulations.

A big one for us would be why has the Legislature not approved previous attempts for staffing ratios? Could it be that lawmakers see this as bad medicine, regardless of the claims made by the MNA? Or was it, as some assert, that the hospital lobby has prevailed?

It’s a complicated issue, one that deserves a lot more public discourse and investigation. We hope this will happen as the effort gets under way for signatures.

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