Spaulding Cape Cod Physicians Speak Out Against Ballot Question 1

SANDWICH, MA –  In an effort to educate the public about the potential damaging effects of ballot question 1, physicians at  Spaulding Rehabilitation Hospital Cape Cod have written letters to the editor stating their opposition to rigid nurse staffing ratios.  Their letter follows:

As physicians at Spaulding Rehabilitation Hospital Cape Cod, we feel compelled to share why we are voting no on Question 1 and to correct some of the misleading information that is confusing voters.

In our hospital setting, we work in teams with nurses, aides, therapists and others to deliver highly individualized care to persons following serious illness, injury, disability, and surgery.  Our model of care requires collaboration, flexibility, and a commitment to work together to put patients’ needs first.  The mandated ratios proposed by the nurses’ union would reduce complex staffing decisions to a simplistic formula, where every patient in every rehab unit in the state is treated the same, regardless of the patient’s needs, the staff’s experience and skill, and the setting.  The proposal is flawed at its most fundamental level, because that’s not how we care for patients in 2018.  

The nurses’ union claims that mandated ratios improve quality of care.   In our decades of experience in different hospital settings, we have found that quality of care is determined by many, interrelated factors.  According to nationally respected industry organizations that evaluate and track quality and safety of care, MA hospitals far outperform CA hospitals.  California’s lackluster outcomes are in spite of the fact that its hospitals have had 14 years to realize the benefits of mandated ratios on quality of care.  Massachusetts hospitals have worked hard to earn their status as some of the best hospitals in the country.  Passing this ballot would erode quality of care, not improve it.

One of the nurses’ union’s most misleading claims is that 86% of nurses support Question 1.  This number is based on a poll of only 302 nurses conducted by the union – that’s less than 1% of the state’s nurses.  The much-touted 86% is statistically meaningless.

We want to be clear:  we’re not against hiring more nurses.  It’s obvious that having enough nurses with the right skill set to meet patients’ needs is desirable and in everyone’s interests.  But this bill is not the answer. It would take us backwards, not forwards.

For one thing, there are not enough nurses in MA to meet current demand, let alone satisfy the proposed ratios.  Hospitals would face a terrible dilemma:  pay punitive fines (up to $25,000 per incident, per day) or close beds and reduce services to stay within the ratios.  For Spaulding Cape Cod, reducing our number of beds will mean that many patients needing hospital-level, specialty rehabilitation care will have to seek that care off-Cape.   This would be burdensome for patients and their families who seek to support their loved one during the rehab stay.  This is counter to our mission and detrimental to the community, which we know will need more rehab services as our population ages.

We urge voters to look behind the misleading statements and get the facts before voting.  Ballot Question 1 has too many negative consequences for patients, hospitals and nurses.  It will hinder, not support, our ability to give the best possible care to our patients and force us to make bad compromises in our model of care.  Over time, we will not have the resources to maintain our services or staff, including nurses and the aides who support them every day, and patients will lose access to advanced rehabilitation care.  No one wins if the ballot passes.

Rummana Aslam, M.D., Chief Medical Officer

Scott Abramson, M.D.

Sherri Clayton, M.D.

Joseph Condon, M.D.

Susan Ehrenthal, M.D.

Andrew Judelson, M.D.

Mark Nickels, M.D.

Ann-Marie Thomas, M.D.

Heidi Wennemer, M.D.

Media Contacts

For media inquiries, please contact the Spaulding Communications Department at (617) 952-5325 or by email