The California Department of Public Health says the agency is enforcing state requirements, despite deep budget cuts.

By Mark Kreidler, Capital & Main

This story is produced by the award-winning journalism nonprofit Capital & Main and co-published here with permission.

Pediatric nurses at the UC Davis Medical Center say they are in the midst of a staffing crisis, a claim the health system flatly denies. Nurses at Ronald Reagan UCLA Medical Center report severe overcrowding and patients sometimes placed in hallways in the emergency department for days, which UCLA says it has received waivers from the state to allow.

Neither concern has been addressed to nurses’ satisfaction at the local level. That’s not uncommon; it’s one reason they’re represented by a union. But when the union and the hospitals still can’t agree on the issues, the cases escalate to the state level.

That’s where it gets fuzzy.

On Tuesday in Sacramento, members of the California Nurses Association/National Nurses United rallied in front of the offices of the California Department of Public Health, or CDPH. The union, which represents nearly 20,000 nurses in the University of California system, wants more transparency from the giant state agency when it comes to investigations of their complaints — complaints, nurses say, that still aren’t being adequately addressed. (Disclosure: CNA is a financial supporter of Capital & Main.)

More to the point, the nurses say they’re not being interviewed or even contacted by CDPH as their cases go forward. The department’s investigators do speak with hospital management, they say, but neither patients nor nurses have had a voice in the process.

“In their mission vision, the CDPH states that one of their essential functions is to protect patient safety in hospitals, but we’re not receiving the appropriate action back from them,” said Ashley Johnson, a UC Davis nurse. “We had to make them see and hear how important patient safety is to us.”

In response to questions from Capital & Main about staffing issues at UC Davis, emergency department crowding at UCLA and its own investigation process, a CDPH representative said the agency takes seriously its role in patient safety “and thoroughly investigates every complaint we receive.”

“All health facilities we license and regulate must adhere to a broad set of requirements to ensure all patients receive safe, high-quality care,” said a statement delivered by the CDPH Office of Communications. “Any noncompliance by a facility to meet those requirements will face enforcement by the department to correct those errors, or further action if deemed necessary.” The agency forwarded a link through which anyone can file a complaint if they feel proper care is not being provided at a facility.

The department’s response did not address the specific concerns raised by the nurses. Union members say no one from CDPH spoke with them at Tuesday’s rally, during which they presented a letter to a department employee requesting more transparency from the agency.

Staffing shortages at hospitals up and down the state have been an issue for years, and they were radically worsened by the arrival of COVID-19 in early 2020. Moreover, health systems of all kinds, including those across the UC system, have acknowledged they’ve struggled for years to either hire or retain sufficient numbers of nurses.

In the case of UC Davis, registered nurses said they became alarmed that staffing in the pediatric intensive care unit (ICU) consistently fell below what they deemed to be safe levels. State law mandates a minimum ratio of one nurse for every two ICU patients, but it also says that registered nurse staffing must be increased based upon the acuity of those patients — that is, the severity of their cases.

“UC Davis administration has been gaslighting nurses about nurse-to-patient ratios,” said Melissa Beebe, a registered nurse at UC Davis and the chief nurse representative for the California Nurses Association. “The ratios must also take acuity into account. In the pediatric ICU, we have some very, very sick children. Some of our patients need one-to-one care, and some patients even need two nurses. But management is not assigning enough nurses to do that.”

In addition, nurses said, CDPH’s subsequent investigation involved speaking with UC Davis management, but not them. “We have not had anyone speak with staff or patients, or sort of review the environment,” Johnson said.

UC Davis Health officials pushed back forcefully on the nurses’ assertions, accusing the union of using the ratio system, the only one of its kind in the U.S., as a “labor relations tactic” and denying that acuity concerns are not being addressed.

“There are no staffing issues in the Pediatric ICU,” said Edwin Garcia, senior public information officer for the system. “UC Davis has won, and continues to win, multiple national awards for the quality of work of our nurses … These allegations, along with other allegations, are not true. It’s clear that the union leaders are grasping at straws as a public relations tactic to smear our nationally ranked hospital.”

At the UCLA facility, nurses said overcrowding in the emergency department was so severe that it was common for patients to be placed on stretchers in hallways or placed two to a room in spaces designed for only one patient.

But when registered nurse Kathrin Muellerchen filed a safety complaint to CDPH a few weeks ago as part of her role as a member of UCLA’s Professional Practice Committee, she said she heard nothing in reply beyond an acknowledgement that the department was investigating.

“They don’t talk to us as nurses,” Muellerchen said. “Sometimes they say they came and investigated and didn’t see any fault — but they didn’t talk to me. We need a better response.”

Reached for comment, a UCLA Health spokesperson acknowledged patients being placed in emergency department “designated overflow areas” due to the continuously high influx of those needing care, and said some single inpatient rooms had been modified for two people. But he said that those moves remained within state staffing ratios and at the permission of CDPH in the form of renewable waivers, which were used extensively in the early months of the pandemic. Nurses say they haven’t seen renewal approval of those waivers and can’t get answers.

CDPH has been asked to work with less recently, including enacted and proposed budget cuts in each of the last two fiscal years. Its ability to continue investigating safety concerns, not just at UC health systems but across the state, depends upon a commitment to resources — but also to a thorough process that incorporates feedback from nurses and patients.

“We can’t provide safe patient care like this,” Muellerchen said. “It’s unsustainable.”

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