Who is Protecting NJ’s Health Care?

Christie at his best -- surrounded by supporters and being himself.  The governor waves while announcing his candidacy for the Republican presidential nomination at Livingston High School on June 30, 2015. (Jeff Zelevansky/Getty Images)

Christie at his best — surrounded by supporters and being himself. The governor waves while announcing his candidacy for the Republican presidential nomination at Livingston High School on June 30, 2015. (Jeff Zelevansky/Getty Images)

Chris Christie is traveling the country campaigning for the Republican nomination for President and bragging about his fiscally responsible and transparent leadership of our state.  As healthcare workers and advocates, that’s not been our experience.  But now, top cabinet members are also leaving, including Department of Health (DOH) Commissioner Mary O’Dowd.

Healthcare advocates, like my union, the Health Professionals and Allied Employees (HPAE) AFT/AFL-CIO, have often criticized the Christie administration and DOH for its hands-off approach to regulation and enforcement.  Perhaps we can hope that in Governor Christie’s absence, Commissioner O’Dowd’s successor can take a more proactive approach to the mission of the DOH: protecting access to quality care for our communities.

For healthcare advocates, it is not acceptable to ignore hospital consolidations and their impact on costs, or to let the marketplace prevail when hospitals are failing, or when hospitals and insurers battle over excessive payments at the expense of patients and workers.  We cannot sit by when the DOH fails to enforce its own rules or take an active role in ensuring safe patient care.

HPAE members work on the frontlines of healthcare, in hospitals, long-term care facilities, research and academic institutions and blood banks.  Our members take pride in our reputation as advocates for measures that promote access to safe and effective patient care; advance professional practice; protect the safety and health of healthcare workers, and assure adequate funding for medical research and for regulatory agencies.

So as we congratulate Catherine Bennett on her appointment as Acting Commissioner of the NJ Department of Health (DoH), we want to raise again many of the same concerns we have raised – often without resolution – to the DOH during the Christie administration.

Hospital inspections

The NJDOH abandoned hospital licensing inspections in 2011, giving this critical patient safety assurance role to private companies who are hired and paid by the hospitals they are inspecting. These inspection reports are not available to the public, and assess only whether hospitals meet federal Medicare conditions.  As a result, they do not inspect whether hospitals are complying with state laws, like NJ’s ban on forced overtime, or our violence prevention and safe patient handling laws.

DOH hospital inspections should resume, as should the DOH’s former practice of posting on its website hospital complaint inspection results for the public.

Safe Staffing

The DOH has not updated its hospital nurse staffing standards in 28 years, despite major shifts in patient acuity, technology and hospital admission and discharge practices.  Research supports what frontline nurses know from their daily experience: safe staffing goes hand in hand with better patient outcomes and safer working conditions. Instead of radio silence, the DOH should come out in support of S1183/A647, a bill mandating nurse safe staffing ratios and acuity systems in NJ hospitals.

Hospital Financial Transparency

One year ago, as a result of the Governor’s veto of hospital transparency legislation, the DOH issued a “Hospital Financial Transparency” Report with recommendations to strengthen the financial accountability of  both non-profit and for-profit hospitals, providing communities and employees with the information on how  patient care dollars are being spent.

Among its recommendations, the Report clearly states:

  • Hospitals “should” post their annual audited and quarterly unaudited financial statements on their websites;
  • The DOH “should” levy escalating fines for each day a hospital’s audited financial statement is overdue to the Department of Health;
  • The DOH “should” work with stakeholders to explore when and how hospitals report contracts with related parties and public access to that information.

The Report also recommends that a working group review current regulations related to hospital boards and make recommendations to strengthen hospital board accountability.  Only in recent weeks has this working group been called to a meeting.

The DOH has failed to keep all stakeholders informed about and engaged in the implementation of these recommendations.  When we search hospital websites for their financial statements, we don’t find them.

Under Governor Christie and current leadership, the DOH has simply failed to enforce its own rules and regulations.

Health and Safety

The Safe Patient Handling Act and the Violence Prevention in Health Care Facilities Act of 2007 represented landmark protections for workers and patients, and I am proud of my union’s efforts in winning passage of these laws.

To our knowledge, the NJDOH has not conducted any outreach to covered healthcare employers or healthcare workers to inform them of their rights and responsibilities under these laws and regulations.  The NJDOH website does not appear to have any information on health and safety protections for healthcare workers.  A 2013 informal HPAE survey of NJ Registered Nurses found that less than one-quarter of respondents worked in facilities with joint labor-management workplace violence prevention and safe patient handling committees.

Again, DOH abdicated its responsibility to enforce these laws, and we continue to witness violent assaults against healthcare workers, and repeated injuries due to lack of training and equipment necessary for safe patient handling.

Hospital Consolidations, Mergers  and Healthcare Costs

Debates continue in the legislature over major trends in healthcare, including hospital consolidations, mergers and acquisitions, the future of healthcare in Newark, and exorbitant out-of-network charges by some for-profit hospital systems.

Some predict that there will only be 5 or 6 health systems in NJ in a few years.  Studies point to increased cost, without increased quality, as a result of mergers.  The DOH has taken a very passive position regarding its oversight responsibilities for consolidations and mergers involving not-for-profit hospitals and health systems.  The debate over out-of-network charges desperately needs the voice of the DOH, which is charged with protecting access to health care for all of our communities.  The DOH has failed to aggressively enforce the Conditions it set regarding maintaining insurance contracts when some for-profits took over community hospitals.

Healthcare workers, patients, and our communities need and deserve a Department of Health fully committed to its mission as public health protector and advocate, and willing to act proactively to assure access to safe, effective and affordable care for all the residents of NJ even in the face of pressure from wealthy or well-connected special interests.

Perhaps this list of open and unresolved items should also be a warning to health advocates around the country, as Governor Christie campaigns for the Presidency.  Look closely at the record, not the rhetoric.

And for New Jerseyans, can we ask: Is it too much to expect real transparency and oversight from the next Commissioner?  Or our next Governor?

Who is Protecting NJ’s Health Care?