I write to all of you to speak about the November ballot Question 1 regarding government-mandated nurse staffing ratios. I want to let you know that Milford Regional strongly opposes Question 1 because of the devastating impact it would have on Massachusetts healthcare and specifically to Milford Regional.

Question 1 proposes more nurse staffing for patients which, on the surface, seems desirable. In support of nurses, many would say why not? However, as is often the case, good intentions can create unintended consequences. Unfortunately, in this case, should Question 1 pass, the consequences would be disastrous causing significant access issues, gridlock, much higher costs of healthcare and the likely closing of community hospitals.

First, let me say that we are so fortunate to have such highly skilled and caring registered nurses at Milford Regional. I respect all of their views on both sides of this issue. In my position as CEO of Milford Regional, my concern is what ballot Question 1 would do to the Massachusetts healthcare industry as a whole and to Milford Regional. The ballot question calls for inflexible nurse-to-patient staffing ratios across all specialties to be implemented within 60 days of passing. The estimated 4,500 nurses it would take to fulfill this mandate statewide would create a demand that is not achievable. This significant shortage of required nurses would force hospitals (such as ours) to close beds in order to remain compliant with the mandated staffing ratio. This reduction in bed count would dramatically limit access for patients who need to be admitted causing gridlock in our emergency department.  Ultimately, to adhere to the strict mandated nurse staffing ratio, patients may need to be turned away or transferred to other hospitals. In addition, Question 1 would decimate behavioral health hospitals, home health agencies and skilled nursing facilities as hospitals draw nurses away from these much-needed healthcare providers to meet their mandated nurse staffing requirements. The ripple effect would severely impact hospital inpatient services with the inability to discharge patients that require placement in these skilled nursing facilities or home with VNA services. Furthermore, patients that require transfer to a behavioral health facility would languish in our emergency department due to the reduced access imposed upon their industry by the rigid nurse staffing ratios. During a time of critical need for available behavioral health beds, imagine the impact when approximately 1,000 beds are closed throughout Massachusetts.

Another highly consequential issue related to ballot Question 1 is the cost. The government mandated ratios are expected to cost Massachusetts hospitals $1.3B in the first year and approximately $900M as an ongoing annual cost. The estimated impact for Milford Regional would be $5M annually.  Considering that we operate on a razor-thin margin, I am not exaggerating when I say that this additional cost could mark the beginning of the end of a hospital that has lovingly cared for this community since 1903. To start— bed closures, reduced access, cuts in patient services, staff reductions, delayed upgrades in medical/diagnostic technologies as well as elimination of new technologies and longer wait times in the emergency department are just some of the unintended consequences that could take place if Question 1 passes.   

To close, I understand that the ballot question is likely to confuse a lot of our Massachusetts residents. What I want to make clear is that Question 1, without a doubt, would have devastating consequences to the Massachusetts healthcare industry and specifically to Milford Regional. It will significantly limit access to the care our patients have come to count on, eliminate vital services and take away the flexibility and critical thinking skills of our registered nurses. Question 1 will add significant costs to healthcare putting the future of Milford Regional at risk. Registered nurses in the commonwealth and specifically Milford Regional are the backbone of healthcare services. However, this ballot initiative, which might be thought of as well intended on the surface, will devastate healthcare in Massachusetts and particularly at Milford Regional.

Help us retain the high quality healthcare that Massachusetts is recognized for nationally. On behalf of Milford Regional and our community, I encourage you to vote NO on Question 1.

Edward J. Kelly, President/CEO, Milford Regional Medical Center