At 4:30 PM, September 13, leaders at Lawrence General Hospital were alerted to multiple natural gas explosions in Lawrence and adjacent Andover and North Andover. That day, gas explosions would simultaneously burn up to 80 houses, injure dozens of people and kill one teenager. Thousands were evacuated from their homes. Many of those residents remain unable to return home. One of the witnesses on the scene of the explosions noted “It looked like Armageddon.” The smoke in the air was reminiscent of lower Manhattan on 9/11. At Ground Zero was Lawrence General Hospital. Upon learning of the incident, Lawrence General Hospital leaders immediately shut down the hospital’s own natural gas supply out of an abundance of caution. Raging fires could be seen burning across the river from the hospital. Smoke drifted onto their hospital campus.

“At the time, I had the horrible thought; what if the nurse staffing ratio law had actually been implemented?”

Leaders at Lawrence General Hospital activated their emergency management plan before the first patient arrived at their doors. This emergency plan included notifying their staff, both within the hospital and those who had the day off.

Everybody did what they could. For example, the Chief Financial Officer, Felix Mercado, (who is an accountant by training, not a clinician) left his office to see how he could best serve the patients and their families in the emergency room. He actually served as a translator that day. Other administrators put on rubber gloves and made sandwiches for the families. The staff at Lawrence General Hospital are proud of the way their community pulled together, as they knew it would in times such as these.

Of the thirteen injured people who were rushed to their emergency room that day, only one person had to be airlifted out, to Massachusetts General Hospital. The rest of the patients were cared for locally at Lawrence General Hospital, a well-known resource for their community.

What if the misguided Question 1 ballot initiative were law that day? Robin Hynds, MSN, RN, CPHM, Executive Director Merrimack Health Network responded that they probably would have been forced to break the law and suffer heavy fines for doing the right thing. She said, “What can we do? Of course we will always take care of the patients. We are the closest hospital to the incident and the best able to provide care locally.” “We support the community. It’s the right thing to do.”

Robin also noted, “At the time, I had the horrible thought; what if the nurse staffing ratio law had actually been implemented? We would have had some hard choices to make, and certainly waits for less urgent care would have been much longer.”

The Boston Globe urges us, “Vote ‘no’ on Question 1. The Nurse staffing ratio is wrong for Mass.

The Lawrence General Hospital leaders I spoke to were proud of the way their on-call and off-duty staff responded. Robin shared, “Many of our nurses came in, on their time off, out of the goodness of their hearts. They were literally running in through the front doors. Physicians too, including trauma surgeons.”

If Question 1 passes this November 6, it would be illegal for hospitals to admit both their routine patients and an unexpected rush of patients from a tragic accident such as the Columbia Gas explosions. This is because the ballot initiative requires a fixed at-all-times rigid number of patients to be assigned to each nurse.

Question 1 is a disaster waiting to happen. The proposed law would require all hospitals to adopt the same rigid, scientifically unproven, one-size-fits-all ratios of nurses-to-patients, at all times – regardless of a hospital’s size, location, or needs of those receiving care.

Question 1 would override the professional judgement and experience of nurses in favor of a rigid government mandate (based on numbers that have no scientific validity). At the bedside, such a law would take real time decision-making power away from professional nurses. In the current system, care team assignments are made based on the ever changing needs of the patients and skill set of nurses.

Question 1 would limit the services hospitals can provide at any given time if they cannot provide enough nurses to fulfill the ratios. Emergency room wait times would dramatically increase, other services will be delayed, and patients would be forced to travel extended distances for care as hospitals scramble to assign and re-assign nurses to fulfill each ratio as the number of patients fluctuates.

Question 1 would be ridiculously complex to implement: I urge you to read the ballot initiative and see for yourself: For example, it specifies 4 different nurse to patient ratios in the Emergency Department (from 1:1 for “critical patients,” 1:2 for “critical stable patients;” 1:3 for “urgent stable patients,” and 1:5 for “non-urgent stable patients.”) How could this even be implemented in the ED, where patients’ conditions change minute by minute?

Isn’t healthcare already expensive enough in Massachusetts? The Massachusetts Health Policy Commission, an independent state agency, recently issued a report that the ballot question would cost upwards of $900 million annually.

Question 1 would cripple community hospitals. Some community hospitals, perhaps yours, would be forced to close if Question 1 passes. This is particularly true for hospitals outside of Boston. Other hospitals will be forced to make painful, significant service reductions in order to keep their doors open.

The Boston Globe states, “Vote ‘no’ on Question 1. The Nurse staffing ratio is wrong for Mass.”

I am a physician and I am voting No on 1. I urge you to vote no on Question 1 too.