Category: Daily News

Nursing turnover continues to be a substantial challenge for healthcare organizations as the nursing shortage remains high nationwide, and in California, with no particular solution on the horizon.

A study from Nursing Solutions Inc. (NSI) showed that actual reported hospital and staff RN turnover increased from 18 percent in fiscal year 2020 to 27 percent in fiscal year 2021; the same March 2022 study reported that the workforce lost about 2.5 percent of RNs in 2021. In the latest NSI report (March 2023), turnover reduced to 23 percent in fiscal year 2022 but still remains elevated compared with prepandemic levels.

A Health Affairs study published in April 2022 found that the RN workforce fell by about 100,000 by the end of 2021, which is a “far greater drop than ever observed over the past four decades.” This decline was particularly pronounced among midtenure nurses (aged 35 to 49).

Career satisfaction, intention to leave jobs, and mental health and wellbeing issues among registered nurses have gotten significantly worse since the midst of the COVID-19 pandemic, according to the AMN Healthcare 2023 Survey of Registered Nurses.

The AMN Healthcare 2023 Survey of Registered Nurses, based on responses from more than 18,000 nurses in January 2023, found that career satisfaction dropped by 10 percentage points since the middle of the pandemic in 2021. In addition, the likelihood of encouraging others to become a nurse declined 14 points since 2021.

So this data begs the question about possible solutions.

In 2022, the US Department of Labor budgeted $80 million to encourage not-for-profit organizations, educational institutions, and tribal organizations to apply for grants of up to $6 million each to train current and former nurses to become nursing educators and frontline healthcare workers to train for nursing careers.

At the local level, CalMatters reports that the California Legislature is looking at several ideas to address the nursing shortage by bringing more early-career nurses into the field. But so far, the groups with most to gain – or lose – are at odds over how to solve the staffing problems afflicting California’s health care workforce.

Labor organizations and hospitals want nursing schools to prioritize certain applicants for admission, such as people who already have experience in the industry. But the schools say that won’t help them graduate more nurses. They need more faculty and more hands-on training opportunities to increase class sizes.

Hospitals and unions say they don’t have much time to waste. Estimates show California faces a shortage of about 36,000 licensed nurses, according to the UC San Francisco Health Workforce Research Center on Long-Term Care.

Labor advocates say the nursing shortage creates a vicious cycle. The nurses on shift wind up doing more work. They get burned out and flee the industry, worsening the problem.

Service Employees International Union (SEIU) and the United Nurses Associations of California/Union of Health Care Professionals turned their attention to the state’s community college system, where graduates can earn degrees to become nursing assistants, licensed vocational nurses or registered nurses. Both groups say community colleges offer the most affordable and efficient way to earn a nursing degree.

But community college and some university nursing school leaders contend they cannot boost the number of graduates. Nursing programs are full, they say, and the proposals do nothing to expand the number of admission slots.

About 14,000 new students enrolled in nursing programs during the 2020-21 school year, according to the Board of Registered Nursing’s annual school report. That’s about 1,000 fewer students than the previous two years due to smaller class sizes, but schools across the state received more than 55,000 applications, a 10-year record.

United Nurses Associations of California/United Health Care Professionals lobbied for a $300 million investment over five years to double the state’s nursing school capacity. It was included in the state budget Gov. Gavin Newsom signed earlier this summer. The details of how the money will be spent have not been decided.

The new 93 page working paper – Temperature, Workplace Safety, and Labor Market Inequality – by researchers from the University of California, Los Angeles and Stanford University documents, for the first time, the growing safety risks of excessive heat for U.S. workers in occupations not just where the work is mostly outside but also indoors.

The researchers examined 11,146,912 confidential records of workplace injuries in California from the Department of Workers’ Compensation (DWC) over the period 2001 to 2018 combined with zip code level information on daily temperature from the same period. The data also included the medically determined cause (e.g. fall), type (e.g. strain), and body parts affected (e.g. knee) by the incident, as well as some limited demographic information including age and gender for each claim.

They found that hotter temperature significantly increases the likelihood of injury on the job. A day with high temperatures between 85 and 90 leads to a 5 to 7 percent increase in same-day injury risk, relative to a day in the 60’s. A day above 100 leads to a 10 to 15 percent increase. Causal identification relies on the premise that idiosyncratic variation in daily temperature within a given zip code-month is plausibly exogenous, and that the resulting effect on injuries is not driven by potential endogenous changes in labor inputs.

Higher temperatures also increase injuries in some industries where work typically occurs indoors. In manufacturing, for instance, a day with highs above 95 increases injury risk by approximately 7 percent relative to a day in the low 60’s. In wholesale, the effect is nearly 10 percent. They also found that claims for many injuries not typically considered heat-related rise on hotter days. These include injuries caused by falling from heights, being struck by a moving vehicle, or mishandling dangerous machinery. The increase in injuries affects a wide range of body parts, suggesting that the mechanisms may not be limited to heat-illnesses such as heat stroke or heat syncope.

The risks are “substantially larger for men versus women; for younger versus older workers; and for workers at the lower end of the income distribution.“

“These are previously undocumented facts with possibly significant policy implications, given the nearly exclusive attention to date on outdoor workers and heat illnesses: i.e. incidents that are medically coded as due to heat exposure.”

The researcher estimated that hotter temperature has caused approximately 360,000 additional injuries in California over the period 2001-2018, or roughly 20,000 per year relative to a hypothetical benchmark in which all workers experience only optimal temperatures.

“For perspective, this is roughly eleven times the number of workplace concussions, and at least nineteen times the annual number of workplace injuries the worker compensation microdata records as caused by extreme temperature.”

They estimate the socioeconomic costs of these injuries are on the order of $525 million to $875 million per year, given the costs of healthcare, lost wages and productivity, and other knock-on costs such as work disruptions and potential permanent disability.

However researchers also found evidence of significant adaptation potential, as they noted that the effect of temperature on injuries falls significantly during the study period.  For instance, the effect of a day above 90 falls by roughly a third between 2000 and 2018, and the effect of days above 100 is statistically indistinguishable from zero after 2005.  The temporal profile of heat’s effects on injuries coincides with the introduction of what was at the time the nation’s first heat safety mandate, the California Heat Illness Prevention Standard (Q3 2005), which applied only to outdoor workplaces.

“While we remain agnostic to the source of the decline in heat-related injuries, our findings are consistent more broadly with the possibility of adaptation using existing technologies.”

A new AB 1643 – California Heat Study: Advisory Committee is set to use this data as part of a roadmap to tackle hot workplace issues. The group of state agency staffers and scholars will examine persistent problems with underreported heat-related illness and injuries, as well as gaps in data collection and the financial toll on workers and businesses when temperatures rise and production falls.

Brian Hill, 64, and Leslie Hill, 68, a husband and wife from Bakersfield, have been charged with multiple felony counts of insurance fraud and conspiracy after a Department of Insurance investigation found the couple under-reported over $4 million in employee payroll for the construction company they owned.

The Department began an investigation into Brian Hill Construction, Inc., owned by the Hills, after receiving information that the company paid an employee with a combination of check and cash, and that the cash pay was not reported to the company’s workers’ compensation carrier.

Between July 2017 and October 2019 Brian Hill Construction Inc. held a workers’ compensation insurance policy through State Compensation Insurance Fund and between October 2019 and October 2020 held a workers’ compensation insurance policy through Benchmark Insurance.

An investigation into Brian Hill Construction, Inc., revealed the company reported approximately $135,667 in employee payroll between July 2017 and October 2019 to State Compensation Insurance Fund. However, an audit by the Department revealed the business actually had over $3.6 million in employee payroll for the same time period.

The investigation also revealed Brian Hill Construction, Inc. reported approximately $9,140 in employee payroll between October 2019 and June 2020 to Benchmark Insurance, but an additional Department audit revealed the company actually had over $500,000 in employee payroll for the same time period.

Over the course of three years, Brian and Leslie Hill failed to report over $4,025,250 in employee payroll to their insurance carriers. The hiding of employee payroll resulted in the illegal reduction of workers’ compensation insurance premiums paid and $2,542,365 in premium owed to the insurance companies.

The investigation also discovered one employee of Brian Hill Construction Inc. was injured on the job and sent to a local hospital where they received minimal medical treatment. By law the employer was required to file a workers’ compensation claim, but the Hills circumvented the workers’ compensation process by paying the medical facility directly and eliminating benefits the injured worker may have been entitled to.

Brian Hill was arraigned yesterday and Leslie Hill is scheduled to be arraigned on Thursday, July 27, 2023. The Kern County District Attorney’s Office is prosecuting this case.

Milan Cvejic worked for Skyview Capital LLC. He filed a lawsuit against them and others in state court after his termination of employment, claiming causes of action for employment law issues.

His employment agreement with them contained an arbitration clause. Thus Skyview moved to compel arbitration. The trial court granted the motion and stayed proceedings.

The case went before a panel of three arbitrators through the American Arbitration Association under the rules for commercial cases. After at least one continuance, the final hearing on the merits was set to begin August 5, 2021. Skyview had to pay arbitration fees ahead of the hearing. The fees were due June 4, 2021.

On July 7, 2021, Cvejic’s counsel asked the case manager whether Skyview had paid the deposits. On July 8, 2021, the case manager confirmed by email that Skyview had not paid. The manager scheduled a call to address the situation. During the call, Skyview’s counsel reported there was “no further explanation” for his clients’ failure to pay the fees. Cvejic reserved his rights to proceed under the Code of Civil Procedure. The panel stated “[t]he Hearing fees have been requested and the deadline for making the deposits has passed.” It set a new deadline of July 14th for payment of the fees.

Within about an hour of the call, Cvejic’s counsel wrote the panel to say Cvejic was withdrawing from the arbitration under Code of Civil Procedure section 1281.98. The panel chair responded that Cvejic’s request was “premature” – presumably because the deadline was now July 14th. Thereafter the panel ruled section 1281.98 was not in play because Skyview “came into compliance with the Panel’s Orders regarding posting deposits.” Skyview ultimately paid its fee by July 14th.

On July 21, 2021, Cvejic filed in the trial court a section 1281.98 Election to Withdraw from Arbitration. Soon after, he sought ex parte relief, which the court denied due to the absence of emergency. In December 2021, Cvejic refiled his section 1281.98 election, which included a request for sanctions under the statute and a motion to vacate the earlier order staying court proceedings. Skyview opposed the filing. The court’s February 2022 order granted Cvejic’s request to withdraw from arbitration, vacated the order staying proceedings, and awarded Cvejic reasonable expenses under section 1281.99.

The employer appealed the trial court Order. The Court of Appeal affirmed the trial court in the published case of Cvejic v. Seaview Capital LLC – B318880 (June, 2023).

The Legislature enacted section Code of Civil Procedure 1281.98 in 2019 to curb a particular arbitration abuse. The abuse was that a defendant could force a case into arbitration but, once there, could refuse to pay the arbitration fees, thus effectively stalling the matter and stymying the plaintiff’s effort to obtain relief. The Legislature called this “procedural limbo.” (Gallo v. Wood Ranch USA, Inc. (2022) 81 Cal.App.5th 621, 634 (Gallo) [quoting legislative history].) It has also been described as “procedural purgatory.” (Ibid.)

Subdivision (b) of the statute provides employees and consumers with a choice of forum upon breach: They may elect to “[w]ithdraw the claim from arbitration and proceed in a court of appropriate jurisdiction” or “[c]ontinue the arbitration proceeding” should the provider agree to continue. (§ 1281.98, subds. (b)(1) & (2).) The statute also empowers courts to award fees, costs, and sanctions.

After the current fee dispute arose, the Legislature amended both sections section 1281.97 along with section 1281.98 in 2021. The amendments added a new subdivision to section 1281.98 that compelled arbitrators to provide invoices to all parties, specified requirements for these invoices, and clarified the due date for fees.

The new subdivision also includes this new sentence: “Any extension of time for the due date shall be agreed upon by all parties.” (§ 1281.98, subd. (a)(2).) The amendments became effective January 1, 2022.

The Legislature sought a clear rule for determining whether the late payment of a fee by a drafting party constituted a material contract breach.

The Court of Appeal concluded by noting “Skyview’s fees were due June 4, 2021. By July 9th, Skyview had not paid. Skyview was in material breach of the parties’ arbitration agreement. Section 1281.98 entitled Cvejic to withdraw from the arbitration. It is that simple.”

“The statute does not empower an arbitrator to cure a party’s missed payment. There is no escape hatch for companies that may have an arbitrator’s favor. Nor is there a hatch for an arbitrator eager to keep hold of a matter. As the trial court observed, ‘If . . . the drafting party were permitted numerous continuances for failure to pay arbitration fees, therefore delaying the proceedings, C.C.P. section 1281.98 would have no meaning, force, or effect.’ ”

California passed Assembly Bill 112 – the Distressed Hospital Loan Program – as an emergency statute in May 2023. The program provides interest-free loans to not-for-profit and public hospitals in significant financial distress, as well as to governmental entities representing a closed hospital. The goal of the program is to prevent hospital closures and to help hospitals stay afloat while they work to improve their financial health. The law appropriated $150 million for the loan program.

Legislators and hospital administrators have acknowledged a loan program is only a stop-gap for a number of hospitals that for months have warned of their precarious fiscal situations. Legislators fast-tracked action following the closure of Madera Community Hospital at the start of this year, which left San Joaquin Valley county of 160,000 people without a local emergency room.

Since then, another hospital, Beverly Hospital in the city of Montebello, has filed for bankruptcy.

In legislative hearings leading to passage of this program, lawmakers asked why the state wasn’t conducting its own analysis of hospitals’ current situation so that the Legislature knows exactly which hospitals are in immediate need of relief.

“We don’t know how many hospitals, we don’t know which hospitals. We don’t know which areas those hospitals are (in), we don’t know anything. And now we’re asked to approve $150 million to be doled out without access to plans, without access to the finances that would give us the evidence to feel comfortable with this,” said Sen. Maria Elena Durazo, a Los Angeles Democrat, during a Senate budget committee hearing

According to a report by Inewsource.com sixteen facilities have applied so far for the newly created Loan Program which has a deadline for applications by the end of July.

The Madera Community Hospital, which shut down earlier this year but could reopen under new owners, has requested $80 million alone.

El Centro Regional Medical Center, Imperial County’s largest hospital, is seeking a $40 million state loan in its latest attempt to keep it’s doors open. El Centro Regional board members voted to apply for the program late last month. CEO Pablo Velez, who took over the hospital in April, confirmed to inewsource last week that its application remains under review.

A city-owned, 161-bed facility, El Centro Regional has been struggling with rising costs and declining revenues since the COVID-19 pandemic. The hospital already received a separate $5 million loan from the state earlier this year, and its latest audit raised “substantial doubt” about whether it can continue operating because it lacked recurring income sufficient to meet operating costs and its debt payments.

Board members also delayed adopting a new budget, saying it needed to “confirm the applicability of the current budget” before passing a new spending plan. The latest proposed budget, set to be considered this week, projects a nearly $10 million net deficit. The latest finance report showed El Centro Regional had fewer than 20 days cash on hand.

Officials have hinted at dire consequences if either of the two hospitals in Imperial County were to close. Pioneers Memorial in Brawley has also faced financial problems, though not as severe as that of El Centro Regional. Residents in the county, one of the poorest in the state, would be forced to travel some two hours away if those facilities weren’t available.

A report commissioned by the California Hospital Association earlier this year found that one-in-five hospitals is at risk of closing. More than half are operating at a loss.

These include: Kaweah Health Medical Center in Visalia, MLK Jr. Community Hospital in Los Angeles, Hazel Hawkins Memorial Hospital in Hollister, Sierra View Medical Center in Porterville and Mad River Community Hospital in Humboldt County, all of which have reports of financial stress.

With eyes on the upcoming fiscal year, the California Hospital Association has asked the state for $1.5 billion in one-time relief, a tough request in a deficit year. But Senate Democrats are in support, proposing that hospitals get $400 million annually for four years that would come with requirements and conditions, according to their budget proposal that is to be finalized this summer.