Question 1 would hurt MVH

Courtesy Martha's Vineyard Hospital

To the Editor:

You have probably seen TV commercials defending both sides of the debate on Question 1. This ballot question proposes strict nurse staffing ratios at all Massachusetts hospitals and will be decided on Election Day, this Nov. 6th.

We all want appropriate and safe nurse staffing, but we do not believe the proposed regulation is the correct approach. A one-size-fits-all approach would tie the hands of all healthcare professionals. We appreciate that this is a difficult and hotly debated topic. This is not about our nurses. We are proud of our incredible nurses, and celebrate them every day. This is about arbitrary, expensive, bureaucratic policies that will significantly raise costs and cause devastating harm to the Massachusetts healthcare system without improving your care.

Below are some of the reasons why the Martha’s Vineyard Hospital and Windemere board of trustees has joined every other hospital in Massachusetts in opposing this ballot initiative.

Passage of Question 1:

  • Would impose rigid, government-mandated nurse staffing ratios in every unit of every hospital — large or small, teaching or community — across the state, every hour of every day. Patients have different care needs. These mandated ratios would not take the individual needs of patients into consideration.
  • Would take decisions out of the hands of experienced nurses at the bedside and put them in the hands of the government.
  • Will dramatically increase emergency room wait times, and delay services throughout the hospital, including those that are time-sensitive and life-saving, whenever we do not have the mandated nurse-patient ratio in place. Imagine our busiest months in the summer, when beds are full, and all emergency room bays are in use! This could put you, your families, and your friends at risk. There is no other hospital on the Island for you to seek care from.
  • Will reduce access to critically needed psychiatric beds in all of Massachusetts. It is estimated that 1,000 behavioral health beds across the state would need to close. This will affect access to these off-Island facilities for Island residents.
  • Could force Martha’s Vineyard Hospital to close beds, which would limit access to our services for you, our community members whom we have pledged to serve. Some hospitals in the state would be forced to close altogether.
  • Will impact Windermere by luring away nursing staff to acute-care hospitals off-Island where, due to an increased demand for nurses, pay will be higher. Without enough nurses, we may need to close beds.

(Source: Hospital Compare.)

  • Would cost Martha’s Vineyard Hospital up to $2.6 million per year. The state of Massachusetts estimates that the proposal would cost Massachusetts more than $900 million a year.

California is the only state currently with mandated nurse-to-patient ratios. Government-mandated ratios in that state have had no beneficial effect on the quality of healthcare. Without government-mandated nurse staffing, Massachusetts consistently ranks among the best states in the U.S. on hospital quality and patient outcome measures, and has earned national acclaim, including from the Commonwealth Fund’s State Health System Performance, placing second overall in the nation, versus California’s 14th-place finish. (See accompanying charts.)

Our staffing supports the Island’s unique swings in seasonal volume, and allows us the flexibility to provide quality care despite our isolated geography. This flexibility is crucial to our success, and would be eliminated under the proposed mandates in Question 1.

The future of our hospitals is at stake. Let’s keep staffing decisions in the hands of our nurses. On Nov. 6, please join us and vote NO on Ballot Question 1.


Earl (Sandy) Ray, chairman

On behalf of Martha’s Vineyard Hospital and Windemere Nursing and Rehabilitation board of trustees


  1. Well by now you have seen both my commentary promoting Question 1 and Chairman of the MV Hospital board, Mr. Earl (Sandy) Ray’s opposition position statements. If I were you I would be scratching my head thinking, “How can this be?” and “These view points are like night and day so how can I make an informed decision on this?” All I can say is that my opinion was written from my heart, based on my 40 years of personal experience as an RN, backed up by studies showing that patients have better outcomes when they are cared for by a nurse that has a reasonable patient assignment, and from positive experiences of patients and nurses that have had Safe Patient Limits in California for 14 years. And I can also assure you that this is my opinion. It took me 4 days to try to get everything I felt was important for the public to know and explain the complexities of the issue so you could understand it.
    I fear that Mr. Ray cannot say the same. My gut tells me the body of his letter came either from the PR department of Partners Healthcare or from the Massachusetts Health & Hospital Association’s boilerplate room, distributed to all MA hospitals to be the party line for this important issue.
    All that said you, the voting public, still have to make your decision on who you believe. It comes down to do you side with the nurses that care for you and your families, when you are sick or injured or do you believe the hospital industry that has mounted a multi-million dollar campaign to confuse and scare you? The choice is yours and for all of our sakes, I hope you make the correct one.

  2. This is not an Island Hospital Issue. Mandated minimums are foolhardy. Do the patients also get a credit/ or a larger bill based patient to staff ratios? Next- are we mandating aircraft stewards to customers? Police to number of homes? Where and when does it end?

  3. Thank you Mr. Ray and the Board of Trustees for highlighting why the Safe Staffing bill is so important to nurses across Massachusetts. Administrators have not listened. Nurses are not in control of staffing levels in most hospitals.

    Patients and nurses are suffering.

    I must address one point made in Mr. Ray’s statement. Re: Windemere may lose nurses because MVH and other hospitals would be so appealing to work at (safe conditions, what a novelty). Do you suggest the current nursing staff at MVH decline any further education? Or perhaps they should refuse their unpaid lunch breaks to decrease the risk of “luring” any qualified nurses from Windemere to seek out better opportunities. If we all just lower our standards of practice then everyone will feel equally abused and poorly cared for, patients and nurses alike. Problem solved!

    Ask someone who works at the bedside. Vote YES on 1.

  4. Mr Ray states that the passing of Question 1 would cost the hospital $2.6 million per year. In a previous local news article published on October 12th the hospital CEO Denise Schepici confirmed the $2.6 million amount and said, …..“It’s equivalent to about 10 more nurses.”
    Let’s see, the cost of hiring 10 nurses equals $2.6 million meaning the cost per nurse is $260,000 per year. After reviewing the current RN pay scale and factoring in employer portions of social security, medical insurance, unemployment, and pension plan contributions, I can only come up with a benefit package of about $95,000 per year. That is 36.5% of the hospitals estimation. If the $260,000 per year benefit package for an RN were somehow true, I might just have to consider coming out of retirement when Question 1 passes. Don’t be fooled VOTE “YES” on Question 1 – “Safe Patient Limits” on November 6th.

  5. I find it interesting that the folks that own and operate the hospitals at the executive level want to vote no on this Question, but those folks who are regular paid staff in hospitals want to vote yes.

    The above opinion piece says, “Let’s keep staffing decisions in the hands of our nurses.” Well wait…if was in the hands of nurses in the first place, who want this question passed affirmatively, we probably wouldn’t be here discussing this.

  6. Mr. Earl (Sandy) Ray speaks for the
    Hospital Administration not for the people of this Island. As a nurse for
    over 30 years at the bedside. I have cared for many of you. This bill is about each of you and your family members. It was presented by nurses for nurses who each and every minute of every day take care of people like you. Often times neglecting their own needs meeting your needs and still go home at the end of their shift feeling they didn’t do enough.
    Mr. Ray says,”California is the only state currently with mandated nurse-to-patient ratios. Government-mandated ratios in that state have had no beneficial effect on the quality of healthcare. ”Mr. Ray you are right in CA is the only state currently with
    Mandated nurse staff ratio. They have had safe patient nurse ratios since 2004, and studies have shown better patient outcomes. Less patient complications,readmissions and shorter ER wait times. Isn’t that what we want for our Island community? Patient limits mean your nurse will have more time to meet your needs, monitor your care and intervene quickly to prevent complications in your care. Would you rather share your nurse with 7 other patients or 3? Vote yes on question 1. Your nurses care about you. Do you care about your nurses?

  7. Mr. Ray appears well versed in the slick PR-driven hospital industry rhetoric intended to convince voters of a doomsday type scenario should Question 1 pass. With nearly 20 million dollars spent on the hospital industry’s campaign to defeat this nurse driven effort to improve the safety of the care our patients receive, it is hard to swallow the story that hospitals cannot afford this. The fact that costs have come down, no hospitals have closed, and patient safety and nurse retention has improved in California, where similar staffing ratios were put into effect in 2004, refutes the claims of decreasing bed capacity and hospital closures.
    Mr. Ray states that Question 1 “would take decisions out of the hands of experienced nurses at the bedside and put them in the hands of the government”. This is a nurse driven initiative, and in no way hands over control to the government. Nurses have pushed for decades to be included in staffing decisions, to no avail. Bedside nurses have no say in staffing ratios. Bedside nurses want, and should have, a say in a delivery of care model as equal professional partners in the healthcare team. This legislation is intended to do just that, with no impact whatsoever on the crucial flexibility required to continue to provide quality care during any season here on Martha’s Vineyard.
    I’ve been an RN for 30 years, and I know that years of research supports the concept that lower nurse to patient ratios improves the care we deliver by decreasing hospital acquired infection and errors. Better patient outcomes are worth investing in.
    Mr. Ray says “The future of our hospitals is at stake. Let’s keep staffing decisions in the hands of our nurses.” Let’s correct that statement to say “The future of our PATIENTS is at stake. Let’s PUT staffing decisions in the hands of our nurses.” That requires a YES vote on Question 1. Patients before profits.

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