The California Nurses United, the state affiliate of NNU, held a strike of 18000 nurses on Tuesday and Wednesday, against health care providers throughout the state to demand better protection standards. As a result the California Department of Industrial Relations and the California Department of Public Health issued regulations last Friday (11/14/2014) that are more stringent than the CDC guidelines as described by the media:
The new guidelines, which build on the department’s Interim Guidance for Ebola released Oct. 15, require workers at risk of contracting the virus to be covered head to toe in fluid-resistant protective garb. The measures go a step further than the current Centers for Disease Control and Prevention standards by requiring battery-powered air purifying respirators, which must include full hoods to cover the face, neck and torso. They also require the hospital to provide in-person training to staff on the donning and removal of the equipment.
October 10, 2014, the Department of Health and Human Services through their two agencies, CDC and ASPR, sent this memorandum outling a "policy" and "strongly" "urging" hospitals to comply. The National Nurses United are asking in their petition for a "must" from the President. California issued new standards, which is a state issue and within their jurisdiction. So, the question is whether the President can mandate hospital standards?
Previously, I have written how the President could declare a National Public Health Emergency, which would allow the President to take greater authority to mandate action. Even the suspension of narrowly selected regulations for a short period of time may be reasonable in a declared national public health emergency, but not otherwise. Because the President has not had his DHHS Secretary declare a national public health emergency, it is unlikely that he would impose standards on hospitals that are regulated by federal law, like EMTALA, for emergencies. That said, without a declared national public health emergency, the President could mandate such standards as long as it is not contrary to law and is not a constitutional violation of federalism by trying to replace or contradict state law. Given these choices, it is not likely the President will mandate hospital standards.
Here is the National Nurses United petition:
Nurses across America demand that President Obama and Congress act now.
On behalf of registered nurses and other healthcare workers across the United States, we understand that the only way to adequately confront the Ebola crisis, which the World Health Organization has termed the most significant health crisis in modern history, is for the President to invoke his executive authority to mandate uniform, national standards for care and protocols that all hospitals must follow to safely protect patients, registered nurses, other front-line healthcare workers, and the public. Every healthcare employer must be directed to follow the Precautionary Principle and institute optimal protocols and personal protective equipment for Ebola that meets the highest standards used by Nebraska Medical Center, or a higher standard, including:- Full-body hazmat suits that meet the American Society for Testing and Materials (ASTM) F1670 standard for blood penetration, the ASTM F1671 standard for viral penetration which leaves no skin exposed or unprotected.
- National Institute for Occupational Safety and Health-approved powered air purifying respirators with an assigned protection factor of at least 50 — or a higher standard as appropriate.
- Continuous interactive training with the RNs who are exposed to patients, continuous updated training and education for all RNs that is responsive to the changing nature of disease, and continuous interactive training and expertise from facilities where state-of-the-art disease containment is occurring.
- If the Employer has a program with standards that exceed those used by Nebraska Medical Center, the higher standard shall be used. The Ebola pandemic and the exposure of healthcare workers to the virus represent a clear and present danger to public health. We know that without these mandates to healthcare facilities, we are putting registered nurses, physicians and other healthcare workers at extreme risk. They are our first line of defense. We would not send soldiers to the battlefield without armor and weapons.
It is not a surprise that the nurses in California wanted better protection lieu of the Ebola outbreak. I think it is very interesting that the nurse's were the ones that stepped forward and demanded better standards, rather than the CDC itself. Although the CDC might not think these additional protective measures, it is obvious that nurses do not feel that the protective equipment they are wearing currently is good enough. These nurses are the ones on the front line dealing with patients with these diseases, so maybe we should listen to them! If the nurses do not feel safe in the equipment they are given currently, maybe it is time the CDC increased their standards as well.
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