Think You Know Hospital Staffing Levels?

A lot of people think they know something about hospital staffing levels: the proper ratio of nurses to patients. From time to time a legislator, patient advocate, or union spokesman will propose a required ratio—often a one-size-fits-all number.

They ought to take a look at a recent federal court decision on the subject. It holds that hospital staffing levels are a subject reserved for expert testimony. What’s more, it makes clear that the bar for qualifying as an expert is very high, indeed.

Gloria Quimbey, taken to the Las Cruces Med Center ER, died following a stroke. The plaintiff alleged malpractice and focused on the hospital’s stroke protocol, including staffing levels in the telemetry unit. When the plaintiff offered the testimony of John Stein MD and Fred Hyde as experts, the hospital moved to strike their testimony on staffing levels.

The court first ruled that staffing levels are a subject requiring expert rather than lay testimony and then turned to the qualifications of the two witnesses.

Stein received his MD from Dartmouth, has held teaching positions at University of California, San Francisco (UCSF), since 2001, and is currently associate professor there, focusing primarily on ER medicine. He spends 32 hours a month as an attending physician in the UCSF ER. He has set up two stroke programs in hospitals.

The court ruled that Stein qualified as an expert on certain matters, but not on staffing levels. His testimony on that subject was excluded.

Hyde graduated from Yale Medical School and Yale Law School. He served as VP at Yale-New Haven Hospital and Director of Faculty Practice at Yale Medical School. He has served as CEO of two hospitals and a hospital network. He is currently a professor in Columbia University School of Public Health, teaching hospital administration, and he teaches health policy and management in Columbia Business School.

The court ruled that Hyde was an expert on many things, but not staff ratios. His testimony on that subject was excluded.

Still think you know hospital staffing levels?


The case is Faure v. Las Cruces Med. Center, No. 14cv559 KG/KBM (D. N.Mex., Aug. 22, 2017).

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