Dr. Margot Hartmann: Why I’m Voting No on Question 1

Among the important choices we face on Election Day, which is set for Tuesday, Nov. 6th, is ballot question 1, which would regulate nurse staffing ratios at Massachusetts hospitals.

As President and CEO of Nantucket Cottage Hospital (NCH), I will be voting no on ballot question 1, and I urge you to join me in opposing this initiative that would have a significant negative impact on community hospitals like NCH. Here’s why.

Nantucket Cottage Hospital is among the smallest hospitals in the state. With the island’s remote geography and acute housing crisis, we already face significant staffing challenges that require our hospital to be creative and flexible in meeting the needs of our patients. I’m happy to say today that the unique staffing model we have developed and implemented at NCH in recent years has resulted in better patient outcomes, shorter wait times, higher patient satisfaction, and fewer patient transports off-island.

Ballot question 1 threatens this model, and would impose rigid government mandates on our hospital that would override the local decision-making of our nurse managers and physicians about how to best care for patients. The creativity and flexibility that are necessary to run a hospital 30 miles at sea would be outlawed under ballot question 1, and NCH would be forced to follow a one-size-fits-all mandate that requires small hospitals like us to staff at the same level as Boston teaching hospitals that have up to 1,000 beds and much more complex patients. Small community hospitals like NCH would have to follow these regulations at all times or suffer severe financial penalties – as much as $25,000 per occurrence – that would further threaten our organization.

With our high fixed costs and low patient volume during the offseason, Nantucket Cottage Hospital already operates on a razor thin margin and relies upon the generous donations from the island community to sustain us throughout the year. The Massachusetts Hospital Association (MHA) estimates the passage of ballot question 1 would result in $2.6 million in additional expenses to NCH, an unsustainable amount that would result in program cuts.  

Furthermore, the MHA advises that ballot question 1 will devastate Massachusetts behavioral health programs, cutting as many as 1,000 behavioral health beds across the state. With no licensed psychiatric hospital on Nantucket, the impact on these off-island facilities that we work closely with and rely upon to care for island patients when a transport is necessary would be disastrous and traumatic to our patients.

In early October, the Massachusetts Health Policy Commission, which is our state’s independent health care watchdog agency, completed its own analysis of Question 1 which concluded that the proposal would cost Massachusetts more than $900 million a year, and severely impact community hospitals like NCH.

While this ballot question may be well-intentioned, the negative impacts have the potential to do harm across the Massachusetts healthcare system, raise costs for patients, and are particularly worrisome for our hospital.

For these reasons, I ask you to join me in voting no on ballot question 1 in November.


Margot Hartmann, MD, PhD

President & CEO | Nantucket Cottage Hospital


General News

10 / 4 / 2018 by