Though Yale-New Haven Hospital has vowed to make staffing cuts a last resort, many fear that if Gov. Dannel Malloy’s proposed budget is passed unamended, patient care will suffer due to a shortage in nurses employed by the Yale New Haven Health System.

On Feb. 18, YNHHS discovered that it may face a $67 million reduction in the amount of money it brings in from Medicaid reimbursements. Though the system now loses roughly 40 cents per dollar for every dollar spent on a Medicaid patient, the budget would increase that number by 50 percent, leaving the system shouldered with 60 cents per dollar for every Medicaid patient it serves. YNHH was able to survive $100 million cuts in 2013 after merging with the hospital of St. Raphael’s in 2012, but it may not be so lucky near the end of May if Malloy’s budget passes. As YNHH awaits the alternative budget from the Appropriations Committee, which will be released next week, the atmosphere at the hospital remains tense.

“YNHHS should not be penalized for the mission-driven work that it does,” YNHH Senior Vice President of Public Affairs Vince Petrini said. “We will look for opportunities to increase efficiencies well before laying people off.”

In 2013, over $500 million was cut from Connecticut’s hospitals, with more than 20 percent of this figure being shouldered by YNHHS, the largest provider of Medicaid services in the state. Luckily, Petrini said, YNHH’s 2012 merger with St. Raphael’s allowed it to streamline its costs without laying off a significant number of people. Instead, YNHH removed and consolidated systematic redundancies, such as inefficient programs. Petrini explained that employees who were displaced by these reintegrations were given new positions elsewhere in the hospital system, as YNHH aimed to “minimize the effect on the people,” he said.

But Malloy’s cuts, which would coincide with increases in hospital taxes levied by the state, are set to have a much larger impact on YNHH’s finances — this time there will be no hospital merger to reduce redundancies and cushion the fall.

Patrick McCabe, senior vice president of corporate finance at YNHHS, said the $67 million in lost funds that would be brought on by Malloy’s budget will need to be restored in some fashion in order for the hospital to achieve a margin that can sufficiently pay employees’ pensions and retirement funds. Expenditures would likely take a sizeable hit from the cut, he said.

Though McCabe emphasized that the hospital is not currently planning for layoffs and would prefer to reduce cost through increasing efficiency, he acknowledged that staffing numbers may be negatively affected. The hospital system might have to resort to leaving vacancies unfilled in order to save money.

Marjorie Funk NUR ’84 SPH ’92 GRD ’92, professor of nursing who began her career as a YNHH staff nurse, said she never felt like there was any shortage of nurses when she worked in the Intensive Care Unit. But Funk said she cannot speak for the general wards, where, when staffing problems arise, tend to manifest most.

Wendy Duarte, who worked at YNHH for over 20 years, said these shortages existed long before the state budget forced the hospital system to restructure and that the number of nurses available to patients in the general wards is a concern.

“[Yale-New Haven Hospital] is a good hospital, but it is understaffed,” Duarte said. “I have been spouting that message for years.”

Duarte added that though the quality of care from both physicians and nurses at the hospital is excellent, the low nurse-to-patient ratio in the general wards makes it difficult for nurses to do their jobs well.

She claimed that since her departure in 2009, she has not been replaced. Her colleagues, she said, have told her that they have been left to take up the extra work without a corresponding increase in salary, she said.

“Yale employees do the work of several people but only get paid for one job,” she said. “Nurses are rushing around and believe me, hand washing is skipped plenty by exhausted and overworked staff.”

Petrini emphasized that, right now, it is tremendously unusual for laid-off or retired staff members not to be replaced, and that the hospital is constantly focusing its energies on recruitment and building relationships with institutions that train nurses.

YNHHS discharged over 110,000 inpatients in 2013.